Postmortem tryptase is a useful biochemical test to aid the diagnosis of anaphylaxis. Multiple perimortem and postmortem factors have been documented to cause an elevation in postmortem tryptase level. One factor that was recently recognized to have an impact on postmortem tryptase level is correct sampling technique. A recent study recommended aspirating blood samples from a clamped femoral/external iliac vein to be used for reliable postmortem tryptase analysis. This study sampled 120 consecutive nonanaphylactic deaths in which all the peripheral bloods were sampled as recommended. Postmortem interval, resuscitation, different nonanaphylactic causes of death, sex, and age did not show any statistical significant relation to postmortem tryptase level in Student t test, Pearson correlation, and univariate and multivariate analyses. The mean (SD) postmortem tryptase level was 8.4 (5.2) μg/L (minimum, 1.0 μg/L; maximum, 36.1 μg/L; median, 7.3 μg/L). Using nonparametric methods, the postmortem tryptase reference range in nonanaphylactic death was established as <23 μg/L (97.5th percentile).
Ruptured esophageal varices can present as sudden death from gastrointestinal hemorrhage. The most common underlying pathology causing esophageal varices is cirrhosis leading to portal hypertension. However, not all esophageal varices arise from portal hypertension, and not all portal hypertensions are caused by cirrhosis. We present a rare case of ruptured esophageal varices casing death in an individual with metastatic tumor (high-grade) neuroendocrine tumor in the liver causing portal hypertension. This is, to the best of our knowledge, the first case report in the literature reporting a neuroendocrine tumor causing esophageal varices. This case report aims to document this rather rare entity, highlight another mechanism on how metastatic disease can result in sudden death, and give a brief review of literature on metastatic tumor in the liver causing esophageal varices.
The GIT (gastrointestinal tract) is the most common site of extranodal primary NHL (non-Hodgkin's lymphoma), accounting for ~30-40% of such cases. 1 However, primary follicular lymphoma of the rectum is very rare and accounts for less than 1% of GI-NHL cases overall, 1 and less than 1% of all primary rectal malignancies, 2 with very few cases reported in the literature to date. We discuss a case of a 69-year-old female (born in Hiroshima, Japan), who had two episodes of rectal bleeding and mucus discharge over a 6 month period but was otherwise well. She underwent a colonoscopy due to a positive FOBT (faecal occult blood test) result as part of the NBCSP (National Bowel Cancer Screening Program). Biopsies were taken during the colonoscopy, including from polypoid areas in the rectum, in which histology and immunohistochemistry confirmed a WHO Grade 2 follicular lymphoma. She did not have any known personal or family history of haematopoietic malignancies, and this rectal follicular lymphoma is a new diagnosis. Subsequent work-up (including a PET scan) has been arranged to ascertain if the rectal follicular lymphoma is a primary or secondary process.
Solid papillary carcinoma with reverse polarity is a rare breast cancer of specific morphologic and immunohistochemical profile with favourable prognosis. However, this carcinoma is not yet included in the current WHO classification. The tumour shows histologic features resembling tall cell variant of papillary thyroid carcinoma. We report a case of a 63-year-old lady with an incidental finding of a discrete oval mass on routine breast screening. Clinical and radiological findings are suggestive of a fibroadenoma. Histologically, the tumour shows papillary, follicular and solid structures. The cells are tall and columnar with abundant eosinophilic cytoplasm and apically located nuclei giving the impression of reverse nuclear polarity. Eosinophilic colloid like secretion is present. Nuclear pseudoinclusions and occasional grooves are also observed. Immunohistochemistry stains demonstrate the lack of myoepithelial cells, indicating its invasive nature. The tumour shows positive staining for cytokeratin 5/6, calretinin and luminal staining for EMA. Thyroid marker, TTF1, is negative. Despite the indolent behaviour, the tumour is triple negative (negative ER, PR and HER2). Our findings demonstrate that solid papillary carcinoma with reverse polarity is a unique breast neoplasm that should be distinguished from other papillary carcinomas of the breast.Dabigatran is a direct thrombin inhibitor frequently prescribed for prophylaxis of stroke in the setting of atrial fibrillation. The histologic features of dabigatran-induced drug injury have not been described in the literature. We describe herein five patients taking dabigatran, presenting with histologic features of oesophagitis dissecans superficialis. The patients included three men and two women with a median age of 82 years (range 67-91 years). The clinical indications for taking dabigatran were atrial fibrillation (80%) and deep vein thrombosis (20%). Presenting symptoms included dysphagia (40%), anaemia (40%), nausea and vomiting (40%), and epigastric pain (20%). Endoscopically, epithelial sloughing typical of oesophagitis dissecans was seen in the mid or lower oesophagus in all patients. Histologically the oesophageal biopsies showed necrosis and splitting of the superficial squamous epithelium with preservation of the basal cell layer, characteristic of oesophagitis dissecans superficialis. This is the first report describing histologic features of dabigatran-induced drug injury in the gastrointestinal tract.Background: The RCPA Structured Reporting Protocol for Excisions and Colposcopic Biopsies Performed for the Diagnosis and Treatment of Pre-invasive Cervical Neoplasia was developed to provide consistent terminology for histological reporting, allowing for data capture and clear implementation of management guidelines within the NCSP. Aims: To report distribution of cases, assess practical utility and potential issues associated with the use of diagnostic categories for reporting histological cervical specimens. Methods: Reports from consecutive diagnostic c...
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