Autopsy Study Research Articles

An Overview of Aortopulmonary Window

Aortopulmonary (AP) window is exactly a rare congenital anomaly that represents approximately 0.2 and 0.5% of all congenital heart abnormalities. It consists of communication between the aorta and the pulmonary artery or its branches. Although closely related to AP window, the pulmonary artery origin from the ascending aorta (also termed “hemitruncus”) is classified as a separate defect. AP window was first described by Elliotson in 1830 in an autopsy study. In 1948, Robert Gross successfully ligated an AP window in a patient undergoing a thoracotomy for closure of a patent ductus arteriosus (PDA). In 1957, Cooley and associates described the first successful repair of AP window using cardiopulmonary bypass. Aortopulmonary window occurs due to the abnormal development of the heart’s major blood vessels during early fetal growth. In most cases, this heart defect occurs by chance, with no clear reason. This condition can occur on its own or with other heart defects such as: 1. Tetralogy of Fallot, 2. Pulmonary atresia, 3. Truncus arteriosus, 4. Atrial septal defect, 5. Patent ductus arteriosus, 6. Interrupted aortic arch. Treatment for aortopulmonary window involves surgery to close the hole between the aorta and the pulmonary artery with a patch or device. This surgery is normally done as soon as possible after the diagnosis is made, usually when the child is a newborn. Associated lesions are usually repaired during the same surgery. Associated lesions are usually repaired during the same surgery. More complex repairs and myocardial protection strategies are required in patients with associated lesions, increasing the morbidity and mortality associated with the operation.

TH1 lymphocytes in the perivascular adipose tissue correlate with plaque composition and increase the risk of intraplaque haemorrhages in coronary arteries: an autopsy study

Abstract Background Inflammation in the perivascular adipose tissue (PvAT) might play a role in coronary artery disease. The T helper 1 (Th1) lymphocytes are the most popular T helper (Th) lymphocytes in atherosclerotic plaques and are proatherogenic. However, the association between the Th1 and Th lymphocytes in the PvAT with coronary atherosclerosis composition was not previously investigated in humans. Purpose We investigated the correlation between Th CD4+ and Th1 CD4+CXCR3+ lymphocytes in the PvAT with atherosclerotic plaque composition. Methods Human coronary arteries were freshly dissected with adjacent PvAT. The most important atherosclerotic plaque was selected of the main coronary arteries and was stained with hematoxylin-eosin, Masson's trichrome, and Verhöeff. We calculated the percentage of arterial obstruction, intima-media thickness, the minimum fibrous cap thickness, and the percentual of collagen, smooth muscle cells (SMC), fibrous cap, calcification, lipid, necrosis, and intraplaque hemorrhage. The atherosclerotic plaques were classified in stable and unstable plaques (hemorrhages and thrombus). The density of Th lymphocytes (CD4+), Th1 (CD4+CXCR3+), and the ratio of Th1/Th were detected using the immunohistochemistry double staining technique. The densities and the ratio Th1/Th were correlated with plaque composition using linear, negative binomial, or Poisson regressions models with clustering for multiple measures in the same individual and adjusted for age, sex, hypertension, diabetes, body mass index, sedentary lifestyle, smoking, and alcohol consumption. Results We evaluated a sample of 126 coronary arteries from 58 subjects. The individuals were older (70.4±14.3 years old), sex was equally distributed, 74% had hypertension, and 40% diabetes. In multivariate analysis, the Th lymphocytes were negatively correlated with calcification content (β=−0.21, 95% CI: −0.41; −0.006, p=0.043). The Th1 lymphocytes were not correlated with plaque composition; however, the increase of Th1 density in relation to Th lymphocytes was negatively correlated with SMC (β=−35.6, 95% CI: −68.5; −2.83, p=0.03) and the fibrous cap content (β=−11.6, 95% CI: −19.1; −4.05, p=0.003). Additionally, the higher proportion of Th1/Th lymphocytes increased the risk of intraplaque haemorrhages compared to stable coronary plaques (OR=15.5, 95% CI: 1.23; 196.4, p=0.03). Conclusions The increase of pro-inflammatory Th1 lymphocytes in the PvAT was correlated to the decrease of components in atherosclerotic plaques related to plaque stabilization, such as SMC and fibrous cap content. Additionally, the increase in the proportion of pro-inflammatory Th1 lymphocytes in the PvAT also increases the risk of intraplaque haemorrhages in coronary arteries. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): São Paulo Research Foundation (FAPESP) Figure 1Figure 2

BACTERIAL MYOCARDITIS IN SICKLE CELL PATIENT WITH ACUTE CHEST SYNDROME

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Sickle cell anemia is an autosomal recessive disorder leading to chronic hemolytic anemia secondary to abnormal hemoglobin. Sickle cell anemia has numerous clinical consequences such as acute pain crisis, acute chest syndrome, osteomyelitis, and renal failure. The most common cause of death for sickle cell patients is infection. A rare cause of death for sickle cell patients is infection secondary to viral myocarditis; and even rarer is bacterial myocarditis. In this case, our sickle cell patient passed away from a staphylococcal bacterial myocarditis. CASE PRESENTATION: A 44-year-old female with a significant past medical history of Sickle Cell Disease (Hemoglobin SS) presented to the emergency department with complaints of shortness of breath, 5 days of fever with abdominal pain and dysuria. Initial pertinent investigations showed a hemoglobin of 5.3, WBC 23.5, and mild hypokalemia with an acute kidney injury with elevated BUN/Creatinine (71/2.31). The urine analysis was positive, although the culture was negative. Blood cultures were drawn. Ceftriaxone and IV fluids were started. A CT abdomen and chest was obtained and showed mixed alveolar and interstitial opacities in bilateral lower lobes consistent with acute chest syndrome, hepatomegaly, and an enlarged heart. She was transferred to a tertiary center due to acute sickle cell pain crisis complicated by AKI, and acute chest syndrome. Patient was given a PCA pump with hydromorphone. Hematology recommended starting hydroxyurea and transfusing 2 units packed red blood cells. Troponin levels became elevated. Echocardiogram showed no wall motion abnormalities and a normal ejection fraction (50-55%). Patient continued to clinically deteriorate, so an exchange transfusion was started. During the exchange transfusion the patient coded and passed away. An autopsy was performed and showed interstitial neutrophilic infiltrates within the myocardium with micro abscesses with gram positive cocci identified. Blood cultures were positive for Staphylococcus aureus. The cause of death was identified as staphylococcal bacterial myocarditis. DISCUSSION: Sickle cell patients are susceptible to serious adverse outcomes from infections; notably infections are the leading cause of death in sickle cell patients. Death is often sudden and unexpected. Our patient was an example of an extremely rare cause of staphylococcal bacterial myocarditis with a concomitant acute chest syndrome that may have contributed to masking the underlying myocarditis and thus ultimately leading to death. CONCLUSIONS: Bacterial myocarditis is a very rare but potential cause of death in patients with sickle cell disease and the symptoms could be concealed from the clinician due to and overlapping acute chest syndrome. REFERENCE #1: Manci EA, Culberson DE, Yang YM, et al; Investigators of the Cooperative Study of Sickle Cell Disease. Causes of death in sickle cell disease: an autopsy study. Br J Haematol. 2003 Oct;123(2):359-65. REFERENCE #2: Cooper LT Jr. Myocarditis. N Engl J Med. 2009 Apr 9;360(15):1526-38. REFERENCE #3: McGee M, Shiel E, Brienesse S, et al; Staphylococcus aureus Myocarditis with Associated Left Ventricular Apical Thrombus. Case Rep Cardiol. 2018 May 23;2018:7017286. DISCLOSURES: No relevant relationships by Chad DeMott, source=Web Response No relevant relationships by Badri Giri, source=Web Response No relevant relationships by Elspeth Springsted, source=Web Response

Psychological autopsy study and risk factors for suicide in Muslim countries.

BackgroundSuicide and risk factors have been poorly studied in the Muslim‐majority countries that hinder the formulation of prevention strategies and affect suicide prevention eventually.ObjectivesWe aimed at identifying and analyzing the psychological autopsy studies assessing the risk factors for suicide conducted in Muslim‐majority countries.MethodsWe did a search to trace all the available psychological autopsy studies in the Muslim countries with the search term “psychological autopsy study in Muslim countries.” We also checked the available bibliographies to identify the psychological autopsy studies in the Muslim countries so that all the possible studies could be included.ResultsOut of the Muslim countries, only eight psychological autopsy studies were identified in five countries (Bangladesh [1], Indonesia [1], Iran [1], Pakistan [2], and Turkey [3]). Six studies adopted a case‐control study design, and all were carried out in urban settings. The prevalence of psychiatric disorders among case‐control studies varied from 52.8% in Turkey to 96% in Pakistan. Psychiatric illness, self‐harm, and stressful life events were the commonly replicated risk factors for suicide across studies.ConclusionsPsychological autopsy studies have been conducted only in five Muslim countries revealing that the risk factor for suicide is certainly under‐researched in the incumbent countries. This review identified a similar list of risk factors for suicide, namely, psychiatric disorder, past non‐fatal attempts, and adverse life events compared to the Western countries even though the rate varies.

An autopsy study of 64 homicidal crushing injuries to head (bludgeon injury)

This Prospective Study was conducted during the period 2009 to November 2020.A Total of 9684 Autopsies were Conducted during this period, Homicidal Fatal Crush Injury Head cases comprised of 64 cases, i.e.0.66% of Cases. The Majority of the Victims were Females,72% [n-46] and Males 28% cases.Sex related Motives were the Major Factor in Female[24 cases] Homicides, Followed by Loot in 09 cases. In Males Loathing and Loot were the main factors contributing in 6& 4 cases. The Majority of the Females Victims Occupation was Sex Worker/Prostitutes & Labor Class comprising 27 % 09 cases respectively. In Majority of Female Homicides the Murder Weapon was recovered next to the body in 23 of the cases whereas the same was recovered in only 03 cases in Males. Granite Block or Boulder Formed the Major Choice of Bludgeon or Murder Weapon in 34 cases of Female Victims and 08 cases of Male Victims. The Majority of the Female Victims [22 cases] were Bludgeoned on the Mud floor. The Majority of the Victims in Both the sexes belonged to the age group 21-30 years, contributing to 9 & 21 cases in Male and Females Respectively.

A prospective study of medicolegal autopsies to establish profile of burn deaths

Burns injuries have been a one of the major cause of concern since prehistoric time to the present era of modern medicine. Burn is considered to be the commonest cause of unnatural death in India.Burns are injuries produced by application of dry heat such as flame, radiant heat or some heated solid substance like metal or glass to the body. Dry heat, application of hot bodies, licking by flames resulting in simple burns causes local injury to the body. Moist heat leading to scalds, corrosive poisons resulting in corrosive burns. Electric spark, discharges, flashes and lightning leads to electric burns.Present study aim to know the magnitude of burn deaths in the region of southern marathwada region. Two years prospective study was conducted at Government Medical College Latur. Study of medico legal autopsies to establish the profile of burn deaths was carried out. In the present study, it is found that burns are commonly found in female (72.04%) than in females. Housewives (43.52%) were common victims followed by works (9.80%). Most of the incidences took place in morning hours (45.53%). Most common place of incidence was house (83%). Kerosene (57.63%) was the most common accelerant used to cause burn. If percentage of burn increases, the survival period decreases and vice versa. Most common alleged manner of death was accident (53, 6%).

An autopsy study on injuries in homicidal deaths due to weapons

Homicide is defined as the intentional act of taking another person’s life. This study was conducted in a tertiary care hospital and Medical College at Pondicherry between 2004 to 2019. It included all homicide deaths with weapon autopsied in the department of Forensic Medicine. A total of 74 cases of homicide was identified and studied. The male : female ratio was 4:1. Commonest age group was 21- 30 years of age. 78% of cases had fatal injuries in more than one anatomical region and head was the most targeted region. More than one type of injuries was present in 65% of cases. In this study male victim had mostly sharp force weapon induced injuries and female victims had blunt force weapon induced injuries. It was also found that in age groups less than 10 years and more than 60 years blunt force weapon induced injuries predominated, whereas in other young adult age groups sharp force weapon induced injuries were predominately seen.

An autopsy study of suicidal hanging

Hanging is the most preferred method of Suicide. Individuals are known to use different Ligature material and suspend completely or partially. hence, it is important to understand the Parameters involved in it. Large number of Suicidal death are reported. To Understand Suicidal Hanging by studying different parameters involved in it like Ligature Material, Type of Knot. Sex and Age Group, involved, kind of Suspension and Position of knot. A total of 634 cases were studied . Crime scene examination was done only in those cases where their were Suspicion on the Suspension Deaths. Rest of the cases the crime scene photographs and investigating officer records were the inputs. Only Suicidal Hanging were Considered for the Study. Suicidal Hanging contributed to 6.5% of the Total Cases. The Ropes[27%%] and Stole [36%]Contributed to the Most Preferred Ligature Material and Shoe Lace contribute[0.5%] to the least preferred Material for Self Suspension. Complete Suspension was observed in 62% of cases. The Majority of the Victims were Females contributing to 62% of the Deaths. The Major Age Group[50.76%] Involved was between 21-30years and the Uneffected Age group were those in the Extremes of Life i.e 1-10 and 61-70years. A Slip Knot was used on 97.73% of suspensions. In 78% of Suspension the Position of the Knot was situated over the [Typical Hanging]Nape of Neck. Married Victims Contributed to 37.45% of cases. The different Parameters of Suicidal Hanging are necessary to understand the Suicidal Nature of Hanging.

Evaluation of Fibrosis and Histopathological Changes in the Psoas Muscle with E- Cadherin, Claudin-5 Expression and Demographic Data: An Autopsy Study

Evaluation of Fibrosis and Histopathological Changes in the Psoas Muscle with E- Cadherin, Claudin-5 Expression and Demographic Data: An Autopsy Study

Evaluation of Fibrosis and Histopathological Changes in the Psoas Muscle with E- Cadherin, Claudin-5 Expression and Demographic Data: An Autopsy Study

Evaluation of Fibrosis and Histopathological Changes in the Psoas Muscle with E- Cadherin, Claudin-5 Expression and Demographic Data: An Autopsy Study

Acute respiratory distress syndrome

Context:In this autopsy study, the various morphological patterns of acute respiratory distress syndrome (ARDS) have been analyzed and compared along with their etiopathogenesis.Aims:We aimed to study the prevalence and clinicopathological correlation of ARDS based on age, gender, hospital stay, symptoms, clinical diagnosis, gross, and microscopy findings.Subjects and Methods:Total 130 cases of ARDS were studied over a period of 5 years. Age, gender, hospital stay duration, symptoms, clinical diagnosis, gross and microscopic lung finding, clinicopathological correlation, and cause of death were documented and analyzed. Special stains were done whenever required.Statistical Analysis:This is an observational study, and simple statistics such as mean, median, and standard deviation have been used for continuous variables.Results:The prevalence of ARDS among the adult autopsy was 6.05%. Majority of the cases were in the age group of 18–30 years (36.9%), with a male: female ratio of 1.7:1. Chief complaints were fever (71%), breathlessness (54.6%), and chills (43.8%). The main clinical diagnoses were ARDS (41.6%), sepsis (28.3%), acute febrile illness (17%), and lower respiratory tract infection (12.5%). Most of the patients had a hospital stay of <1 day. Associated conditions mostly included chronic alcoholism (16.1%), pregnancy (16.1%), and chronic smoking (10.7%). Major findings on gross examination were intrapulmonary hemorrhage (38.5%), ARDS (33%), pulmonary edema (13%), and pneumonia (15.3%). On microscopy, major findings were hyaline membrane (84.6%), intrapulmonary hemorrhage (76.1%), pulmonary edema (75.3%), organizing fibrin (55.3%), and bronchopneumonia (36.2%).Conclusion:Infections were one of the major predisposing causes of ARDS. Due to the short interval, the underlying cause for ARDS often goes undiagnosed.

Pulmonary tumor embolism: A retrospective study over a 30-year period

BackgroundPulmonary tumor embolism (PTE) is difficult to detect before death, and it is unclear whether the discrepancy between antemortem clinical and postmortem diagnosis improves with the advance of the diagnostic technologies. In this study we determined the incidence of PTE and analyzed the discrepancy between antemortem clinical and postmortem diagnosis.MethodsWe performed a retrospective autopsy study on patients with the history of malignant solid tumors from 1990 to 2020 and reviewed all the slides of the patients with PTE. We also analyzed the discrepancies between antemortem clinical and postmortem diagnosis in 1999, 2009 and 2019 by using the Goldman criteria. Goldman category major 1 refers to cases in which an autopsy diagnosis was the direct cause of death and was not recognized clinically, but if it had been recognized, it may have changed treatment or prolonged survival.ResultsWe found 20 (3%) cases with PTE out of the 658 autopsy cases with solid malignancies. Out of these 20 cases, urothelial carcinoma (30%, 6/20) and invasive ductal carcinoma of the breast (4/20, 20%) were the most common primary malignancies. Seven patients with shortness of breath died within 3–17 days (average 8.4±2.2 days) after onset of the symptoms. Pulmonary embolism was clinically suspected in seven out of twenty (35%, 7/20) patients before death, but only two patients (10, 2/20) were diagnosed by imaging studies before death. The rate of Goldman category major 1 was 13.2% (10/76) in 1999, 7.3% (4/55) in 2009 and 6.9% (8/116) in 2019. Although the rate of Goldman category major 1 appeared decreasing, the difference was not statistically significant. The autopsy rate was significantly higher in 2019 (8.4%, 116/1386) than in 2009 (4.4%, 55/1240).ConclusionsThe incidence of PTE is uncommon. Despite the advances of the radiological techniques, radiological imaging studies did not detect the majority of PTEs. The discrepancy between the antemortem clinical and the postmortem diagnosis has not improved significantly over the past 30 years, emphasizing the value of autopsy.

Predictors of cognitive impairment in primary age-related tauopathy: an autopsy study

Primary age-related tauopathy (PART) is a form of Alzheimer-type neurofibrillary degeneration occurring in the absence of amyloid-beta (Aβ) plaques. While PART shares some features with Alzheimer disease (AD), such as progressive accumulation of neurofibrillary tangle pathology in the medial temporal lobe and other brain regions, it does not progress extensively to neocortical regions. Given this restricted pathoanatomical pattern and variable symptomatology, there is a need to reexamine and improve upon how PART is neuropathologically assessed and staged. We performed a retrospective autopsy study in a collection (n = 174) of post-mortem PART brains and used logistic regression to determine the extent to which a set of clinical and neuropathological features predict cognitive impairment. We compared Braak staging, which focuses on hierarchical neuroanatomical progression of AD tau and Aβ pathology, with quantitative assessments of neurofibrillary burden using computer-derived positive pixel counts on digitized whole slide images of sections stained immunohistochemically with antibodies targeting abnormal hyperphosphorylated tau (p-tau) in the entorhinal region and hippocampus. We also assessed other factors affecting cognition, including aging-related tau astrogliopathy (ARTAG) and atrophy. We found no association between Braak stage and cognitive impairment when controlling for age (p = 0.76). In contrast, p-tau burden was significantly correlated with cognitive impairment even when adjusting for age (p = 0.03). The strongest correlate of cognitive impairment was cerebrovascular disease, a well-known risk factor (p < 0.0001), but other features including ARTAG (p = 0.03) and hippocampal atrophy (p = 0.04) were also associated. In contrast, sex, APOE, psychiatric illness, education, argyrophilic grains, and incidental Lewy bodies were not. These findings support the hypothesis that comorbid pathologies contribute to cognitive impairment in subjects with PART. Quantitative approaches beyond Braak staging are critical for advancing our understanding of the extent to which age-related tauopathy changes impact cognitive function.

Coronavirus disease 2019-associated pulmonary fibrosis: clinical findings, pathogenesis, and potential treatment.

Coronavirus disease 2019-associated pulmonary fibrosis: clinical findings, pathogenesis, and potential treatment.

A case report of secondary neurolymphomatosis showing selective nerve infiltration and massive lumbar plexus enlargement

BackgroundNeurolymphomatosis (NL) is a rare manifestation of malignant lymphoma that shows selective infiltration to the peripheral nervous system primarily or secondarily. We report a patient with secondary NL caused by germinal center B-cell (GCB)-type diffuse large B-cell lymphoma (DLBCL) who showed selective infiltration of the lumbar plexus to the spinal cord and massive nerve enlargement resulting in severe pain.Case presentationA 72-year-old female exhibited asymmetric motor and sensory impairments and pain in the lower limbs that progressed for five months. Magnetic resonance imaging (MRI) showed an enlarged lumbar plexus, which continued to the cauda equina via the L3 and L4 spinal nerves. Her symptoms gradually worsened. Ten months after the onset of symptoms, the enlarged cauda equina filled the spinal canal space, and the spinal cord was swollen. A cauda equina biopsy was performed, and she was diagnosed with GCB-type DLBCL with CD10 positivity. The primary tumor was found in a mammary cyst. The autopsy study did not show apparent infiltration, except in the nervous system.ConclusionsAlthough there are many neurologic phenotypes of malignant lymphoma, the association between the cytological characteristics of lymphoma and the neurological phenotypes is still unclear. Several reports of CD10-positive secondary NL are available, whereas peripheral or central nervous tissue origin lymphoma cases are mostly negative for CD10. CD10 staining may be useful for distinguishing primary NL from secondary NL. NL often has a strong organotropism for peripheral nervous tissue, which makes early diagnosis challenging.

Relationship between impulsivity and suicide among the rural elderly in China: a case-control psychological autopsy study.

BackgroundThe relationship between impulsivity and suicide is inconsistent in different populations. Hence, the relationship between impulsivity and suicide still needs to be studied among the elderly population. The present study intends to explore the relationship between impulsivity and suicide among the rural Chinese elderly.MethodsA case-control psychological autopsy study was conducted from February 1, 2014 to December 18, 2015 among rural residents over the age of 60 who died by suicide. The sample consisted of 242 suicides as the case group and 242 living individuals as the control group. Data on demographic characteristics, impulsivity, previous history of suicide attempts, social support, negative life events, and suicidal behavior were collected.ResultsOur study found that impulsivity increased the risk of suicide. The case group showed a higher Barratt Impulsiveness Scale score compared with the control group (p < 0.001), which indicates that impulsivity was higher among the elderly suicides. In addition, regression analyses show that impulsivity (odds ratio: 1.03, 95% confidence interval: 1.01–1.06) is an independent risk factor of suicide, after controlling for the effects of marital status, education, family annual income, being left behind, social support, and negative life events. Finally, compared with elderly who do not have a history of attempted suicide, elderly with a history of attempted suicide showed higher impulsivity (p = 0.001).

SARS-CoV-2, myocardial injury and inflammation: insights from a large clinical and autopsy study

ObjectiveDespite growing evidence about myocardial injury in hospitalized COronaVIrus Disease 2019 (COVID-19) patients, the mechanism behind this injury is only poorly understood and little is known about its association with SARS-CoV-2-mediated myocarditis. Furthermore, definite evidence of the presence and role of SARS-CoV-2 in cardiomyocytes in the clinical scenario is still lacking.MethodsWe histologically characterized myocardial tissue of 40 patients deceased with severe SARS-CoV-2 infection during the first wave of the pandemic. Clinical data were also recorded and analyzed. In case of findings supportive of myocardial inflammation, histological analysis was complemented by RT-PCR and immunohistochemistry for SARS-CoV-2 viral antigens and in situ RNA hybridization for the detection of viral genomes.ResultsBoth chronic and acute myocardial damage was invariably present, correlating with the age and comorbidities of our population. Myocarditis of overt entity was found in one case (2.5%). SARS-CoV-2 genome was not found in the cardiomyocytes of the patient with myocarditis, while it was focally and negligibly present in cardiomyocytes of patients with known viral persistence in the lungs and no signs of myocardial inflammation. The presence of myocardial injury was not associated with myocardial inflammatory infiltrates.ConclusionsIn this autopsy cohort of COVID-19 patients, myocarditis is rarely found and not associated with SARS-CoV-2 presence in cardiomyocytes. Chronic and acute forms of myocardial damage are constantly found and correlate with the severity of COVID-19 disease and pre-existing comorbidities.Graphic abstract

Pulmonary arterial hypertension (PAH) from autopsy study: T-cells, B-cells and mastocytes detection as morphological evidence of immunologically mediated pathogenesis

BackgroundPulmonary arterial hypertension (PAH) is characterized by severe vascular remodelling, resulting in increased pulmonary vascular resistance with cardiac hypertrophy and heart failure. However, the diagnosis of PAH is often inaccurate. Many cases of PAH are incorrectly diagnosed or missed, and they are often associated with death. The aim of this study was to verify the morphological and histological criteria of fatal cases of PAH and evaluate the lymphocytic populations associated to lesions with reactive neo-angiogenesis. MethodsPulmonary lung sections from 10 cases of sudden unexpected death (SUD) in the absence of previously diagnosed diseases and in an apparent state of well-being, with final histological post autopsy diagnosis of PAH were collected. The pathological findings were compared using ten controls from non-pathological lung from deaths from other causes. The autopsies included 4 males (40%) and 6 females (60%) with an average age of 52.1 ± 10.1 years. Sections stained with hematoxylin and eosin (H&E) were revised for a morphological diagnosis. Subsequently, serial sections were performed and stained with immunohistochemistry for anti-CD20 (B-lymphocytes), anti-CD3 (T-lymphocytes), anti-CD4 (T-helper lumphocytes), anti-CD8 (T-cytotoxic lymphocytes) and anti-CD117/C-Kit (mast cells/MCs) to detect inflammatory infiltrate and different ratios of cell-type. Statistical analysis was conducted using a paired t-test looking at 100 cells in 3 different tissue samples representative of vascular lesion and 3 different random normal lung parenchyma fields without lesion (from 10 normal control lungs), to identify specific lymphocyte subpopulations in inflammatory infiltrates. ResultsThere was a significant percentage increase of CD20 (p < 0.001), CD8 (p = 0.002), CD4 (p < 0.001), and CD117/C-Kit positive (C-Kit+; p < 0.001) cells mainly detected around wall vessels; while increased MCs positivity and C-Kit+ were observed especially in alveolar septa. In addition, reactive angiomatosis was observed. ConclusionsThe inflammatory infiltrate should be included for a correct diagnosis of PAH besides the vascular remodelling. The inflammatory infiltrate seems to be implicated as a main factor in the pathogenesis. This finding is important to rule out secondary pulmonary hypertension, to identify SUDs of unknown causes and to add new elements to the literature that can explain the immunologically related pathogenesis of PAH.

Testicular pathology in fatal COVID-19: A descriptive autopsy study.

BackgroundMulti‐organ damage is a common feature of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection, going beyond the initially observed severe pneumonia. Evidence that the testis is also compromised is growing.ObjectiveTo describe the pathological findings in testes from fatal cases of COVID‐19, including the detection of viral particles and antigens, and inflammatory cell subsets.Materials and methodsPostmortem testicular samples were obtained by percutaneous puncture from 11 deceased men and examined by reverse‐transcription polymerase chain reaction (RT‐PCR) for RNA detection and by light and electron microscopy (EM) for SARS‐CoV‐2. Immunohistochemistry (IHC) for the SARS‐CoV‐2 N‐protein and lymphocytic and histiocytic markers was also performed.ResultsEight patients had mild interstitial orchitis, composed mainly of CD68+ and TCD8+ cells. Fibrin thrombi were detected in five cases. All cases presented congestion, interstitial edema, thickening of the tubular basal membrane, decreased Leydig and Sertoli cells with reduced spermatogenesis, and strong expression of vascular cell adhesion molecule (VCAM) in vessels. IHC detected SARS‐Cov‐2 antigen in Leydig cells, Sertoli cells, spermatogonia, and fibroblasts in all cases. EM detected viral particles in the cytoplasm of fibroblasts, endothelium, Sertoli and Leydig cells, spermatids, and epithelial cells of the rete testis in four cases, while RT‐PCR detected SARS‐CoV‐2 RNA in three cases.Discussion and conclusionThe COVID‐19‐associated testicular lesion revealed a combination of orchitis, vascular changes, basal membrane thickening, Leydig and Sertoli cell scarcity, and reduced spermatogenesis associated with SARS‐CoV‐2 local infection that may impair hormonal function and fertility in men.

Autopsy Study of Calretinin Immunohistochemistry in the Anorectal Canal in Young Infants and Potential Implications for Rectal Biopsy Approach in the Neonatal Period.

Absent submucosal ganglion cells in biopsies 1-3 cm above the pectinate line establishes the pathologic diagnosis of Hirschsprung Disease (HD). Calretinin stains both ganglion cells and their mucosal neurites and has gained importance in HD diagnosis. Absent calretinin positive mucosal neurites in biopsies at the appropriate level above the pectinate line is highly specific for HD. Whether this applies to lower biopsies is uncertain. To address this, we studied anorectal canal autopsy specimens from infants. We performed an autopsy study of infant anorectal canal specimens to describe calretinin staining in this region. Calretinin staining was correlated with histologic and gross landmarks. In all 15 non-HD specimens, calretinin positive mucosal neurites were present in glandular mucosa up to the anorectal line where neurites rapidly diminished. Age range was preterm 26 weeks to 3 months. Calretinin positive mucosal neurites are present in glandular mucosa up to the anorectal line in young infants. This is potentially important regarding neonatal HD biopsy level and diagnosis. Positive calretinin staining at the anorectal line favors normal innervation making HD unlikely. Absent calretinin positive neurites in glandular mucosa is worrisome for HD in young infants, regardless of location.