This blog will discuss anything related to the practice of forensic pathology. Topics will including recent articles in the medical literature, interesting cases in the news, TV forensics, and the general day to day things I have to deal with as a forensic pathologist. If there is something you want to know or have an idea for a topic, drop me a line. I am going to try and spend some time on histopathology with the hope of getting fellows ready for the boards!
Tuesday, February 22, 2011
What's the Diagnosis?
What is the organ and what is the diagnosis?? You can click on the picture for a larger view!
Alright, this one may have been tough. If 100% of the people get the question wrong, the examiner is at fault! it is pancreas. It's from a person who died of hypothermia. I didn't expect anyone to get that, but what I was hoping for was that someone would call it acute pancreatitis. The pancreas can become hemorrhagic in hypothermia and as an artifact of decomposition. It is important to be able to distinguish these processes from something more acute, like acute pancreatitis. Two things are helpful when one is trying to decide: one, is there acute inflammation? Notice the total lack of neutrophils in this section. Two, is there tissue necrosis? Sometimes differentiating autolysis from necrosis is difficult, but look for inflammation. In autolysis the outlines of the tissue remain and the nuclei vanish. I can't seem to be able to upload a photo to the comments, so click on this link to see a photo of autolytic pancreas:
I can see why people called this amyloid. Forensic histopathology is filed with weird artifacts and changes that are not normally seen with surgical path slides or hospital autopsy slides, it's a very unique aspect to our field. The red blood cells in this case have begun to breakdown, forming a homogeneous sort of blur. If you look the edge, you can see some intact red blood cells. The pancreas has not really begun to autolyze yet, so this process happening to the red blood cells is most likely an artifact of fixation.
This is amyloidosis of some gland, probably the anterior pituitary.
ReplyDeleteAmyloidosis of Pancreas?
ReplyDeletepancreas is also a good idea...
ReplyDeleteOk, so it is pancreas. It's not amyloid. I can see why you might say that. Look closer at the edges of the 'amyloid', see any red dots?? Try again!
ReplyDeleteis it only a fresh hemorrhage then? I have no other ideas...
ReplyDeleteAlright, this one may have been tough. If 100% of the people get the question wrong, the examiner is at fault! it is pancreas. It's from a person who died of hypothermia. I didn't expect anyone to get that, but what I was hoping for was that someone would call it acute pancreatitis. The pancreas can become hemorrhagic in hypothermia and as an artifact of decomposition. It is important to be able to distinguish these processes from something more acute, like acute pancreatitis. Two things are helpful when one is trying to decide: one, is there acute inflammation? Notice the total lack of neutrophils in this section. Two, is there tissue necrosis? Sometimes differentiating autolysis from necrosis is difficult, but look for inflammation. In autolysis the outlines of the tissue remain and the nuclei vanish. I can't seem to be able to upload a photo to the comments, so click on this link to see a photo of autolytic pancreas:
ReplyDeletehttp://www.forensicneuropathology.com/blog_photos/Forensic_Pathology_Blog.html
I can see why people called this amyloid. Forensic histopathology is filed with weird artifacts and changes that are not normally seen with surgical path slides or hospital autopsy slides, it's a very unique aspect to our field. The red blood cells in this case have begun to breakdown, forming a homogeneous sort of blur. If you look the edge, you can see some intact red blood cells. The pancreas has not really begun to autolyze yet, so this process happening to the red blood cells is most likely an artifact of fixation.
Tough case, good thinking all the way around!
What do you think about fat vacuole in pancreas of hypothermia case?
ReplyDeleteVery impressive, it doesn't looks like hemorrhage, but I don't think it may be pancreatitis.
ReplyDelete