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Galante N, Bedeschi MF, Beltrami B, Bailo P, Silva Palomino LA, Piccinini A. Reviewing hereditary connective tissue disorders: Proposals of harmonic medicolegal assessments. Int J Legal Med 2024:10.1007/s00414-024-03290-4. [PMID: 39008115 DOI: 10.1007/s00414-024-03290-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/09/2024] [Indexed: 07/16/2024]
Abstract
Hereditary connective tissue disorders (HCTDs) are a heterogeneous group of inherited diseases. These disorders show genetic mutations with loss of function of primary components of connective tissue, such as collagen and elastic fibers. There are more than 200 conditions that involve hereditary connective tissue disorders, while the most known are Marfan syndrome, Osteogenesis Imperfecta, and Ehlers-Danlos syndromes. These disorders need continuous updates, multidisciplinary skills, and specific methodologic evaluations sharing many medicolegal issues. Marfan syndrome and Ehlers-Danlos syndromes show a high risk of early sudden death. As a consequence of this, postmortem genetic testing can identify novel genotype-phenotype correlations which help the clinicians to assess personalized cardiovascular screening programs among the ill subjects. Genetic testing is also essential to identify children suffering from Osteogenesis Imperfecta, especially when a physical abuse is clinically suspected. However, this is a well-known clinical problem even though there are still challenges to interpret genetic data and variants of unknown significance due to the current extensive use of new genetic/genomic techniques. Additionally, the more significant applications and complexities of genomic testing raise novel responsibilities on the clinicians, geneticists, and forensic practitioners as well, increasing potential liability and medical malpractice claims. This systematic review provides a detailed overview on how multidisciplinary skills belonging to clinicians, medicolegal consultants, radiologists, and geneticists can cooperate to manage HCTDs from autopsy or clinical findings to genetic testing. Thus, technical aspects need to be addressed to the medicolegal community since there is no consensus works or guidelines which specifically discuss these issues.
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Affiliation(s)
- Nicola Galante
- Section of Legal Medicine of Milan, University of Milan, Via Luigi Mangiagalli 37, 20133, Milan, Italy.
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 37, 20133, Milan, Italy.
| | | | - Benedetta Beltrami
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Medical Genetic Unit, Milan, Italy
| | - Paolo Bailo
- Section of Legal Medicine of Milan, University of Milan, Via Luigi Mangiagalli 37, 20133, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 37, 20133, Milan, Italy
| | | | - Andrea Piccinini
- Section of Legal Medicine of Milan, University of Milan, Via Luigi Mangiagalli 37, 20133, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 37, 20133, Milan, Italy
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Blichárová A, Benetinová Z, Mátyás T, Labaj P, Verbóová Ľ, Tancoš V, Nedoroščík A. Peliosis of the spleen as an unusual cause of splenic rupture: A case report and a review of literature. J Forensic Leg Med 2024; 103:102659. [PMID: 38431990 DOI: 10.1016/j.jflm.2024.102659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 02/01/2024] [Accepted: 02/18/2024] [Indexed: 03/05/2024]
Abstract
Isolated splenic peliosis is an extremely rare condition characterized by the presence of multiple blood-filled cavities, occasionally resulting in non-traumatic splenic rupture with fatal bleeding. In our case, a 64-year-old man was brought by ambulance due to weakness and abdominal pain without nausea or febrility. On clinical examination, the patient was sensitive to palpation with significant tenderness over the abdomen but no associated features of peritonitis. He collapsed during the imaging examination and became unconscious and asystolic. Cardiopulmonary resuscitation was not successful. The patient died approximately within 2 hours of admission to the hospital. Postmortal examination showed 2800 ml of intraperitoneal blood with clots and a laceration of the lower pole of the spleen. Macroscopic examination of the spleen revealed huge nodular splenomegaly, measuring 21 cm x 19 cm x 5 cm, weighing 755 g. On the cut surfaces, multiple randomly distributed blood-filled cavities ranging from 0,5 to 2 cm in diameter were seen. At microscopic examination, the specimens showed multiple irregular haemorrhagic cyst-like lesions that were not lined by any epithelium or sinusoidal endothelium, consistent with the diagnosis of peliosis lienis. Although the condition is often clinically silent, the forensic pathological significance arises from the differential diagnosis of resultant intraperitoneal haemorrhage and sudden death, mimicking a violent death.
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Affiliation(s)
- Alžbeta Blichárová
- Department of Pathology, Faculty of Medicine, Pavol Jozef Šafárik University and Louis Pasteur University Hospital in Košice, Rastislavova 43, 040 01, Košice, Slovakia.
| | - Zuzana Benetinová
- Department of Pathology, Faculty of Medicine, Pavol Jozef Šafárik University and Louis Pasteur University Hospital in Košice, Rastislavova 43, 040 01, Košice, Slovakia.
| | - Tibor Mátyás
- Forensic Medicine and Pathological Anatomy Workplace in Košice of Health Care Surveillance Authority, Ipeľská 1, 043 74, Košice, Slovakia.
| | - Peter Labaj
- Forensic Medicine and Pathological Anatomy Workplace in Košice of Health Care Surveillance Authority, Ipeľská 1, 043 74, Košice, Slovakia.
| | - Ľudmila Verbóová
- Department of Pathology, Faculty of Medicine, Pavol Jozef Šafárik University and Louis Pasteur University Hospital in Košice, Rastislavova 43, 040 01, Košice, Slovakia.
| | - Vladimír Tancoš
- Department of Pathology, Faculty of Medicine, Pavol Jozef Šafárik University and Louis Pasteur University Hospital in Košice, Rastislavova 43, 040 01, Košice, Slovakia.
| | - Adam Nedoroščík
- Department of Pathology, Faculty of Medicine, Pavol Jozef Šafárik University and Louis Pasteur University Hospital in Košice, Rastislavova 43, 040 01, Košice, Slovakia.
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