Sudden Death Caused by Gastroesophageal Varices Rupture: Insights From an Autopsy-Based Case Series Unraveling the Pathological Events

Sudden death is characterized by natural yet unexpected death, typically occurring within 24 hours from the onset of the patient's symptoms. While the majority of sudden deaths stem from cardiac issues/causes, there are instances where non-cardiac factors are at play. One such scenario involves hemorrhage from ruptured esophageal varices, a complication that stems from portal hypertension. Portal hypertension can manifest due to a range of pre-hepatic, hepatic, and post-hepatic conditions, with liver cirrhosis being the primary culprit. Although sudden death cases linked to the gastrointestinal system are relatively rare, the rupture of gastroesophageal varices, precipitating severe morbidity and a high mortality rate, represents a life-threatening condition. In this context, we present a case series encompassing five instances of sudden natural deaths arising from the rupture of gastroesophageal varices.

Epidermoid Cyst: An Esthetic Challenge, If Neglected-A Comprehensive Analysis of 217 Cases

Background

An epidermoid cyst is a benign keratin-filled cyst, commonly located in the face, scalp, neck, and trunk. Although it is a common benign cystic neoplasm, large series of analyses in English literature are still scarce. To comprehend the clinical and pathological variation of epidermoid cysts in the sub-Himalayan region of India, as well as their clinical implications for late diagnosis, a retrospective study on epidermoid cysts was conducted.

Materials and Methods

This was a retrospective observational study conducted on 217 cases of epidermoid cyst subjected for fine-needle aspiration cytology over a period of 3.6 years (from 2018 to 2021). The clinical details and other epidemiological data were archived from the pathology requisition forms.

Results

It showed slight male preponderance with head and neck site as the most common area. Most patients were adults. Few uncommon sites were also seen namely breast, parotid, epididymis, and tonsils. Few large lesions were identified measuring up to 10 cm. The skin changes were seen in 5.5% cases, 0.9% cases show extreme ulceration, and 4.1% cases show foreign body giant cell reactions. Due to the province's steep terrain and limited access to medical services, the majority of patients arrived at out patient department (OPD) late.

Conclusion

The findings suggest that fine-needle aspiration can be used as a quick diagnostic test even in remote areas by the general practitioner who can send the slides for evaluation to a pathologist. Many times, clinically looking epidermoid cyst can reveal certain challenging entities such as a biphasic fibroepithelial tumor with cystic squamous metaplasia and proliferating pilar tumor in our series. The study of this lesion is also needed for early diagnosis as long-standing lesion may rupture and cause requirement of extensive treatment followed cosmetic impairment.

Medullary carcinoma of jejunum presenting as perforation peritonitis: A case report

Small intestinal medullary carcinoma (MC) is a newly recognized subclass of small intestinal carcinomas and is an exceptional entity for this site. A search of the literature for similar cases arising in the small intestine revealed only six previously reported cases. Here we present a case of MC arising in the jejunum of a 65-year-old male. The patient presented to the emergency with features of perforation peritonitis with liver metastasis and no known predisposing factors like inflammatory bowel disease and celiac disease. Studies conducted on this tumor's colonic counterpart have shown microsatellite instability (MSI) and B-type Raf kinase (BRAF) mutations; however, few exceptions are known. Also, this subtype of carcinoma is known to have a better prognosis than its other histological subtypes.

Metachronous Osseous Metastases From Gliobliostoma Mutiforme: An Unusual Presentation

Metastasis occurs very rarely in glioblastoma cases. Diagnosing metastatic glioblastoma has to follow a strict protocol to avoid misdiagnosis. Weiss’s 1955 criteria, which is in prevalence, needs to be modified to include current standards of investigation. We report an interesting case of metachronous osseous metastasis from a primary glioblastoma with a complete response at a local site. We also suggest modifications to Weiss’ criteria, which may improve its utility in establishing the diagnosis of metastatic glioblastoma.

Hydatid cyst of femur, radiologically mimicking a sarcoma

Hydatid disease is a rare pathology, but relatively common in the Mediterranean, the Middle East, Central Asia, and East Africa. It may develop in almost any part of the body, although most hydatid cysts occur in the liver or in the lung. Bone involvement is rare, and accounts for only 0.5% to 4% of all locations. Most of the hydatid cyst are diagnosed on the basis of their clinical and radiological presentation. However, in cases with an atypical presentation, FNAC may be used to evaluate the nature of lesion.