Indian Journal of Forensic Medicine and Pathology

Background: Primary liver cancer is the second most common cancer in Asia, hepatocellular carcinoma being the most common histological type. Hepatocellular carcinoma with sarcomatoid features and osteoclast like giant cells is a rare malignancy and has higher risk of metastasis as compared to usual Hepatocellular carcinoma. Case Description: We recently encountered an autopsy case of cirrhotic liver with sarcomatoid variant of Hepatocellular carcinoma in a 59 year old male. Macroscopically, it presented as a grey white to grey yellow ill defined nodule with central necrosis and surrounding micronodular cirrhotic changes. Microscopically, tumor predominantly composed of two cell types were noticed- classical hepatocellular carcinoma with atypical hepatocytes and pleomorphic spindle cells with frequent mitosis and multinucleated giant cells. As the tumor had both epithelial and mesenchymal differentiation in the same lesion, the diagnosis of sarcomatoid variant of hepatocellular carcinoma was made. Literature Review: Sarcomatoid variant of carcinoma has to have both epithelial and mesenchymal differentiation in the same lesion. Occasionally when the tumor is fully composed of malignant spindle cells, it is difficult to distinguish from various primary sarcomas and has to be confirmed by immunohistochemical staining Clinical relevance: The prognosis of the sarcomatoid variant of Hepatocellular carcinoma is unfavourable compared with classical Hepatocellular carcinoma which could be attributed to aggressive intrahepatic spreading and frequent metastasis. Histopathological study is the only effective diagnostic tool for confirmation.

Keywords: Hepatocellular Carcinoma; Sarcomatoid; Osteoclast Like Giant Cells. 

Drug trafficking is an international problem and has increased in prevalence and concealment methods over the years. Body packers either swallow drug-filled packets or introduce packets into their bodies rectally or vaginally with the purpose of concealing them and mainly smuggle cocaine, heroin and cannabis products. Increased sophistication of traffickers and improved packaging poses difficulty in detection. Sometimes the packets can leak and cause intoxication of the individual and even death. We report a case of death due to heroin leakage in a body packer, attempting to smuggle the drug by concealing it in his stomach. This article aims to highlight the existence of drug traffickers as Body packers so that preventive steps may be taken at the points of transit from other countries as they may be masquerading as Medical tourists, coming to India for treatment.

Keywords: Drug Trafficking; Body Packer; Heroin; Cocaine; Medical Tourist; Drug Intoxication.

Background: To know why India has failed to achieve Millennium Development Goal (MDG) 4. This aims at reducing U5MR by two- third between 1990-2015. Aim: To know the cause of paediatric death in North Maharashtra (Khandesh region) with 70% of Rural population. Measures to be taken to achieve MDG 4. To achieve clinico-pathological correlation in the cause of paediatric death. Material and Methods: A total of 124 cases were received for histopathological examination in the period of three year span from January 2014 to December 2016. 4 cases were completely autolysed. Hence 120 cases were included in the study. 9.6% cases belonged to neonatal age group, in whom perinatal asphyxia was the common cause. 15.3% belonged to infant and 71.7% belonged to childhood deaths. In both the age group, infection 78% was the main cause of death. On clinical correlation 16.6% discrepancy was present in neonate, 5.2% in infant and 4.4% in childhood. Medico-legal cases were seen in adolescent age group. Results: Prolonged labour and home delivery was the reason for perinatal asphyxia, which was the main cause of perinatal death in our study. Hence a good obstetric care in primary health centre along with educating mother is need in rural India. Effective intervention will be helpful in decreasing the mortality due to infection in infant and childhood deaths. Educating teenagers for hormonal changes is important in rural area too. Thus an autopsy study of paediatric deaths is informative and it can form baseline information for Promise of Renewal Movement.

Keyword: Millennium Development Goal (MDG ) 4. 

Context: Lymph nodes are common sites for primaries as well for different metastatic cancers. Thus clinical recognition and urgent diagnosis of palpable lymphadenopathy is of paramount importance specially to differentiate between inflammatory lesions or metastatic or primary neoplastic tumor. Objectives: Role of FNAC in Primary and Secondary Lymphnode Neoplasm among Patients attended at Tertiary Teaching Health Care Centre, Mumbai. Methods: A retro-prospective study was carried out on the patients admitted in medical and surgical ward and from OPD with clinically diagnosed lymphadenopathy, in the department of Pathology of LTMMC & GH, Sion, Mumbai, during the period of January 2007 to August 2011. Results: In lymphoma group, Non- Hodgkin’s Lymphoma was commonest (66.67%) followed by Hodgkin’s lymphoma (33.33%). In malignant lymphoma group the diagnostic accuracy was 85.71%. In metastatic group, the commonest metastatic lesion observed was squamous cell carcinoma (65.39%) followed by undifferentiated epithelial malignancy (21.03%), and infiltrating ductal carcinoma of breast in (6.47%). Conclusion: Fine Needle Aspiration Cytology is logical extension of the more formalized biopsy procedure, lending itself to saving of time and cost and is convenient for both patients and physician in the management and follow up of malignant lymphadenopathies. FNAC helps in defining the tumor type, while the clinical history and investigations help in identifying the tumor site.

Keywords: Fine Needle Aspiration Cytology; Primary Lymphnode Neoplasm; Metastatic; Tertiary Health Care Centre. 

Though all of us agree that organ donation is the need of the hour, myths and misconceptions regarding it abounds accompanied with very poor knowledge and attitude towards this noble act. The rate of organ donation in India is low and research on organ donation among the general population is limited. Lack of knowledge and understanding about organ donations, religious attitudes, and superstitious beliefs have generated fear and mistrust in the minds of the common man and, especially, the terminally ill patients [1, 2]. There is an inadequate supply of cadaver organs commensurate with need. Health-care professionals are the critical link in augmenting public awareness about organ donation. Their knowledge and beliefs can influence the public opinion. This descriptive cross sectional study aims at understanding the perception, knowledge and awareness among the medical graduate students and students from police training as constables. A total 200 students participated in the study. A specially de-signed questionnaire was used in assessment.

Keywords: Awareness of Organ Donation; Perception; Knowledge. 

Introduction: Sudden death is one of the common mode of the death now a days. According to ICD 10 of the World Health Organization sudden death is defined as “Death occurring in less than 24 hours from onset of symptoms not otherwise explained”. It also emphasizes that sudden death is better known as non-violent or instantaneous for which no cause can be discovered. Despite modernization in medicine, the diagnosing tools lack in accuracy to find clinical cause of death in comparison with autopsy cause of death. Across all age groups, cardiac related diseases play a significant role in both sudden and unexpected death. In this study, cases of sudden deaths are examined histopathologically to establish possible causes of the sudden deaths. Aim: To study histopathology of the organs of sudden death cases in autopsy and identify common but clinically important causes of sudden death. This study would show the impact of lifestyle of our society and thus help to increase awareness in population at risk as well as lifestyle modification which might reduce the incidence of sudden death. Material and Method: A study of autopsies of sudden deaths between August 2014 to July 2017(3 Years) at department of Pathology, BRIMS, Bidar. Result: Total autopsies received during August 2014 to July 2017 were 198, among which those with sudden death were 54 cases (27.27%). The age ranged from 11 years to 90 years, among which sudden death was maximum in 41 to 60 years of age and males were affected more than the females. Out of 54 sudden deaths, 37 cases (68.52%) died of cardiovascular causes, mainly myocardial infarction; while 17cases (31.48%) were of non cardiac causes, in which pulmonary aetiologies predominate. Among 37 cases of cardiovascular causes, 9 had other co-morbid conditions. Conclusion: It is concluded that sudden deaths were more common in 4th and 5th decade of life with male preponderance and most common causes are cardiovascular, while sudden deaths between 11 to 30 years of age were mainly due to non cardiac causes.

Keywords: Sudden Death; Autopsy; Cardiovascular and Non Cardiac Causes. 

Background: Many cases of sudden natural non-traumatic deaths (SNND) occur in individuals without known medical diseases. Many systems, more commonly cardiovascular and respiratory, are known to be involved in such deaths. This prospective autopsy based study was decided to determine the frequency of system involvement & survival period in sudden natural non-traumatic deaths. Material and Methods: During the study period from 1st October 2010 to 31st August 2012 total 1711 consecutive medico-legal autopsies were performed by the Department of Forensic Medicine and Toxicology, S.V.N. Government Medical College, Yavatmal, of which 125 (7.3%) cases were turned out to be of SNND, which were studied to determine the frequency of system involvement & survival period. Results: Maximum i.e. 41 (32.8%) cases were related to cardiovascular system causes followed by 32 (25.6%) to respiratory system causes. 17 (13.6%) cases related to central nervous system causes, 20 (16%) were related to gastrointestinal system causes, 05 (04%) due to genitourinary system causes and 10 (08%) were of miscellaneous causes. Out of cardiovascular causes, coronary artery disease contributed for 80.4% of cases. Out of total 125 cases, 71 (56.8%) cases survived less than 6 hours, 22 (17.6%) survived between 06 to 12 hours, 23 (18.4%) survived between 12 to 18 hours and 09 (7.2%) survived between 18 to 24 hours. It is pertinent to note that the primary system involved has had direct correlation with survival period. Out of cardiovascular cases, 37 (90.2%) survived less than 6:00 hours and 17 (41.5%) survived less than 1:00 hour. The system wise difference in period of survival was found to be statistically significant in hours (2= 46.91, p= 0.00003801). Average survival period for SNND cases was 06:56±0.26 hours and lowest i.e. 02:37±0.14 hours for deaths due to cardiovascular causes. Conclusion: Cardiovascular system pathologies remain the leading cause of sudden natural non-traumatic deaths with lowest survival period in this study. The people should undergo regular medical check-ups for early detection and proper management of cardiovascular diseases. Importance of survival period is for the assessment of suddenness of death, vulnerability of system and for future planning and providing of transport facilities and emergency medical service depots to cope with immediate events prior to death.

Keywords: Sudden Natural Non-Traumatic; Deaths; Autopsy; System Involvement; Survival Period. 

Parasitic infections and allergies are the major contributing factors of eosinophilia. Aims and Objectives: To study the various haematological parameters of school going children and to find out the correlations between the haematological parameters. Materials and Methods: The study was carried out on 130 students of a secondary public school of rural area of Nashik district. The haematological samples were processed on fully automated 5-part haematology cell analyzer. Eosiniphilia was divided into: mild: 351-1500/mm3 of blood, moderate: 1500-5000/mm3 of blood, severe: >5000/mm3 of blood. Statistical analysis of the various haematological parameters was done subsequently. Results: Eosinophilia was present in 45.38% of children. Total leucocyte count (White blood cell count/ WBC/TLC) was normal in 95.38% children. Mild to moderate anaemia was seen in 66.9% children. Conclusion: Eosinophilia is common among the school going children in our study.

Keywords: Eosinophilia; Haematological Parameters; Children. 

Background: Self intentionalviolent acts are one of the important causes of death nowadays. Burning is one of the modes of committing suicide, although it is painful and non-instantaneous death as compared to others modes of suicide. Since limited data is available on suicidal burn in this part of India i.e. Ranchi, Jharkhand. Therefore, we have planned this study to know the profile and attributing factors for suicidal burn in the state of Jharkhand of India. Materials & Methods: This prospective study which was carried out on 162 cases of death due to burns in the department of forensic medicine & toxicology of Rajendra Institute of Medical sciences, Ranchi during from 15th April, 2012 to 14th October, 2013. Information regarding the sociodemographic, mode of suicides, time of incidence, place of incidence, occupation, etc were gathered from the police papers like inquest report, dead body challan etc, and through detailed interviews of the relatives, neighbors, friends, and police officials accompanying the dead bodies. Results: Hindu married females belonging to rural backgroundbetween ages15 years to 44 years were most common victims of suicidal burns. Most of the suicidal burns occurred during summer season (61%) followed by winter (Dec-March) (17%). Majority (56%) were chose In Law’s home followed by parental home (44%). The maximum suicidal burns incidence occurred at evening (between 4 PM to 8 PM), which accounts 33% followed by late night (between 12 AM to 4 AM) with 22%. Conclusion: The present study has findings more or lessconsistent with the findings of the other studies conducted in Indian.

Keyword: Suicidal Burn; Seasonal Variations; Place of Incidence. 

Introduction: Barr body has been recognized as the cytological manifestation of the inactive X chromosome in interphase nuclei in a highly condensed state. Aims and Objectives: To assess the efficacy of sex determination between pap stained buccal mucosal scrapes and leishman stained drumstick appearance in peripheral smear. Material and Methods: Buccal mucosal smears and peripheral smears are collected from 100 individuals who visit K. R. hospital and Cheluvamba hospital of age ranging from 20-30 years. The buccal mucosal scrapes were stained with papanicolaou stain and peripheral smear of the same individual were stained with leishman stain. Results: In females and males drumstick appearance was more compared to barr body. Conclusion: Sex determination using buccal scrapes and peripheral smear stained with papanicolaou stain and leishman stain proved to be simple, accurate and cost effective method in our study.

Keywords: Barr Body; Drumstick; Papanicolaou Stain; Leishman Stain. 

Benign Prostatic hyperplasia (BPH) and carcinoma prostate are increasingly frequent with advancing age. Prostatic intraepithelial neoplasia (PIN) is the most established precursor of prostatic carcinoma. HGPIN and prostate cancer share genetic and molecular markers as well, with PIN representing an intermediate stage between benign epithelium and invasive malignant carcinoma. The clinical significance of HGPIN is that it identifies patients at risk for malignancy. Purpose of this study was to find out the incidence of prostatic intraepithelial neoplasia (PIN) and to study the histochemical characters of PIN and prostatic adenocarcinoma. Method: The present study included prostatic tissue specimen of 150 cases received in the pathology Department during period of April 2013 to December 2014. Histopathological evaluation of all cases were done in the department. Results: PIN accounted for 8.6% (13 cases) with a peak incidence in age group of 70-79 years. LGPIN accounted for 8% (12 cases) and HGPIN accounted for 0.6% (1 case).

Keywords: Benign Prostatic Hyperplasia; Prostatic Intraepithelial Neoplasia (PIN). 

To ascertain the cause of death is the most important objective behind a medico- legal autopsy. To this objective, ruling out torture or any other form of forceful activity done by the authorities is added while performing the custodial deaths’ autopsy. Medico- legal autopsy of custodial deaths has to be prompt and precise, to achieve such objectives and to collect evidences. National Human Rights Commission (NHRC) has laid down certain guidelines at different levels at regular intervals to achieve the objectives behind custodial deaths’ autopsy. Authorities working under these guidelines encounter different problems at their level. This study was aimed at identifying few of those problems, analyzing them and find out solutions in the form of recommendations on the basis of conclusions drawn.

Keywords: Custodial Death; Autopsy; National Human Rights Commission (NHRC); Problems. 

Aims: This retrospective study was carried out to know the different epidemiological aspects of maternal deaths. Material and Method: This three year retrospective study was carried out in department of Forensic Medicine & Toxicology, Dr Vaishampayan Memoral Government Medical College Solapur, and Maharashtra from January 2014 to December 2016. This study is based on the medico-legal autopsy record of maternal deaths. Results: Overall MMR of the Institution was 369 and the incidence of maternal deaths due to obstetric causes as compared to overall medico-legal autopsies was 1.70 for the study period respectively. Most of the deaths occurred in the age group 21 to 25 i.e. 42.71%. Urban deaths were more 57.28% as compared to rural population. Hindu population deaths were 66.99% as compared to Muslims and other religious groups. 48.31% of deaths took place at tertiary care unit. In 38.83% of cases the tertiary care unit was within reach that is less than 10 km from the place of residence. 33% of deaths have taken place in between 12 pm to 6 pm. Conclusion: Maternal death is social injustice and to be dealt with sensibly.

Keywords: MMR; Maternal Mortality; Autopsy.