ECP 2022 Abstract Book

Virchows Archiv (2022) 481 (Suppl 1):S1–S364 13 Microscopic examination revealed undifferentiated pancreatic car- cinoma with irregular tumour glands with cribriform components embedded in the desmoplastic stroma. Changes in the myocardium included necrosis with prominent neutrophilic infiltration, indicat- ing an acute state of secondary myofiber necrosis (4-5 days). Conclusion: Features of this case include undifferentiated pancre- atic carcinoma undiagnosed during life; no visible changes in the pancreas during the autopsy; lesions in the myocardium, that are considered secondary to necrosis. E-PS-01-003 Incidental multilocular cystic nephroma in forensic pathology C. Amalinei*, L.A. Riscanu, A. Grigoras *"Grigore T. Popa" University of Medicine and Pharmacy Iasi and Institute of Legal Medicine Iasi, Romania Background & objectives: Multilocular cystic nephroma is a rare cystic tumour without a grossly appreciable solid component, which mainly occurs in adult women. The aim of our study is to report five cases of multilocular cystic nephroma incidentally discovered in the necroptic examination. Methods: The reports from autopsies performed in the last five years in our department have been reviewed and five cases of multilocular cystic nephroma, with age range between 50 to 80 years old (four females vs. one male), have been selected. The necroptic examination has been associated to collection of tissue specimens for microscopy, followed by paraffin-embedding and routine staining. Results: The gross findings were that of multiple well-circum- scribed, multilocular cystic renal masses, with variable size, rang- ing between approximately 4-7.5mm diameter, filled with serous to serosanguinous fluid, eccentrically-located, and pushing the renal pelvis. The microscopic examination revealed numerous cysts lined by a single layer of cells with various morphology (flat, cuboidal, and hobnail type), with minimal cytological atypia, and no evi- dent mitoses. The cysts have been characteristically associated with fibroblastic stroma, containing hemosiderin-laden macrophages and focal chronic inflammation. Polycystic renal disease has been excluded in all cases. Conclusion: Despite their rare occurrence, multilocular cystic nephromas should be considered in the differential diagnosis of cystic renal cancers or benign tumours, such as mixed epithelial and stromal tumour (MEST), angiomyolipoma with epithelial cysts, partially differentiated cystic nephroblastoma (CPDN), and tubulocystic renal cell carcinoma. They may be incidentally discovered during necropsy and microscopic examination may certify the diagnosis. E-PS-01-004 Fatalities in environmental heat exposure C. Amalinei*, A.A. Hlescu, A. Grigoras *"Grigore T. Popa" University of Medicine and Pharmacy Iasi and Institute of Legal Medicine Iasi, Romania Background & objectives: Death from hyperthermia may occur when the core body temperature is higher than 40 degrees Celsius. The aim of our study is to report the microscopical and immunohistochemical features of hyperthermia from our files, in the appropriate environ- mental conditions. Methods: The autopsy reports of our department, from the last 12 years, have been reviewed, and four cases of hyperthermia have been selected, in men with an age range between 31-49 years old. Routine hematoxylin and eosin staining, along with Periodic Acid- Schiff (PAS) and immunohistochemistry using Sirtuin1 (SIRT1), Ubiquitin (Ub), Heat shock protein 70 (Hsp70), and Aquaporin-1 (AQP-1) have been performed. Results: The gross findings showed pulmonary and cerebral oedema, along with pleural, epicardial, and peritoneal haem- orrhagic petechiae (3 cases), along with myocardial fibrosis and hepatic steatosis (2 cases). Microscopy revealed alveo- lar and cerebral oedema, pleural and epicardial microhaem- orrhages. AQP-1 immunopositivity was observed in lung endothelial cells, while neurons showed a positive expression of Hsp70. Cardiomyocytes showed vacuolar degeneration and contraction bands, along with SIRT1 weak immunoreactiv- ity and its focal positivity loss in areas associated with con- traction bands. Amorphous intra-tubular and intra-capsular space material, renal corpuscle basal lamina thickening, and Ub intense positive expression in distal convoluted tubules epithelium and in the outer layer of the Bowman’s capsule have been also identified. Conclusion: Death from environmental-induced hyperthermia is a rare condition in legal medicine, which occurs when the ther- moregulatory mechanisms are no longer capable of effectively dissipate the heat. The microscopic examination and immuno- histochemistry may add valuable information for diagnosis in these cases. E-PS-01-005 Capnocytophaga canimorsus septicaemia diagnosed post- mortem - a case report A. Hennessy*, N. Shah *University Hospital Waterford, Ireland Background & objectives: Capnocytophaga canimorsus is a gram negative bacteria which is a constituent of the oral flora of dogs. Infection in humans is uncommon, however predisposing factors include alcoholism, asplenia, and immunosuppression. A case of fatal C.canimorsus infection diagnosed post-mortem is described. Methods: A 60 year old male patient presented to the emer- gency department with a history of epigastric pain and a low- grade temperature, on a background of recent heavy alcohol consumption. The initial impression was acute pancreatitis, however the patient rapidly deteriorated, developing respira- tory failure within an hour of presentation. He subsequently had a cardiopulmonary arrest which was not amenable to resuscitation. Results: A post-mortem examination carried out demonstrated severe coronary artery atheroma and biventricular hypertrophy. Of note, there were no findings suggestive of recent animal- inflicted trauma. The initial patient history did not enquire about animal exposure or dog bites or scratches, however subsequent history from the family revealed the patient had been a dog- owner and had a history of alcohol abuse. C.canimorsus was isolated on ante-mortem blood cultures after a prolonged incu- bation period. Conclusion: C.canimorsus infection is associated with a mortality of between 25 to 30%. The diagnosis is often difficult due to the variable presentation, and the elusiveness of diagnosis can lead to adverse outcomes. A high level of suspicion in patients presenting with sepsis in the presence of risk factors is important. The rapid deterioration of the patient in this case highlights the importance of considering C.canimorsus in the differential diagnosis, and in initiating antimicrobial therapy promptly. S187