ECP 2022 Abstract Book

Virchows Archiv (2022) 481 (Suppl 1):S1–S364 13 E-PS-01-006 Spontaneous coronary artery dissection in a pregnant woman with COVID-19 L. Chinezu*, C.C. Radu *UMFST G.E. Palade Tg. Mures, Romania Background & objectives: Spontaneous coronary artery dissection (SCAD) is a rare condition with life-threatening maternal complication. We describe a case of a 35-year-old pregnant woman, who died with an acute myocardial infarction (AMI) and try to highlight the possible association with COVID-19. Methods: During the third trimester of pregnancy, the patient presented with chest pain and was diagnosed with AMI caused by SCAD on the left anterior descending (LAD) coronary artery. Stenting of the LAD was performed. Concomitantly, the patient was tested positive for COVID-19. Due to life threatening cardiac instability, an emergency caesarean section was performed, and she died shortly after. Results: The autopsy was performed at the Institute of Foren- sic Medicine of Targu Mures and revealed an extensive anterior AMI of the left ventricle. A permeable stent on the LAD with an important subintimal haemorrhage was seen. On microscopic view, the transmural AMI was confirmed. LAD examination revealed a discontinuous intimal area and a massive haemorrhage into the subjacent media. Based on elastica van Gieson staining the fibro-muscular dysplasia diagnosis was infirmed. Massive acute pulmonary oedema was also seen, but without pathologi- cal changes suggestive for COVID-19 pulmonary involvement. Conclusion: SCAD is a rare event, and its causes are still debated. The association of COVID-19 with some other known risk factors (age >30 years and smoking) could have aggravated the underlying condition and lead to the occurrence of this SCAD. Funding: Acknowledgement “This work was supported by the University of Medicine, Pharmacy, Science, and Technology „George Emil Palade“ of Târgu Mure ș Research Grant number 510/2/17.01.2022” E-PS-01-008 An unusual case of infrarenal pheochromocytoma developed on ectopic adrenal tissue R. Chiciudean*, T. Bara, I. Jung, S. Gurzu *Department of Pathology, Mures County Emergency Hospital, Romania Background & objectives: Pheochromocytomas are catecholamine- secreting tumours arising from the chromaffin cells of the adrenal medulla. Ectopic adrenal tissue is usually formed by cortex only. We describe an unusual case of pheochromocytoma located in the infrarenal area associated with bilateral adrenal hyperplasia. Methods: A 70-year-old patient was admitted for syncope, dia- phoresis, and high blood pressure. Computed tomography showed a 73x70x72 mm mass of the left infrarenal/paraaortic area. High levels of metanephrine and noradrenaline were found in the urine. Tumour resection was performed. After surgery, the blood pressure suddenly decreased and could not be restored. A few days after the surgery the patient died. Results: Histopathological examination of the surgical specimen revealed a proliferation of tumoural monotonous cells, with eosinophilic cytoplasm, round nuclei with prominent nucleoli arranged in clusters. Among them, there were highly pleomorphic areas composed of large, atypical cells, with abundant, eosinophilic cytoplasm and irregular, hyperchromatic nuclei. Large areas of haemorrhage were observed, same as vascular invasion. Immunohistochemically (IHC), the neoplastic cells were positive for Synaptophysin and Chromogranin, showed a Ki67 index over 80% and did not express Inhibin A and S100. At the autopsy, both adrenal glands proved to show hyperplasia but unrelated to the tumour mass. The histological aspect, location, and immunophenotype indicated an ectopic infrarenal pheochromocytoma. Conclusion: In patients with pheochromocytoma developed on ectopic adrenal tissue clinical management might be difficult and diagnosis can be sometimes established only based on post-mortem histopathological examination. Autopsy can be extremely useful in such cases with unexplained evolution. E-PS-01-009 Covid-19 and granulomatosis with polyangiitis. Autopsy report M. Mnikhovich*, O. Sidorova, I. Shiripenko, T. Bezuglova, A. Romanov, T. Sotnikova, M. Mnikhovich, T. Polushkina, D. Pastukhova *Central Pathology Laboratory, Research Institute of Human Mor- phology, Russia Background & objectives: Granulomatosis with polyangiitis is a rare type of autoimmune necrotizing vasculitis typically associated with antineutrophil cytoplasmic antibodies (ANCA). This disease affects small and medium vessel with a perivascular granulomatous inflam- mation. The renal and pulmonary vessels are predominantly involved in process. Methods: We present an autopsy case of 36-years old man with COVID-19 and previously diagnosed untreated granulomatosis with polyangiitis. The patient in a critical condition was trans- ported to the intensive care unit of a hospital where he died within 5 hours despite all the resuscitation treatment. Autopsy examina- tion was performed. Results: An autopsy revealed multiple petechial haemorrhages in the brain with a cerebral oedema. The pleura and the pericar- dium are covered with fibrin deposits. Serous fibrinous effusion in pleural cavity is also revealed. Lungs are oedematous with a foam fluid and blood. The surface of the kidneys was with regenerated infarctions. Histopathological examination of the lungs revealed perivascular and peribronchial sclerosis. Alveoli was with intraalveolar hyaline membranes formations. Interstitium is infiltrated by lymphocytes. Histopathological examination of the kidneys showed emerged necrotizing glomerulonephritis has led to massive glomerulosclero- sis. There was also lymphocytic infiltrate in interstitium of kidneys. Microcirculatory vessels of lungs and kidneys was thrombosed and affected by granulomatous inflammation. Conclusion: In this article we have presented a rare case of a COVID-19 occurring against the background of active phase of untreated granulematosis with poliangiitis. This combination of severe vasculitis of different aetiologies led to multiply damage of highly vascularized organs such as lungs and kidneys. E-PS-01-010 A fatal case of fibrinous pericarditis in a uremic patient – a case report M. Cristóvão*, M. Varela dos Santos, N. Gião, C. Pontinha *Pathology department - CHULC, Portugal Background & objectives: Fibrinous pericarditis is an often-difficult diagnosis, important for its potential complications. Hemopericardium and subsequent cardiac tamponade are life-threatening conditions and S188