ECP 2023 Abstracts

S124 Virchows Archiv (2023) 483 (Suppl 1):S1–S391 13 analysed all invasive fungal infection autopsy cases in patients with haematological malignancies over the past twenty years. Methods: A retrospective study of autopsies was performed on patients with invasive fungal infection and haematological malignancies at Rhode Island Hospital and The Miriam Hospital from 2000 to 2021. The pertinent clinical information was collected and the pathologic data were reviewed in detail. Results: Seven cases were found to have invasive fungal infection, including 4 males and 3 females. The average age at death was 43.2 years (range 4-79 years). Of 7 cases, invasive candidiasis (2/7, 28.6%), invasive mucormycosis (1/7, 14.3%), invasive scedosporium prolificans (1/7, 14.3%), invasive fusarium (1/7, 14.3%), and mixed candida and mucor or aspergillus and mucor (2/7, 28.6%). Most commonly involved organs were lungs (7/7), heart (5/7), kidneys (5/7), thyroid gland (4/7), brain (4/7), spleen (4/7), liver (3/7), lymph nodes (2/7) and GI tract (2/7). Four cases had acute inflammation and abscess formation. The other three cases did not have acute inflammation. All cases did not have granuloma formation. Conclusion: The most common organisms of IFI were candida, mucor and aspergillus species. The most commonly involved organs were lungs, heart, kidneys, thyroid gland, brain and spleen. More than 50% cases had acute inflammatory responses. PS-21-003 Expect unexpected - experiences on neuropathological findings in autopsy material; a case report series P. Grochowski*, T. Schaller, I. Kleinlein, B. Märkl, F. Liesche-Starnecker *General Pathology and Molecular Diagnostics, Medical Faculty, Uni- versity of Augsburg, Germany Background & objectives: The role of autopsies is gradually decreas- ing in pathologists’ routine. In our experience, they often deliver unex- pected, interesting findings, contributing to clinically known disease patterns. We present a case series of patients diagnosed postmortem with relevant, partially unforeseen neuropathological lesions. Methods: The reports from all autopsies conducted in our institute in 2022 were evaluated for relevant neuropathological findings and com- pared to available clinical data, focusing on previously undiagnosed pathologies. Age-related and terminal changes, e.g. terminal oedema, as well as common alterations, especially hypertensive microangiopa- thy, were not taken into account. Results: Brain examination was performed in 175 of 201 autopsies. In 53 (30,3%), relevant cerebral pathologies were found, of which 33 (18,9%) were not clinically known. For eight (4,5%) deceased, cerebral involvement was main cause of death. For example, seven primary and ten secondary neoplasms were detected, in two cases classified as cause of death (intravascular DLBCL and diffuse midline glioma, H3 K27-altered). We also found five benign incidental tumours. Four cases presented with neurodegenerative diseases, including one with so far undiagnosed Parkinson’s disease. Brain autopsy of one case with the very rare Bornavirus encephalitis was included, as well as one limbic encephalopathy and one infant meningocerebral angiodysplasia. Conclusion: Using the example of brain autopsy, we demonstrate that many unusual and unexpected pathologies are waiting to be found. Standardized procedure and established cooperation with clinical coun- terparties can contribute to higher prevalence of findings. In broader perspective, if pathologists deliver more accurate information about cerebral pathologies, that often occur in the background of complex clinical pictures, more attention and carefulness can be prompted to clinicians, which could lead to a better standard of care. PS-21-004 Retrospective study in 20 years of post-mortem and additional clinical examination of (young)adults M. Hoogland*, T. Wemeijer, N. van Zanten, W. Duijst *Isala, The Netherlands Background & objectives: A retrospective study to gain insight into the cause of death in deceased (young) adults, by analysing autopsies and other (post-mortem) clinical examinations (including radiology, toxicology, medical microbiology and clinical chemistry) emphasizing their contribution into finding the cause of death. Methods: Between January 2000 – October 2022, adults within 18-45 years were included who underwent a clinical autopsy at a hospital in Zwolle, the Netherlands. Inclusions had a natural cause of death. For each patient the post-mortem examination and their contribution to diagnosing the cause of death were determined, among other things. Collected data was processed in a database and analysed. Results: Within the research period, 2867 autopsies were performed. 212 autopsies were included, 54 (25,5%) expected and 158 (74,5%) unexpected deaths. Post-mortem examination was subdivided into his- tology, immunohistochemistry, clinical chemistry, medical microbiol- ogy, radiology, toxicology and genetics. 116 deceased had an unknown cause of death (7 expected vs. 109 unexpected). After post-mortem examination, this category decreased to 15 deaths (expected 0 vs. unexpected 15). Of the 96 presumed causes of death for autopsy, 16 (16,7%) cases were stated as Goldman score 1 discrepancy, which led to reclassification of the primary diagnose. In order of most to least contributing post-mortem examination is histology, immunohis- tochemistry, medical microbiology, toxicology radiology, genetics, clinical chemistry. Conclusion: Performing post-mortem examinations reduces the num- ber of unknown causes of death, both in expected and unexpected deaths. Both categories contain discrepancies between presumed causes of death and established causes after autopsy. A combina- tion of several post-mortem examinations gives the greatest chance of determining/confirming cause of death. Additionally, clarity into causes of death provides a better alignment of national statistics with the actual situation. Over the years, more postmortem examinations have been performed, however, post-mortem examination is not yet standard practice. PS-21-005 Complications of SARS-Cov-2 infection in cancer patients – an autopsy-based study É. Kocsmár*, I. Kocsmár, Á. Jakab, T. Várkonyi, T. Glasz, K. Danics, A. Kiss, Z. Schaff, G. Lotz *Semmelweis University, Department of Pathology, Forensic and Insurance Medicine, Hungary Background & objectives: Autopsies performed during the severe acute respiratory syndrome-2 (SARS-CoV-2) infection and disease (COVID-19) pandemic provide insights into the specific features of COVID-19 in cancer patients particularly susceptible to infections but whose altered immunological status may affect the disease course. Methods: Between July 2020 and the end of 2022, a total of 2548 adult autopsies were performed in our department. COVID-19-posi- tive cases were classified as cancer (102 cases) and non-cancer (439 cases) patients and from the second wave onwards, subgrouped as wave 2/3/4/5/5+ according to the course of the pandemic (autopsies were not allowed in the first wave). Results: COVID-19 was significantly more frequent direct cause of death in non-cancer (77.3%) than in cancer patients (48%,p<0.0001), predominantly during waves 2-3 (p<0.001). Mild COVID-19 was more common in cancer (33.3%) than non-cancer patients (14,6%,p<0.0001). In non-cancer cases, COVID-19 was a significantly more frequent direct cause of death in waves 2-3 (83.8%) than in the second half of the pandemic (67.6%,p=0.0001), when mild course of infection/ disease was significantly more common (23.7% vs. 8.5% in waves 2-3,p<0.0001). In cancer patients, no similar difference was observed