ECP 2023 Abstracts

S149 Virchows Archiv (2023) 483 (Suppl 1):S1–S391 13 Methods: The histopathology reports of the cases that were autopsied between 2012 and 2022 were reviewed retrospectively using the key- words "conduction system hamartoma" and "histiocytoid cardiomyo- pathy". The cases were evaluated in terms of histopathological features, demographic data, autopsy findings, causes of death, microbiological results, and accompanying cardiac anomalies. Results: There were a total of four cases. The female-to-male ratio was 3/1. The mean age of the cases was 5.8 months. The average heart weight was 36,3 grams and it was found within the normal range when evaluated according to age and gender. No malforma- tions were observed in the heart or great vessels in any of the cases. Endocardial opacification was observed in one case. Microscopy revealed sharply demarcated cell groups or layers with histiocyte- like cells with foamy cytoplasm. The history of the cases regarding arrhythmias is unknown since hospital records could not be reached. Congenital heart disease and lung infection were given as causes of death in all cases. Conclusion: Previously named histiocytoid cardiomyopathy, infantile cardiomyopathy, arachnocytosis of the myocardium, infantile xan- thomatous cardiomyopathy, focal lipid cardiomyopathy, isolated car- diac lipidosis, foamy myocardial transformation, histiocytoid changes with cardiomyopathy, this lesion is now known as “conduction system hamartoma” within the latest WHO classification (5th edition). Being aware of this entity that causes fatal arrhythmias and sudden cardiac deaths is important for pathologists. The autopsy findings should be evaluated by taking extra samples from the heart if necessary espe- cially in suspected cases under two years. E-PS-01-014 Fatal consequences of adipose tissue manipulation: an autopsy case series of fat embolism syndrome E. Gun*, A. Bugra, T. Das *Basildon University Hospital, Mid and South Essex NHS Foundation Trust, Basildon, Essex, United Kingdom Background & objectives: Although fat embolism in the pulmonary or systemic circulation is usually seen after long bone fractures, it may occur during procedures like liposuction, fat grafting, and joint repair. We aimed to present cases of macro fat embolism that resulted in sudden death. Methods: Among the cases that underwent medicolegal autopsies, three cases with a history of sudden death due to macro fat embolism during the perioperative period were identified and included in the study. The demographical characteristics, surgical operation types and histories, autopsy and histopathological findings of the cases were evaluated. Results: Case 1 is a 31-year-old male with a medical history of penile warts who underwent liposuction for gynecomastia and adi- pose tissue injection to the penis at a private aesthetic surgery clinic. The patient died suddenly following the surgery. The presence of fat globules was identified in the lumens of large and medium-sized ves- sels in the lungs in the postmortem histopathological examination. Case 2 is a 60-year-old female with a history of knee osteoarthritis who died suddenly while receiving a stem-cell injection obtained from abdominal adipose tissue at an orthopaedic clinic. Histopathologically, fat globules were observed in the lumens of medium-sized vessels in the lungs. Conclusion: Case 3 is a 31-year-old female who was admitted to a private aesthetic surgery clinic for abdominal liposuction and died suddenly during the procedure. Fat globules were detected in the medium-sized vessel lumens in the lungs. Grade 4 fat embolism was observed in the capillaries, which stained positively with Oil-Red-O in all cases. Fat embolism syndrome is a rare but life-threatening condition that should be considered in patients with respiratory dis- tress and impaired neurological status in the postoperative period of these procedures. E-PS-01-015 Autoptic demonstration of clinically undiagnosed diseases: fre- quency and association with risk factors in a retrospective study on 648 autopsies U. Maccio*, M. Reinehr, H. Moch, Z. Varga *Universitätsspital Zürich, Institut für Pathologie, Switzerland Background & objectives: Clinically undiagnosed diseases (because not investigated or missed), are often disclosed at autopsy. However, few studies have investigated their frequency and no study examined their association with the most common risk factors (increased age, hypertension, smoking, alcohol abuse, etc.). Methods: Using our electronic report system, we conducted a retro- spective study on all complete adult autopsies performed in our insti- tution in a range of time of three years. We compared clinical and autoptic reports to verify which disorders, demonstrated at autopsy, were clinically undiagnosed. Thus, the correlation of their presence with the most common risk factors was analysed. Results: 648 autopsies were selected. 633 (98%) revealed at least one clinically undiagnosed finding (mode 3, range 1 – 8). Most common non-tumoral entities were bronchopneumonia (31%), coronary artery disease (CAD, 24%) and acute or subacute myocardial ischemia (15%). Most common malignant tumours were prostate cancer in men (3.4%), followed by kidney cancer (1.5%), GIST (gastrointestinal stromal tumour, 1.5%) and lung carcinoma (1.4%) in both sexes. Increased age, hypertension, chronic kidney disease (CKD) increased the probability of finding clinically undiagnosed diseases at autopsy. Hypertension was associated with autopsy-discovered amyloidosis, smoking with coronary artery disease (CAD), alcohol with undiag- nosed liver cirrhosis, CKD with bronchopneumonia and amyloidosis, and age with bronchopneumonia and amyloidosis. Conclusion: Senile cardiac amyloidosis is clinically underdiagnosed. As the prevalence increases with age and the population demographic shifts toward the elderly, clinicians should be more aware of this dis- ease. Although some associations are well known (i.e., smoking-CAD), our study suggests that some entities (i.e., CAD and liver cirrhosis) are clinically still underdiagnosed though the known presence of a spe- cific risk factor. The association between hypertension and amyloidosis deserves further analyses. E-PS-01-016 Carcinoma of gallbladder with the stenosis of pylorus that imitates Krukenberg metastasis S. Nikolaienko*, O. Nikolaienko, M. Plodiienko, O. Orlov, S. Gychka *Bogomolets National Medical, Ukraine Background & objectives: Krukenberg tumour is a frequent clinical manifestation of gastric carcinoma. Clinical and CT signs of antral stenosis in combination with CT signs of neoplasia in ovaries may suggest of gastric carcinoma. We described same picture but connected to gallbladder carcinoma. Methods: Lifetime investigations included cytology and immuno- cytochemistry (CA125, CDX-2, PAX-8) of ascitic fluid, CT, gastric endoscopy with biopsy. Postmortem studies included light microscopy and immunohistochemistry (CK7, CA125, CDX-2, PAX-8, WT-1). Results: Cytology of ascitic fluid: IRSSFC – MAL-S. Immunocyto- chemistry: CDX-2+, CA125+, PAX-8-. Endoscopically and on gastric biopsy – no signs of gastric neoplasia. The autopsy revealed gallstone disease with the presence of several faceted large calculi in the gall- bladder, pronounced adhesion fibrosis of the subhepatic area with its spread to the pyloric part of the stomach causing its stenosis. Carcino- matosis of peritoneum, pleura, 8 cm mass in left ovary. On histology in gallbladder: adenocarcinoma with invasion into gastric wall. In ovary, peritoneum, pleura, lung a histologically similar tumour.