ECP 2023 Abstracts

S151 Virchows Archiv (2023) 483 (Suppl 1):S1–S391 13 place of the neoplasia is indeterminate, it is important to make immu- nohistochemical. Thus, this study aims to show the relevance of immunohistochemical. Methods: Autopsy case study carried out through the analysis of medi- cal records, macroscopic examination of the organs and observation of histological slides of a female patient, 61 years old, found unconscious, dehydrated and with abdominal distension. She had episodes of vom- iting days before her death and arrived at the emergency room with irreversible cardiorespiratory arrest. Results: On examination, dark secretions were found in the mouth and nostrils, a distended abdomen with the presence of a suture in the lower left quadrant, oedema in the right leg, and a very thin aspect, in addition to the presence of pulmonary and cerebral oedema. In addi- tion, a poorly delimited tumour mass with an infiltrative aspect was found from the retroperitoneum to the left ovary and uterine body, the primary site not being evident. Thus, the macroscopic diagnosis of a wasting syndrome associated with malignant neoplasia was reg- istered as causa mortis. Therefore, immunohistochemistry would be important to detect where the neoplasm began, through biomarkers, leading to the consequences of wasting syndrome. On examination, dark secretions were found in the mouth and nostrils, a distended abdomen with the presence of a suture in the lower left quadrant, oedema in the right leg, and a very thin aspect, in addition to the presence of pulmonary and cerebral oedema. In addition, a poorly delimited tumour mass with an infiltrative aspect was found from the retroperitoneum to the left ovary and uterine body, the primary site not being evident. Thus, the macroscopic diagnosis of a wasting syndrome associated with malignant neoplasia was registered as causa mortis. Therefore, immunohistochemistry would be important to detect where the neoplasm began, through biomarkers, leading to the consequences of wasting syndrome. Conclusion: The primary diagnostic hypotheses raised were myo- cardial infarction, stroke or sepsis with an abdominal focus, mainly due to the patient’s presentation (irreversible cardiorespiratory arrest). However, a metastatic malignancy was found, that is, an undetected insidious disease resulting in wasting syndrome. Therefore, the impor- tance of anatomopathological and immunohistochemical analysis is highlighted in the discovery of the local origin of the tumour and in the effective elucidation of the cause of death of each patient. E-PS-01-020 Infectious complications in a large series of patients with cirrhosis: retrospective study of 386 cases (2016-2023) J.P. Olano* *University of Texas Medical Branch, USA Background & objectives: Cirrhosis is a common disease world- wide. The most common etiologic factors are alcohol abuse, hepatitis C and NASH. Cirrhosis increases the risk of infections. This study analyses a cohort of cirrhotic patients with infections leading to the their demise. Methods: Retrospective review of 386 cases of cirrhosis from 2016- 2023. Complete autopsies were performed on all cases and data was collected regarding cirrhosis aetiology and infectious disease complica- tions including their etiologic agent. Only cases where the infectious disease complication was directly related to the cause of death were included. All autopsies included histologic, microbiologic (pre- or post- mortem) and toxicological analysis. Results: 135 (35%) patients died of infectious disease complications. Hepatitis C was the main aetiology (85.9%) followed by alcohol abuse (7.4%) and both Hepatitis C and alcohol (8.1%). Bacterial broncho- pneumonia was the cause of death in 34.8% of cases, followed by cellulitis with septicaemia (14.8%), spontaneous bacterial peritonitis (SBP) with septicaemia (13.3%), bronchopneumonia with septicaemia (9.6%), pyelonephritis (3.7%), infectious endocarditis (3%), septicae- mia diagnosed by pre-mortem blood cultures with no evident focus of infection (3%) and phlegmonous colitis (2.2%). The infectious aetiol- ogy was as follows: Staphylococcus aureus (15.5%), Klebsiella and Streptococcus spp. (8.1%), Candida spp. (5.2%), Enterococcus spp. (4.4%) and others (14 different bacteria; 14.8%). No etiologic agent was identified in 46.7%. Conclusion: Infectious disease complications represent an impor- tant cause of death in patients with cirrhosis. Our cohort is mostly comprised of inmates, hence the high percentage of cirrhosis due to Hepatitis C. A significant percentage of patients died of infectious complications in whom no etiologic agent was identified. The diag- nosis was made histologically and most of them were acute bacterial bronchopneumonias. Cellulitis and SBP were always associated with septicaemia. Cases of sepsis diagnosed by pre-mortem culture were due to unusual bacterial pathogens. E-PS-01-021 The role of foetal autopsy in understanding the causes of intrau- terine death: an interesting illustrative case A. Raicea*, S. Emoke-Andrea, L. Chinezu *Pathology Department of Mures County Clinical Hospital, Romania Background & objectives: Foetal autopsy plays an important role in defining the final diagnosis. The aim was to analyse the extent to which the foetal autopsy and placental examination can provide information to identify the foetal main cause of death. Methods: A histopathologic examination of a second-trimester still- born foetus, its placenta, and umbilical cord was performed at Targu Mures Institute of Forensic Medicine, Romania. Results: Gross examination of foetus and umbilical cord was non- specific. Macroscopic examination of placenta revealed fibrinous foci. Microscopically, the examined placental tissue had the characteristic appearance of a second trimester of pregnancy placenta, presenting with abundant mixed inflammatory infiltrate (more than 10-20 neu- trophils per cluster) in the chorion and amnion, with many neutrophils into decidual tissue and intervillous space setting the diagnosis of acute chorioamnionitis associated with acute deciduitis and intervillositis. At the level of the umbilical cord, both umbilical arteries were involved by the inflammation with confluent collections of neutrophils, that extended out into Wharton’s jelly, setting the diagnosis of arteritis and funisitis. Conclusion: The final diagnosis of the placenta was acute chorioam- nionitis, maternal stage 2, grade 2 associated with deciduitis and inter- villositis, with foetal vascular involvement, foetal stage 2, grade 2. The feto-placental infection remains a major relevant condition associated to stillbirth, especially in early gestational age. E-PS-01-022 Case report: CD74-ROS1 translocation lung adenocarcinoma treated by ALK inhibitors P. Suhaj*, E. Parobkova, T. Olejar, R. Matej *Thomayer University Hospital, Czech Republic Background & objectives: 55 years old female, non-smoker, was diagnosed with ROS1 positive generalized pulmonary adenocarcinoma (T3N3M1c). Treatment with ALK inhibitors resulted in CT regression and stabilization of disease for 1.5 years. We performed autopsy and NGS analysis to explain the patient’s demise. Methods: Modified Letulle’s autoptic technique and serial section- ing of heart and lungs were used. Findings were compared with radiographic studies. FFPE blocks of archival bioptic and necroptic material were used for further analysis. We used antibodies against PDL-1 (22C3 pharmDx), ALK and ROS1.