Because metaplastic carcinoma of the breast encompasses a great variety of histopathology, diagnostic challenges abound, especially within the realm of cytology. The authors compiled and studied an eight-case series comprised of metaplastic breast carcinomas and lesions initially suspicious cytologically for metaplastic carcinoma in order to assess the degree of cytologic-histologic correlation and to identify recurring problematic themes surrounding the cytology-based diagnosis of this neoplasm.The cytologic and histologic slides from eight cases suspicious for metaplastic breast carcinoma diagnosed by fine needle aspiration (FNA) were collected and analyzed through a seven-year retrospective search of case files at our institution. Based on cytologic characteristics, the cases were separated into three groups. Group 1 consisted of three cases presenting with poorly differentiated adenocarcinoma and squamoid components on FNA. Group 2 was composed of two cases that featured a monophasic, malignant ductal cell population on cytology, while the cytologic specimens for the third group of cases presented with a mesenchymal component with or without a malignant glandular constituent.Cytologic-histologic correlation was present in two of three cases demonstrating a mesenchymal component, and there was 100% sensitivity in the cytologic detection of those mesenchymal elements. However, in only one of three cases was there an accurate cytologic diagnosis of metaplastic carcinoma when squamoid changes were present on FNA. Both cases demonstrating only malignant glandular elements on cytologic specimens revealed an additional component of malignant squamous differentiation upon the examination of mastectomy-derived tissue.These results indicate that squamous-like changes identified on FNA should be interpreted with caution and that sampling error remains a problematic recurrence in cytology. Regardless, there appears to be promise concerning the accurate cytologic diagnosis of metaplastic carcinoma when the lesion is characterized by a mesenchymal component. A study implementing a larger case number is essential in determining the significance of these findings.

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Cocaine is associated with many health complications including gastrointestinal ischemia/infarction, and hemorrhage. The clinical medical literature describes such entities, but no case exists within the forensic literature describing life-threatening intraluminal gastrointestinal hemorrhage and sudden death associated with cocaine. A 48-year-old black man died suddenly in his home, with drug paraphernalia near the body. Further investigation revealed blood stains on upholstery, and a toilet filled with fresh blood. External examination of the body revealed fresh blood draining from the anus. Internal examination revealed a dusky portion of distal ileum filled with an abundance of fresh blood. Toxicology confirmed the suspicion of acute cocaine intoxication.Review of the clinical literature revealed several case reports describing an association between cocaine use and intestinal infarction, one with hemoperitoneum. Review of the forensic literature returned one case describing an association between cocaine toxicity and intestinal infarction, but without hemorrhage. To our knowledge, our case represents the first report in the forensic literature describing massive gastrointestinal hemorrhage associated with acute cocaine intoxication. It is important that the forensic pathologist recognize cocaine toxicity as a potential cause of gastrointestinal bleeding, especially in younger male decedents without significant comorbidities. Scene investigation may reveal useful clues pointing to this unusual etiology.

BackgroundPrimary mesothelioma of the pericardium comprises less than 1% of all mesothelioma cases. Its typical presentation is insidious, with nonspecific signs and symptoms, and usually results in heart failure due to cardiac tamponade, either by a serous effusion or by direct tumorous constriction of the heart. With the exception of several case reports, the outcome is uniformly fatal, and patients typically die within six months of diagnosis.Case presentationA 45-year-old African American female presented to the emergency department with several days of dizziness, difficulty walking, and low blood pressure. The patient suddenly suffered cardiac arrest, and her death was pronounced. The medical examiner assumed jurisdiction of the case due to the sudden death nature of the case without known medical history. At autopsy, a one-liter hemopericardium was present, and the pericardial sac was thick, granular and adhesed to the heart, suspicious for pericarditis. Microscopic examination of the pericardial tissue instead led to a diagnosis of primary pericardial mesothelioma.ConclusionOur case demonstrates a pericardial mesothelioma initially masquerading grossly as pericarditis. Microscopic examination of any grossly abnormal pericardial tissue therefore may be warranted so that a neoplastic disease process does not go undetected. Additionally, of the approximately 200 such tumors reported in the medical literature, a case demonstrating marked hemopericardium and resulting in sudden death has not been described until now.