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Colorado Springs, CO, United States

Golardi N.,University of New Mexico | Sramek J.E.,University of New Mexico | Myers J.B.,Penrose St. Francis Hospital | Saffer H.,Analytic Pathology Medical Group | And 2 more authors.
Human Pathology | Year: 2014

Reactive bone marrow mast cells reliably lack the morphologic, immunophenotypic, and molecular features of systemic mastocytosis (SM). We report two unusual cases of acquired aplastic anemia (AA) in which multifocal aggregates of bone marrow mast cells fulfilled morphologic and immunophenotypic criteria for SM according to the World Health Organization 2008 classification. In the absence of clinical symptoms attributable to SM, the patients were treated with immunosuppressive therapy directed towards AA. Clinical follow-up and subsequent bone marrow examination revealed no evidence of overt SM in either patient. These cases represent, to our knowledge, the first reported instances in which criteria for SM have been fulfilled in the presence of AA. However, given the clinical courses followed by our patients, the incidental identification of mast cell lesions consistent with indolent SM may be of uncertain significance in the setting of AA. © 2014 Elsevier Inc. All rights reserved.

White J.K.,Penrose St. Francis Hospital | Carver J.,Denver Office of the Medical Examiner
American Journal of Forensic Medicine and Pathology | Year: 2012

Fractures of the laryngeal skeleton (hyoid bone and thyroid horns) are an important finding in a forensic autopsy because they are almost always caused by significant trauma and often are relevant in determining the cause and manner of death. In the forensic setting, these injuries are seen in some hangings and more frequently in manual strangulation. Less common mechanisms include direct blows, "choke holds," and hyperextension of the neck. We present a case of a 37-year-old woman who died of complications of acute ethanol intoxication. The case involves an incidental hyoid bone fracture unrelated to the cause of death as well as facial petechiae. After review of all of the medical records, autopsy findings and scene/police investigations-the key findings of facial petechial hemorrhages and hyoid bone fracture are best attributed to the mechanism of self-induced vomiting. This case emphasizes the importance of synthesizing autopsy findings with the patient's medical and social history to avoid unnecessary investigation or prosecution. This is the second known case of this novel mechanism of hyoid bone fracture in the medical literature and the first in the forensic literature. Copyright © 2012 by Lippincott Williams & Wilkins.

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