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                                                               OP 1
                                        A Case Study Of Bacillary Angiomatosis

H Pieters1, N Muller1, AC van Wyk2, JW Schneider2
Division of Anatomical Pathology, NHLS Tygerberg 1, Division of Anatomical Pathology, NHLS and University of Stellenbosch2

INTRODUCTION: Bacillary Angiomatosis was first reported in 1983 in a patient who developed disseminated subcutaneous
nodules that resolved completely after treatment with erythromycin. Bacillary Angiomatosis was first seen in HIV positive patients
but is also seen in transplant patients on immunosuppressive therapy. Bacillary Angiomatosis resembles Kaposi sarcoma, but can
be treated with antibiotics.
METHODS: A skin biopsy, fixed in 10% formalin was sent for histology and delivered features suggestive but not diagnostic of
bacillary angiomatosis. A skin biopsy fixed in 3% gluteraldehyde was sent for electron microscopy. Tissue was post fixed in 3%
Osmium tetroxide, processed by normal standard procedure with a Leica tissue processor and imbedded into Spurr's resin.
Toluidine blue sections were cut on a Leica EM ultratome. Selected sections were re-cut and placed on 200 mesh copper grids.
Sections were stained with Uranyl nitrate and lead citrate and studied under a JOEL JEM1011 electron microscope.
RESULTS: Electron Microscopy showed the presence of clusters of small bacilli and cocci in the cytoplasm of the cells.
CONCLUSION: Electron microscopy is a useful tool when making a positive diagnosis of Bacillary Angiomatosis.

                 A Novel Proteomics Assay Using Formalin Fixed Paraffin Embedded Tissue

Richard Naidoo1, Anushka Moothoo-Padayachie2, Micheal Locketz1, Patrick Govender 2, Dhiren Govender1
University of Cape Town/NHLS, Cape Town1, UKZN, Durban2

Backbround: The aim of this study was to investigate a novel proteomics method to investigate the protein profile in a cohort of
gastric carcinomas.
Methods: Novel molecular technologies have had a major influence in both research and diagnostic medicine. This paper
addresses the use of a protein isolation method using proteomics technology as a means of identifying potential biomarkers. A
cohort of formalin fixed paraffin embedded gastric carcinomas and corresponding normal tissue were used in this study (N=10:
Pilot study). Sections (5um) were cut, de-waxed and hydrated. Normal and tumour tissue was scraped and subjected to
ethanol/formic acid extraction procedure. The protein extracts were analysed using MALDI-TOF/MS and the mass spectra
generated was evaluated by Principle Component Analysis (PCA). PCA was performed using the ClinproTools software for
biomarker detection and evaluation.
Results: Our preliminary findings show significant differences in the MALDI-TOF/MS mass spectra between the normal and
corresponding tumour samples.
Conclusions: Proteins can be isolated from formalin fixed paraffin embedded tissue using the methods adopted. Although the
procedure requires further optimisation there are obvious differences in the protein profiles seen between the tumour and
corresponding normal tissue. This data will be further analysed for the identification for potential biomarkers after correlating the
clinical and pathological data.

                                                               OP 3
 Transmissin Electron microscopy, an important tool for diagnosis of various nonneoplastic diseases

V. Necsulescu
SMLTSA, Bloemfontein

Background: The Transmission Electron Microscope (TEM) is a powerful and essential tool in modern histopathology diagnosis
and is called “The Big Eye” of the 21st century. The EM can provide the answer in the diagnosis of those neoplastic and non
neoplastic tumours or diseases that defy histological or immunohistological classification. This presentation is a review of the
most interesting cases of TEM diagnosis of non neoplastic human diseases encountered in our laboratory.
Objectives: To review the characteristics of the cases of non neoplastic diseases and to acknowledge the importance of
transmission electron microscopy in diagnosis of these diseases.
Material and methods: The material used for this presentation are section prepared for TEM from the following tissues: kidney
biopsies for renal diseases, endomyocardium in monitoring cardiac transplant for cardiopathies, myocarditis, skeletal muscle for
myopathies, peripheral nerves for neuropathies, blistering skin for Epidermolysis Bullosa, different tissues for storage diseases,
viral diseases and ciliary dysmorphology. The structures examined with TEM are: cell membrane (basal lamina, immune complex
deposits, intercellular junctions, cilia, microvili), cytoplasmatic content (organelles patterns, nuclear and nucleolar morphology,
granules, filaments, vacuoles, vesicles, specific structures, extra cellular material (collagen, amyloid) and topographic cellular
                                                                                                                                              Pa t h o l o g y
Results and Conclusions: TEM may provide either an answer outright (including answers to questions not asked) or important
clues that guide further workup and narrow the range of diagnostic possibilities. The TEM is more economical than
immunohistochemistry and a very small amount of tissue is necessary. It supports or confirms immunohistochemistry tests.
There are no false results and is fairly fast (in 2-3 days there is a result). TEM remains a useful diagnostic tool with a sure future, due
to the capability to analyse and evaluate critical details in the specimens at ultrastructural level. In addition, the technology of TEM is
advancing fast. The instruments commercially available in this stage have a resolution that resolves individual atoms in many
materials. The development of new technologies like 3DNanoCharacterisation, 3D Nanoprototyping and In Situ NanoProcess make
the TEM and SEM useful machines in better understanding many chemical and physical phenomena, but require collaboration
across traditionally separate fields of knowledge.

                                                                  OP 4
              Clinical utility of transcriptional profiling in South African breast cancer patients

Kathleen Grant1, Justus Apffelstaedt2, Maritha Kotze2, Colleen Wright2
Lecturer CPUT (PhD student, US), Cape Town1, University of Stellenbosch2

Background: Application of microarray technology confirmed the concept that breast cancer is a heterogeneous disease
comprising several histological types that have distinct biological features and clinical behaviour. Due to the relatively high cost of
microarray tests, appropriate patient selection for genetic testing has become an important consideration in clinical service
delivery. The aim was to assess how transcriptional profiling of breast carcinoma may facilitate improved risk stratification for
chemotherapy selection in the South African context.
Subjects and Methods: The commercially available 70-gene MammaPrint® test was applied in 30 breast cancer patients referred
for transcriptional profiling by private practicing clinicians, after providing informed consent for genetic testing. Clinical,
pathological and genetic information of selected patients that become available within the framework of routine patient care were
made available for this study, which includes both a service and research component. This approach involves utilisation of the
online GknowmixTMSoftware, which incorporates clinical, pathological and genetic information into a single test application.
Results: Based on clinical experience in South African breast cancer patients, the selection criteria used for MammaPrint® has
been redefined. The test is only performed on hormone-positive tumours, in contrast with the international criteria that also accept
inclusion of triple-negative cancers for transcriptional profiling. The clinical utility of this approach was assessed on an individual
basis in each patient who provided full informed consent for follow-up studies, after introduction of the South African criteria for
MammaPrint®. A case study is presented to demonstrate the clinical usefulness of MammaPrint® in a patient with bilateral breast
tumours, both of which were classified as low risk using transcriptional profiling. Assessment of the genetic test results as part of
the overall risk profile assisted in the clinical decision-making process and chemotherapy could be avoided.
Conclusions: Improvement of the risk-benefit ratio using a pathology supported genetic testing approach prevented inappropriate
genetic testing. The clinical utility of MammaPrint® in breast cancer patients with oestrogen receptor-positive (ER+),
progesterone receptor-positive (PR+) and human epidermal growth factor receptor 2-positive (HER2+) tumours could be
confirmed in South African breast cancer patients.
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                                                              PP 1
                Hydatid Cysts: Retrospective Study Of 24 Years At The Region Of Mthatha

A de Beer, N Paton, M Garcia-Jardon, E Blanco-Blanco
Department of Anatomical Pathology, Nelson Mandela Academic Hospital, Mthatha, South Africa, National Health
Laboratory Services

Background: Echinococcus granulosus is one of the common aetiologies of cystic lesions examined in the Antatomical
Pathology department. The resulting lesion, known as hydatid cyst, has been described in almost all anatomical locations. We
have noticed an increased incidence of this condition over the past few years; hence, we decided to carry out the study to further
enquire on the epidemiological and clinical findings.
Methods: We carried out a retrospective study from 1987 to 2010. The study was based on the South African population of the
former Transkei attending the Mthatha Academic Hospital Complex in the Eastern Cape. The Anatomical Pathology department
record books were revised and all hydatid cysts in the study period included. Retrieved info included: age, sex and anatomical
Results: A total of 84 cases were found, of which 65 % were female (n=55). Pediatric patients, younger than 14 years
contributed to 44 % of the total (n=37). The most common location of the cysts was lung (40%), followed by liver with 21 cases
(25%) and 16 in the abdominal cavity (19%). Three patients presented with cysts of the eye (3.6%) and two were in the brain
(2.4%). In children, cysts were more often reported in the liver (n=12). Eleven presented in the lung (29.7%) and 8 in the
abdominal cavity (21.6%). A variety of other locations was also involved but the frequency of each was only a single case out of
the total. Majority of the cases (65%) occurred in the ages from 0 to 30 years whilst the frequencies continue to decrease with
increase in age.
Conclusion: The occurrence of hydatid cysts in our setting has increased in the last 10 years. It is more frequent in females and
the more common locations are lung and liver.

                                                              PP 2
                               Candida infection in oral lesions of Kaposi Sarcoma

Arshaad Sibda, Shabnum Meer, Mario Altini
Division of Oral Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg

Background: Oral candidiasis is the most common infection of the oral mucosa of HIV-seropositive patients, although its
frequency is rapidly decreasing with the advent of highly active antiretroviral therapy (HAART). Many questions regarding its
complex pathogenesis remain unanswered. The diagnosis is usually established with non-invasive techniques such as mucosal
smears. Oral lesions of HIV-associated Kaposi sarcoma (HIV-KS) are routinely biopsied and frequently show secondary
infection with Candida albicans or other Candida species. The aim of this investigation was to determine the frequency and
histomorphology of secondary Candidal infection of the surface epithelium of oral HIV-associated KS lesions (HIV-KS), which
are routinely biopsied in HIV infected patients.
Methods: Haematoxylin and eosin (HE), and Periodic Acid-Schiff (PAS) stains of 133 cases of oral Kaposi sarcoma diagnosed
between the period 2003 and 2007 within the Division of Oral Pathology were examined histologically for intensity and
morphology of Candidal colonisation, depth of invasion, number of organisms, epithelial reactions and associated inflammatory
response. The depth of Candidal invasion and severity of infection were correlated with the available CD4 T cell counts of HIV
seropositive patients at the time of biopsy.
Results: Almost forty one percent (40.62%) of all oral HIV-KS cases were secondarily infected with Candida species. The
intensity varied from an isolated single pseudohyphus to matted colonies of vegetative yeasts and pseudohyphae. Whilst in
most cases the organisms did not invade beyond the parakeratin layer, pseudohyphae were noted extending into the stratum
spinosum in 2 cases, and a single case showed a pseudohyphus within the lamina propria. A further 2 cases showed
pseudohyphae growing in the pyogenic membrane. Neutrophilic permeation of the epithelium and Munro micro-abscess
formation, features commonly associated with Candidal infection, were frequently present even in the absence of Candidal
infection. Candidal organisms were often present in the absence of inflammation.
Conclusion: Oral lesions of HIV-KS are commonly secondarily infected with large numbers of Candidal organisms. The
morphological characteristics of secondary Candidal infection within the surface epithelium of HIV-KS lesions suggest an
altered pathogenetic pathway. Further studies are necessary in this regard.
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                                                                PP 3
     Dendritic cells at the oral mucosal interface in oral Kaposi sarcoma with concomitant Candida

Vibha Jivan, Shabnum Meer, Tsholofelo Kungoane, Mario Altini
Division of Oral Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg

Background: A concurrent study in our division has shown that 40% of oral Kaposi sarcoma is co-infected with Candida albicans
or other species. The intensity and depth of invasion varied in each case with hyphae present in the stratum spinosum, pyogenic
membrane and even in the lamina propria. The pattern and intensity of Candidal growth was quite different to that of
immunocompetant persons. This study aimed to determine whether this altered pattern could be ascribed to differences in the
presence of dendritic cells at the oral mucosal interface.
Methods: 5µ sections from 10 cases each of palatal Kaposi sarcoma co-infected with Candida (KSC), palatal Kaposi sarcoma not
co- infected with Candida (KS), pleomorphic adenoma (PA) surfaced by palatal mucosa and fibrous epulides (FE) surfaced by
maxillary buccal gingival were immunohistochemically stained with CD1a (Dako, Glostrup, Denmark) using the standard strep-
avidin-biotin technique. KS and KSC lesions were HIV associated while the latter were not. Positively stained dendritic cells were
counted along 5 standard ruler lengths of basement membrane in each case with the examiner being blinded to the diagnosis. A
sample of sections was recounted immediately and later by the same and different examiner to establish reliability and
reproducibility of data. Only cells with dendritic processes were included. The data was statistically analysed and compared
(p <- 5%).
Results: The highest number of cells per unit length was found in oral mucosa surfacing pleomorphic adenomas (mean 106.73; sd
50.88), with the lowest numbers in surface epithelium of KS co-infected with Candida (mean 21.08; sd 26.32). The difference in
numbers of positive dendritic cells in the mucosa overlying the various lesions was significant: PA and KS (p < 0.01) and KSC (p <
0.0001). Values for KS were significantly higher than those of KSC (p < 0.01) and PA, which were significantly higher than FE
values (p < 0.05).
Conclusion: Oral mucosa interface in KSC contained significantly fewer dendritic cells than either KS or both the controls, PA and
FE. This decrease in immunocompetant cells allows opportunistic fungal organism such as Candida to penetrate deeper, to grow in
unusual locations and to grow in significantly larger numbers than in tissue with normal numbers of immunocompetant dendritic

                                                                PP 4
     Low viral load in HIV infected children: a possible risk factor in parotid lymphoid proliferation

Tsholofelo Kungoane, Shabnum Meer, Mario Altini
Division of Oral Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg

Background: HIV associated parotid lymphoid proliferations in children are not well documented, with most studies concentrating
on the adult population. Despite the advent of HAART, the frequency of these lesions seems to be increasing rapidly. This study
aimed to document the clinical presentation of the disease, risk factors associated with its development and response to
antiretroviral treatment in children.
Methods: The study was conducted at 2 HIV and AIDS treatment and wellness facilities located in the Tshwane region in Gauteng,
South Africa over a 6 month period on HIV infected children attending the clinics as outpatients. The participants in the study which
included children with parotid swellings (Group 1) and those without (Group 2) were examined and their clinical records scrutinised.
Results: Seventy-one HIV positive children between 2 to 14 years, were included; 47 with parotid swellings (Group 1) and 24
without swellings (Group 2). The only significant difference between the 2 groups was that the children in Group 1 had a
significantly lower viral load on presentation (p = 0.02). Of the 26 children in Group 1 that were receiving HAART, 19 reported a
reduction in size of the parotid enlargement, 6 reported no change and only 1 developed the parotid lesion after 11 months of
Conclusion: Children with lower viral loads showed an increased risk of developing parotid lymphoid proliferation. No other
differences between the study group and the control group were noted. The parotid lesions responded well to HAART but the
swellings did not completely resolve. Larger studies are needed to confirm the hypothesis that lower viral load is a major risk factor
for the development of the parotid lymphoid proliferation.
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                                                                PP 5
                            Cystic lymphoid hyperplasia: a clinico-pathological survey

Shailen Dulabh , Shabnum Meer
Division of Oral Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg

Background: Cystic lymphoid hyperplasia (CLH) is a common yet under recognised entity affecting the parotid gland in HIV
infected patients. This is the largest global clinico-pathological study of CLH to date consisting of 167 cases (85M, 82F). This
study aimed to define the clinical parameters, histology and immunopathological features of CLH with a view to elucidating the
Methods: This retrospective study on archival cases of CLH included an analysis of age, race, gender, nature of CLH, HIV status,
CD4 count and viral load where available. 109 cases were histologically reviewed and 25 cases immunohistochemically analysed
with CD3, CD20, CD4, CD8 and p24 using standard procedures. Ethics clearance for the study was granted (M080927;
Results: CLH occurred mainly in the parotid gland of HIV positive males. Submandibular gland (p = 0.27) and bilateral parotid
involvement occurred more in females (2:1). CLH involvement of both the parotid and submandibular glands affected females at a
younger mean age (36.5, 31 years respectively) compared to males (40.9, 42.4 years respectively) (p = 0.0032). Origin within
lymph nodes is favoured over salivary gland origin with 76.1% of cases of CLH arising within entrapped salivary gland remnants in
lymph nodes. Immunostaining with the HIV antibody, P24, showed 90% specificity in HIV associated CLH. 90% of CLH cases
maintained a CD8:CD4 ratio of 1:1 with only exceptional cases showing decreased CD4 immunopositivity in the interfollicular
Conclusion: CLH is the preferred term to describe bilateral parotid enlargement in HIV infected patients characterised by multifocal
benign lymphoepithelial cysts and HIV-induced atypical lymphoid hyperplasia. Origin of CLH following ductal ectasia of entrapped
salivary gland inclusions within atypical lymphoid hyperplasia arising within lymph nodes in the context of an HIV setting is strongly
favoured. CLH should be included in the classification of orofacial lesions strongly associated with HIV and AIDS.

                                                                PP 6
                          Classical Herpes simplex encephalitis an autopsy case report.

FCJ Botha1, Prof. R Hewlett2, Prof. HC Wainwright1
Division of Anatomical Pathology, Groote Schuur Hospital, National Health Labororaty Service and University of Cape Town,
Cape Town1, Department of Forensic Medicine and Toxicology, University of Cape Town, Cape Town2

Background: Acute necrotising encephalitis caused by Herpes simplex virus has an estimated incidence of 1 in 250 000-500 000
immunocompetent persons per year and occurs in 5-10% of patients with generalised Herpes simplex infection. The annual
incidence of Herpes simplex encephalitis within the Groote Schuur Hospital referral network is estimated to be 3-10 cases per year.
We present an autopsy case of a 51 year old HIV negative adult male with background history of heavy alcohol use and poor
nutritional state, who presented with acute onset convulsions and over a 5 week interval developed classical Herpes simplex
encephalitis in the chronic-regressive stage. PCR performed on the CSF isolated HSV-1 & 2 DNA. Brain MR-imaging showed
cavitation and haemorrhagic liquefactive infarction of the left anterior temporal lobe. He died as a result of complicated aspiration
pneumonia and an acute myocardial infarction after a protracted ICU stay.
Methods: The brain was removed from the skull during post-mortem examination and suspended for six weeks in an adequate
volume of 10% buffered formalin. Thereafter, a formal brain dissection, macroscopic examination and axial sectioning, for
correlation with corresponding MRI-images, were performed. Appropriate tissue for histological analysis was sampled. The
tissue was paraffin embedded and the slides were processed for routine H&E staining and examined using light microscopy.
Additional immunohistochemical staining for HSV-1 antigen detection was performed.
Results: Macroscopic: The base of left temporal lobe was covered with a yellow exudate. Haemorrhagic necrosis and cavitation
of the anterior and inferior left temporal lobe was noted. The right temporal lobe showed pigmented atrophy. There was atrophy of
the frontal cortex. Atrophy of the insular cortex was more pronounced on the right side than the left. A small hippocampus was
noted. Dilatation of the anterolateral horn of the right ventricle was noted. There was no evidence of disseminated Herpes simplex
infection in other organs, mucosal surfaces or the skin. Microscopic:
Cavitated glial scar tissue was noted with clusters of lymphocytes in the brain parenchyma. Sparse perivascular aggregates of
lymphocytes were seen. Immunoreactivity for HSV-1 was negative.
Conclusion: This case report demonstrates features of classical Herpes simplex encephalitis in the chronic-regressive phase, an
uncommon entity in our setting. No systemic or skin dissemination of Herpes simplex was observed as would be expected in an
immunosuppressed state. Negative immunoreactivity for HSV-1 is commonly found in the chronic-regressive phase of herpes
simplex encephalitis. Correlation of radiological imaging with autopsy findings is essential to improve reporting accuracy. With
the current declining autopsy rate, it is unusual to have an opportunity to gather teaching material of this rare entity. This material
will be made available for scholarly research on the Stuart Rutherfoord database.
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                                                               PP 7
         Sporadic Kaposis sarcoma of caecal appendix presented as an incidentaloma in a non-
                               immunesuppressed child: Case Report.

Mirta Garcia Jardon1, E. Blanco-Blanco2, M. Larrea-Fabra3
Walter Sisulu University/NHLS1, NHLS/WSU, Mthatha2, WSU, Mthatha3

Backround: Kaposi's sarcoma is commonly found, nowadays, in association with the HIV/AIDS epidemic. It is commonly found in
skin, oral mucosa, conjunctiva, etc. Sporadic cases, non-HIV related have been reported. Those are less common, though.
Methods: This paper is a case report, presenting a Kaposi's sarcoma incidentally found in a 10 year old boy with clinic diagnosis of
acute appendicitis. The appendectomy was performed and the specimen was sent to our department for diagnosis. The HIV
status of the patient is unknown.
Results: No signs of inflammation were found in the appendix. One area showed replacement of some lymph follicles of
submucosa by fascicles of slender cells resembling features of Kaposi's sarcoma. The HV8 immuneperoxidase stain was found to
be positive in the mentioned area.
Conclusion: The case was concluded as sporadic Kaposi's sarcoma of caecal appendix, since no features of immunosuppression
were presented in the patient.

                                                               PP 8
  Moderately differentiated neuroendocrine carcinoma (atypical carcinoid tumour) of the sinonasal

Farzana Mahomed, Shabnum Meer, Mario Altini
Division of Oral Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg

Background: Primary neuroendocrine carcinomas occur infrequently in the head and neck region, where the larynx is the most
common site of occurrence followed by the salivary glands. Small cell carcinoma is the most common subtype while well-
differentiated (typical carcinoid) and moderately differentiated (atypical carcinoid) neuroendocrine carcinomas are extremely
uncommon at this site, with only sporadic cases reported in the literature.
Methods: We report a case of primary atypical carcinoid tumour with oncocytoid appearance involving the maxillary sinus.
Results: The tumour occurred in a 65-year-old female patient who presented with right nasal obstruction. The patient was treated
with surgery and radiotherapy. No recurrence or metastasis occurred within the 4-years after diagnosis. Histological examination
and immunohistochemical staining for cytokeratin (MNF-116), synaptophysin, chromogranin-A and neuron specific enolase
revealed neuroendocrine differentiation in the tumour. Electron microscopic examination confirmed the presence of dense core
granules within the cytoplasm of the tumour cells. Ultrastructural features also demonstrated numerous mitochondria that
accounted for the oncocytic change seen on light microscopy.
Conclusion: The relatively favourable clinical outcome observed in this case suggests that the presence of oncocytoid change
does not portend biological aggression in this tumour.
                                                               PP 9
   Calcifying epithelial odontogenic tumour: light microscopic and ultrastructural observations on a

Farzana Mahomed1, Shabnum Meer2
Division of Oral Pathology, Faculty of Health Sciences, University of the Witwatersrand1

Background: The calcifying epithelial odontogenic tumour (CEOT) is a rare odontogenic benign tumour, occasionally invasive,
which produces a homogeneous, eosinophilic, pale-staining amyloid-like material which may become calcified. Several
histological variants have been described, including CEOT with Langerhans cells, with cementum-like and bone-like material,
combined epithelial odontogenic tumour and adenomatoid odontogenic tumour, myoepithelial cells and the clear cell variant of
Methods: A case of CEOT located in the body of the mandible of a 58-year-old woman and presenting as a painless swelling of the
jaw was studied.
Results: Microscopically, the tumour was composed of both clear cells and polyhedral cells with eosinophilic cytoplasm. There
were frequent homogenous masses within the tumour cell sheets. The clear epithelial cells exhibited granules that were positive for
periodic acid-Schiff and negative for mucicarmine staining. The intercellular homogenous masses stained with Congo red and
showed a green birefringence under polarised light. Polyhedral and clear epithelial cells were immunopositive for AE1/AE3 and p63
but negative for CK7, CK20 and S-100. Ultrastructurally, the clear cells showed abundant glycogen granules and a paucity of
organelles in the cytoplasm.
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Conclusion: Although most clear cell variants of CEOT can be distinguished from other clear cell tumours in the oral and
maxillofacial region on routine histology; histochemical, immunohistochemical and ultrastructural examinations are useful for
providing a definitive diagnosis.

                                                                PP 10
            Peripheral odontogenic myxoma: A review of the literature and report of two cases

SP Ngwenya, EJ Raubenheimer, CEE Noffke, NJ Chabikuli, MMR Bouckaert
University of Limpopo - Medunsa Campus, Pretoria

Background: Odontogenic myxoma (OM) is an infiltrative benign neoplasm unique to the tooth bearing areas of the jaw bones. It is
believed to be derived from odontogenic ectomesenchyme and consists of round and angular cells embedded in a mucoid stroma.
Peripheral odontogenic myxoma (POM) occurs exclusively in gingival soft tissue and is rare with less than five cases reported in the
literature. The purpose of this study was to analyse peripheral odontogenic myxomas (POMs) in a sample of OMs reported at
Medunsa Oral Health Centre.
Methods: The records of 52 cases of OM diagnosed over a period of 23 years were retrieved from the archives of the Department of
Oral Pathology at the University of Limpopo. OMs with a verifiable location in the soft tissue without bone involvement were
retrieved, analysed and compared with similar lesions reported in literature.
Results: 30 of the 52 cases of OM retrieved were centrally located and were reported in 2007. Among the 22 cases excluded from
that sample were two cases of histologically verifiable POM. The first case is a 53 year old female who presented with a large
tumour protruding from the oral cavity and extending beyond the lower lip. The second case is a 38 year old female who presented
with a large tumour protruding from the mouth with the lower lip stretched around it.
Conclusions: This study showed that the two peripheral OMs retrieved from the sample form a distinct clinical entity with a
potential to grow into large disfiguring lesions. Despite their large size, no bony infiltration was present. The probability that small
POMs are interpreted as irritation fibromas may contribute to the small number of POMs reported in literature.

                                                                PP 11
Odontogenic tumours manifesting in the first two decades of life in a rural African population sample:
                                A 26 year retrospective analysis

MMJ Mamabolo, CEE Noffke, EJ Raubenheimer
University of Limpopo, Medunsa Campus, Pretoria

Background: Odontogenic tumours are potentially disfiguring growths that impact on jaw and tooth development in patients in the
first two decades of life. The aim of this study was to determine the relative frequencies and clinicopathological features of
odontogenic tumours affecting the jaw bones of patients in the first two decades of life and of rural and peri urban African extract.
Methods: Files of patients younger than 20 years of age diagnosed over a period of 26 years with odontogenic tumours were
retrieved and analysed for gender, site, tumour size and radiographic appearance.
Results: 33% of odontogenic tumours diagnosed in the population sample presented during the first 2 decades of life.
Ameloblastoma was the most frequent benign tumour (43%) followed by keratocystic odontogenic tumours (19%) and
adenomatoid odontogenic tumours (10%). Four patients (1.6%) presented with ameloblastic carcinoma.
Conclusions: Due to the unique population demographics of South Africa, odontogenic tumours in the first two decades of life
comprise a larger percentage of the number of cases than in other communities. The frequency of the different odontogenic tumour
types generally follows the pattern of those reported in Africa, China and parts of South America. Radiographic examination is
indispensable in establishing an accurate diagnosis.

                                                                PP 12
               The distribution of collagen Types I-IV in benign tumours of odontogenic origin.

J Hangelbroek1, E J Raubenheimer2, SP Ngwenya2
University of Limpopo (Medunsa Campus), Pretoria1, University of Limpopo, Pretoria2

Background: Odontogenic tumours are characterised amongst others by their capacity to deposit basement membrane like
substance and varying amounts of dental hard tissues. Collagen is an important scaffold for these tissues. This study was directed
at illustrating the distribution of collagen types I – IV in different odontogenic tumours.
Methods: Archived wax blocks of 21 odontogenic tumours (ameloblastoma n= 3, Adenomatoid odontogenic tumour n=3,
Ameloblastic fibroma n=3, odontoma n=2, ameloblastic fibro odontoma n=2, ameloblastic fibro dentinoma n=2, odontogenic
myxoma n=3 and odontogenic fibroma n=3) were retrieved, sectioned and stained with H&E, Picrosirius, Reticulin, Masson
Trichrome and the immunoperoxidase technique for collagen type IV (Dako monoclonal anti-human collagen IV M0785).
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Results: Collagen type I was present in the capsule of all tumours and collagen type IV in the basement membrane of blood vessels.
Type III collagen fibres ran perpendicular through the epithelial basement membranes of ameloblastomas. The adenoid structures
of adenomatoid odontogenic tumours showed collagen types II and III in entangled masses. Thick anchoring fibres (collagen type
II) in the basement membranes of ameloblastic fibromas anastomosed with reticulin fibres that were found to be distributed around
stromal fibroblasts. Collagen type III fibrils were arranged in an obtuse relationship to the other fibres in the stroma. With the
induction of hard tissue deposition in ameloblastic fibro odontoma the spatial direction of the collagen changes towards a globular
arrangement. In odontogenic myxomas and odontogenic fibromas coarse type I collagen bundles were intersected at obtuse
angles by delicate type III fibres.
Conclusions: The distribution and typing of collagen fibres facilitate the microscopic differential diagnosis of odontogenic tumours
and serve to identify foci of stromal hard tissue deposition.

                                                               PP 13
Expression of p63, p504S and androgen receptors in salivary gland carcinomas a study of 32 cases.

RJ Vorster1, EJ Raubenheimer1, MMJ Mamabolo2
University of Limpopo, Medunsa Campus, Pretoria1, University of Limpopo, Pretoria2

Background: Immunostaining for p63, p504S and androgen receptor status are important diagnostic markers and prognostic
determinants for prostate carcinomas. Previous studies have identified a potential role for these markers in the diagnosis of other
malignancies, including those originating from salivary glands.
Methods: Wax blocks of 32 malignant salivary gland neoplasms were retrieved, four sections were prepared of each block and
stained with H&E and the immunoperoxidase technique for p63 (Dako N1604), p504S (Dako N1609) and androgen receptors
(Dako M3562) according to the instructions of the manufacturers. The sections were viewed with a light microscope.
Results: Table I: Number of malignant salivary gland neoplasms positive for p63, p504S and androgen receptors.
Type                                             number              P63                P504S              Androgen
Polymorphous low grade adenocarcinoma            7                   2                  0                  1
Adenoid cystic carcinoma                         5                   5                  0                  0
Salivary duct carcinoma                          5                   3                  3                  0
Mucoepidermoid carcinoma                         5                   5                  4                  0
Acinic cell adenocarcinoma                       3                   0                  2                  1
Epimyoepithelial carcinoma                       3                   2                  0                  0
Clear cell carcinoma                             2                   2                  1                  0
Adeno carcinoma                                  2                   1                  0                  0
Conclusions: This study showed a distinct pattern of staining by malignant salivary neoplasms for p63 and p504S. The role of
these markers as indicators of prognosis need to be further investigated.

                                                               PP 14
 Human Papillomavirus Infection Is Not Associated With Dysplasia And Squamous Carcinoma Of The
                    Conjunctiva In A Cohort Of Young Patients In South Africa.

Martin J Hale1, Sharlene Naidoo 2, Sibongile M Muthabeni2
Division of Anatomical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand,
Johannesburg1, NHLS, Johannesburg2

Background: Dysplasia of the conjunctiva and infiltrating squamous carcinoma are associated with long term exposure to
ultraviolet radiation. Typically, these changes are seen in older patients and in particular those who have lived for extended periods
of time in tropical regions of the world. Squamous carcinoma of the conjunctiva has been associated with human
immunodeficiency virus (HIV) infection and there is evidence that the expected demographic profile of patients with dysplasia and
squamous carcinoma of the conjunctiva is changing towards a younger patient, particularly in sub-Saharan Africa as a
consequence of the HIV pandemic. It has also been suggested that infection of the conjunctiva by human papillomavirus (HPV)
may be associated with dysplasia and subsequent squamous carcinoma, but there is conflicting evidence for this.
Methods: The archives of the Division of Anatomical Pathology at Chris Hani Baragwanath were searched for all conjunctival
biopsies in 2007 and 2008 showing dysplasia or squamous carcinoma. Patients 35 years or younger were identified and their
                                                                                                                                              Pa t h o l o g y
pathological changes stratified according to severity of dysplasia and invasive carcinoma. Evidence of possible HPV infection of
the conjunctiva was then sought in this cohort of young patients using the polymerase chain reaction to amplify the L1 region of the
HPV genome which yields a 150bp product usng the GP5+/GP6+ primers, which are generic to all HPV subtypes. PCR amplification
for HPV was also performed on conjunctival biopsies from 10 patients showing no evidence of dysplasia as a control group.
Results: A total of 418 patients with conjunctival biopsies were found, 116 being aged 35 years or younger. Of this group, 51
(44%) showed evidence of dysplasia or invasive carcinoma stratified as follows: 5 patients had mild dysplasia, 13 moderate
dysplasia, 26 severe dysplasia/carcinoma in situ and 7 invasive squamous carcinoma. Dysplastic changes were commoner in the
female gender, 34 (66%) as compared to the male, 17 (34%). There was no evidence of HPV infection in any of the 51 patients with
dysplasia or squamous carcinoma, or in the 10 patients without dysplasia.
Conclusion: There is evidence that increasing numbers of younger patients are presenting with conjunctival dysplasia and
squamous carcinoma of the conjunctiva in South Africa and that this is commoner in the female gender. Furthermore, there is no
evidence to support the notion that human papillomavirus virus plays an aetiological role in this disease in the region. This finding
does not exclude the possibility that HIV infection contributes to the neoplastic process either as a sole initiator or in association with
an as yet unidentified infectious agent.

                                                                  PP 15
                    Overexpression of HER2/neu in gastric cancer in South African patients

PJ Swart1, G Le Roux2, M Myburg2, CA Beukes2, J Goedhals2
University of the Witwatersrand, Johannesburg1, University of the Free State, Bloemfontein2

Background: Overexpression of HER2/neu is an independent prognostic factor in gastric carcinoma. Recent studies have shown
that Trastuzumab suppresses growth of human gastric cancer and this drug is beginning to be used in the treatment of this
malignancy. As it has not been previously investigated in the South African population, this study aims to evaluate the over
expression of HER2/neu in this group.
Design: 149 cases of gastric adenocarcinoma were retrieved from the departmental archives. The cases were sub-typed using
the Lauren-classification. The expression of HER2/neu was assessed utilising the scoring system used in the validation study by
Hoffmann et al. Cases that were awarded a HercepTest-score of 2+ were further analysed with bright field double in situ
hybridisation (BDISH) for amplification of the HER2/neu oncogene.
Results: 4% of cases demonstrated positive immunohistochemistry (IHC) for HER2/neu, 81% had negative HER2 IHC and 4%
demonstrated equivocal IHC. BDISH of the 6 equivocal cases revealed 2 of the cases to be negative for the over amplification of
HER2/neu, 3 were positive and 1 case remained equivocal. Following BDISH of the equivocal cases, the final scores were as
follows: 82% of cases were negative for the over amplification of HER2/neu, 17% of cases were positive and 1% were equivocal.
Intestinal-type adenocarcinoma was most likely to demonstrate over amplification of HER2/neu (24% of cases).
Conclusion: Studies have shown HER2/neu to be overexpressed in 7.1%-42.6% (median19.2%) of gastric cancer, with intestinal-
type adenocarcinoma most likely to demonstrate the overamplification. HER2/neu over expression in gastric cancer in South
African patients seems to follow a similar pattern to that seen in other countries.

                                                                  PP 16
                                      Bilateral Ocular Oncocytomas A Case Report

PJ Swanepoel1, DB Louw2
Ampath Laboratories, Nelspruit1, Private Ophthalmologist, Nelpruit2

Intoduction: The differential diagnosis of tumours of the eyelids and ocular adnexal structures includes epidermal lesions (such as
squamous cell papillomas, seborrheic- and actinic keratoses, keratoacanthomas, invasive squamous- and basal cell carcinomas,
and rarely Merkel cell carcinoma), melanocytic lesions (benign acquired and congenital naevi, other benign naevocellular
proliferations and malignant melanoma), and skin adnexal lesions (hidrocystoma most commonly, but also other glandular and
follicular lesions such as syringocystadenoma papilliferum, chondroid syringoma, sebaceous adenoma, trichoepithelioma,
trichofolliculoma, and pilomatrixoma). Skin adnexal carcinomas in this location are extremely rare. Xanthelasma is rarely biopsied,
but one may encounter other mesenchymal lesions, most commonly vascular proliferations (haemangioma, pyogenic granuloma
and Kaposi sarcoma) and rarely peripheral nerve sheath tumours such as neurofibroma, especially in the setting of
Neurofibromatosis type 1. The most common tumours of the lacrimal apparatus are benign mixed tumours (pleomorphic
adenomas) and adenoid cystic carcinomas; less commonly encountered lesions are oncocytoma, mucoepidermoid carcinoma,
                                                                                                                                         Pa t h o l o g y
squamous carcinoma and malignant lymphoma. Inflammatory and infections conditions may present as lumps or nodules,
notably chalazion, granuloma annulare, sarcoidosis and molluscum contagiosum.
Methods: We report the case of a 62 year old female patient who presented with two ocular lesions – firstly a smooth 9x5mm light
brown nodule on the lacrimal caruncle of the left eye, and secondly a 6x3mm skin-coloured nodule directly lateral to the punctum of
the right lower eyelid. Both lesions were clinically diagnosed as benign cysts, respectively of the conjunctiva and eyelid skin. Both
lesions were excised and submitted for routine histological examination.
Results: The lesions were histologically identical. Both tumours were partially cystic, with intracystic solid and papillary
components consisting of polyhedral oncocytic tumour cells with large volumes of granular bright eosinophilic cytoplasm and
round to oval-shaped nuclei. The nuclei were cytologically bland, mitotically inactive and contained small but inconspicuous
nucleoli. A small amount of blood and serous fluid was present in the cystic areas. The supporting stroma was mildly inflamed.
Conclusion: Oncocytic neoplasms of the eyelids and lacrimal apparatus are extremely rare with isolated case reports and small
series published in the English literature. These lesions typically occur in elderly women and present as small tan-coloured to red-
brown superficial nodules, most commonly located on the lacrimal caruncle; less commonly involving the conjunctiva,
peripunctum, lacrimal glands and -ductular system. It is believed that most ocular oncocytomas arise from oncocytic metaplasia
of ductal and acinar cells of lacrimal or salivary gland tissue located in the ocular adnexa. Malignant oncocytic lesions have been
described in the same anatomical distribution, recently in association with Neurofibromatosis. Histologically benign lesions
(oncocytic adenomas/oncocytomas) have been reported to behave aggressively if untreated, therefore complete surgical excision
is regarded as treatment of choice. The cytokeratin expression profile in oncocytic ocular tumours supports their origin from
lacrimal and accessory lacrimal glandular tissue, and similar to oncocytomas in other anatomical locations (salivary glands and
kidney) electron microscopic studies show that the cytoplasm of these tumour cells are densely packed with mitochondria with
irregular, whorled, or fragmented cristae. To our knowledge this is the first report of a case of bilateral or multicentric ocular

                                                               PP 17
                              Malignant mesenchymoma of the breast: a case report.

A. Czajkowski and Y. Reddy
Department of Anatomical Pathology, Wits University and NHLS, Johannesburg.

Malignant mesenchymomas are rare soft tissue tumours that are composed of two or more different types of malignant
mesenchymomal differentiation, in addition to any undifferentiated or fibrosarcomatous elements. These tumours predominantly
involve the retroperitoneum and soft tissues of the lower limb, however, thoracic localisation has been described involving the
heart, chest wall, lung and pleura. We hereby describe a case of a primary breast malignant mesenchymoma, showing
representation of pleomorphic liposarcoma and osteogenic sarcomatous components. The patient was a 37 year old Black female,
who presented to the Charlotte Maxeke Johannesburg Academic Hospital, with a large fungating mass replacing the entire left
breast. A left mastectomy was performed, and the specimen demonstrated the presence of a large fungating mass involving the
entire left breast and measuring approximately 160mm in maximal dimension, with areas of necrosis and haemorrhage. Multiple
histological sections from the tumour demonstrated a high grade spindle cell sarcoma with prominent pleomorphic
liposarcomatous elements as well as areas with osteogenic sarcoma differentiation. There was no evidence of a malignant
epithelial or myoepithelial component, and no features to suggest a malignant Phyllodes tumour. This case report describes the
relevant clinical presentation, macroscopic and histological findings of this rare tumour, and provides a brief literature overview of
primary malignant mesenchymomas, with specific reference to those primarily localised to the thoracic cavity and chest wall.

                                                               PP 18
        IgG4-related Sclerosing Pachymeningitis Case Report Of A Headache With A Difference.

PJ Swanepoel1, T Slavik2, P Scheepers3, H Neethling4
Ampath Laboratories, Nelspruit, South Africa1, Ampath Laboratories, Pretoria, South Africa2, Private maxillofacial surgeon,
Nelspruit, South Africa3, Private oncologist Nelspruit, South Africa4

Introduction: Aggressive tumours of the skull base and surrounding soft tissue are rare and have a wide differential diagnosis. A
significant degree of overlap exists in the radiological and microscopic features of these tumours, which include various sarcomas,
chordoma, meningeal tumours, lymphomas, central nervous system malignancies with skull involvement, oropharyngeal salivary
gland-type malignancies, nasopharyngeal carcinoma and metastases. Non-neoplastic mass-forming lesions, such as infectious
pseudotumours and idiopathic sclerosing/hypertrophic pachymeningitis, also deserve consideration. In many cases, the final
diagnosis requires clinical, radiological and microbiological correlation, combined with careful morphologic evaluation and
judicious use of immunohistochemical stains.
Method: We report a case of a 46 year old woman who presented with a contrast-enhancing mass lesion in the right sellar
region/cavernous sinus, with radiological features of a meningioma. Due to the inherent risks of performing biopsy or excision, the
                                                                                                                                          Pa t h o l o g y
lesion was irradiated. It recurred two years later, however, demonstrating prominent perineural growth, with extension through the
foramina ovale and –rotunda as well as the orbital apex, involvement of the pterygopalatine fossa, masticator space and orbit, with
resulting proptosis.
Results: Biopsy of recurrent tumour tissue from the pterygopalatine fossa showed a patchy small lymphocyte infiltrate with
perineural accentuation, isolated admixed eosinophils, plasma cells, as well as extensive interstitial sclerosis. No lymphoid follicles
or granulomas were identified. An extensive panel of immunohistochemical stains unequivocally excluded other “small round blue
cell tumours”. The lymphocytic infiltrate was further found to be polyclonal for both B- and T-cell receptors on PCR. Given the
history and histological features, the possibility of an IgG4-related sclerosing pachymeningitis was considered. Subsequent
determination of the serum IgG4 fraction confirmed this to be markedly elevated and the patient responded dramatically to systemic
steroid therapy.
Conclusion: IgG4-related sclerosing disease is a distinct clinicopathological entity with multiorgan/systemic involvement,
characterised by infiltration of various organs by IgG4-positive plasma cells and T-lymphocytes. Although this disease may affect
many organs, involvement of the meninges is seldom seen. The unusual morphologic features of our case are possibly secondary
to prior irradiation. This report emphasises the importance of considering IgG4-related sclerosing disease in a meningeal location,
as misdiagnosis of this rare condition may lead to unnecessary surgery with associated morbidity.

                                                                PP 19
                                          Experiences using a formalin recycler

P Masilo, D Africa, N Ngcakaza
NHLS, NIOH, Pathology Division, Johannesburg

Background: Formalin is the most commonly used fixative in anatomical pathology laboratories. Exposure to formaldehyde
vapour can cause adverse health effects, including cancer. In our anatomical pathology laboratory and autopsy service, we use on
average 500 litres of 10% buffered formalin per week. Formalin that has been used to fix tissue is collected and discarded by a
biological waste company, adding to the cost of running the laboratory and causing environmental damage. Formalin recycling
plants are commercially available but very few laboratories in South Africa are using them. The Pathology Division of the National
Institute for Occupational Health, which is part of the National Health Laboratory Service, acquired a formalin recycler in 2007. This
poster documents our experiences with recycling formalin.
Materials and Methods: The efficiency of the recycler was measured by calculating the volumes of formalin that can be recycled
along with the downtime and maintenance time of the recycler. Costing was based on current prices using the South African Rand.
The cost of maintenance and consumables were calculated to determine the cost of recycled formalin.
Results: The recycler has the capacity to produce 38 litres of formalin in an 18 hour period. With routine cleaning and
maintenance, it is capable of 3 cycles per week, yielding 114 litres of recycled formalin. During the 40 months we have been
operating the recycler it has been unavailable for use due to technical problems and maintenance for approximately 10 months. The
cost of the recycled formalin was calculated to be more than R12.90/litre (excluding depreciation of the plant itself). The cost to buy
formaldehyde to make 10% buffered formalin was calculated to be R3.72 /litre. When the cost of removing waste formalin at
R5.25/litre is added, the total cost for using purchased formalin is R8.97/litre. This cost is R3.93 less than the cost of recycled
formalin. Technologists who routinely operate and maintain the recycler complain of the smell of formaldehyde and of irritation to
the eyes.
Discussion: The capacity of the recycler is inadequate for our laboratory which uses approximately five times the amount of
formalin that the recycler can produce. We were unable to operate the recycler due to technical reasons for approximately 25% of
the time. A service contract is essential to maintain the recycler but this adds to the cost of recycled formalin. Along with the high
cost of consumables the cost of recycled formalin is more expensive than buying new formalin. Recycling formalin saves the cost
of waste removal and is more environmentally friendly. However, technologists may be exposed to high concentrations of
formaldehyde vapour during routine use, maintenance and cleaning of the recycling plant. On balance we would not recommend a
formalin recycler for a laboratory that uses large quantities of formalin. The technology for recycling formalin for anatomical
pathology laboratories needs to be developed further to increase efficiency and reduce costs.

                                                                PP 20
     The use of a rapid PAS stain to distinguish between glycogenation and steatosis in donor liver

Clyde Ntombela1, Marketa Geldenhuys2, Martin Hale3
Department of Anatomical Pathology National Health Laboratory Service, Johannesburg1, SMM Instruments (Pty) Ltd),
Johannesburg2, Department of Anatomical Pathology, National Health Laboratory Service and University of the Witwatersrand,
                                                                                                                                         Pa t h o l o g y
Background: Fatty change within donor livers is a well recognised feature associated with poor post-transplantation liver function.
The recognition of fat on frozen sections is thus essential to assess donor suitability. The distinction between fat and excessive
glycogen is, however, complicated on frozen section biopsies and often poses a diagnostic dilemma. A rapid, technically simple,
efficient, special staining technique is thus desired for use on frozen sections of tissue in this regard.
Methods: A rapid-PAS staining technique for the identification of glycogen on frozen section biopsies is proposed. Several frozen
section wedge biopsies from donor livers were stained using a “rapid-PAS” technique. This involves application of periodic acid to
frozen sections of tissue for 2-minutes followed by three rinses with water. Schiff's reagent is then applied and sections are
microwaved in a domestic oven for 8-seconds on medium power. Sections are then washed in running tap water for a full minute
followed by haematoxylin application for a further 2 minutes. The sections are then slowly dipped into Scott's solution four times.
Finally, the tissue is dehydrated, cleared and mounted.
Results: Areas of PAS-positivity are readily identified by the presence of bright pink-magenta staining representing intracellular
glycogen. Intracellular lipid (fat) does not take up the Schiff's reagent and appears as areas of negative staining against the
intracytoplasmic glycogen that is a normal constituent of liver cells. Histological examination of donor liver biopsies stained by use
of this technique, readily and rapidly distinguishes between glycogen and fat.
Conclusion: We propose a rapid-PAS staining technique for use on frozen sections of donor liver to distinguish between excessive
glycogen and steatosis.

                                                               PP 21
      mRNA Kappa and Lambda in Situ Hybridisation (ISH) in non-Hodgkins Lymphoma: is Tissue
            Microarray a Representative Alternative to Standard Whole Tissue Sections?

Sharlene Naidoo, Yvonne Perner, Martin Hale, Michelle McCabe
Division of Anatomical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand,

Background: mRNA kappa and lambda ISH assists in the distinction between polyclonal (kappa positive, lambda positive mRNA)
proliferations associated with benign reactive plasma cell and B-cell lymphoid proliferations, and monoclonal (marked
predominance of either kappa or lambda light chain) proliferations associated with neoplastic plasma cell and B-cell lymphoid
proliferations. The detection of mRNA kappa and mRNA lambda expression in light chain restricted B-cell diseases is currently
performed on standard whole tissue sections cut from tumour containing paraffin blocks.
Aim: The aim of this study is to compare the results of mRNA cytoplasmic kappa and lambda expression ascertained by in Situ
hybridisation in standard sections of non-Hodgkin's lymphomas to those of tissue microarrays (TMA's).
Method: Standard sections and TMA's constructed from archival paraffin embedded diagnostic biopsies (Department of
Anatomical Pathology, Charlotte Maxeke Johannesburg Academic Hospital) of non- Hodgkin's lymphomas will be subjected to in
Situ hybridisation using the INFORM mRNA Kappa and Lambda probes (Ventana) and the ISH Blue Detection kit (Ventana). A TMA
will be constructed from a representative area of the standard section and subjected to the identical ISH technique. Standard
sections and TMA's will be evaluated according to staining integrity and preservation of tissue morphology.
Discussion and Conclusion:
Tissue Microarray offers a rapid economical tool for microscopic investigation of large case numbers on a single slide. If
substantial concordance between these two types of sections is achieved, mRNA kappa and mRNA lambda ISH using TMA's will be
a reliable alternative to ISH on standard whole tissue sections.

                                                               PP 22
                            Case Study: Systemic Light Chain Associated Amyloidosis

Dr D.Pillay1, Dr N Ramparsad2
National Health Laboratory Services, Gauteng1, National Health Laboratory Services, Johannesburg2

Clinical case: 60 year old HIV negative male who presented in cardiac failure with no obvious macroglossia or hepatomegaly.
Investigations: Full blood count: WCC: 4.47x10^9/l, Hb: 12.1 g/dl, Plts: 252x10^9/l, Urea and electrolytes: Normal, B2
microglobulin: 3.0, Serum protein electrophoresis: presence of a monoclonal band in the gamma region demonstrating lambda
restriction, Serum free light chain assay: kappa:lambda 0.05:1 (Reduced), Corrected calcium: normal,
Urine analysis: Positive for bence jones protein, Endomyocardial biopsy: amyloid deposition, Bone marrow aspirate: normocellular
marrow, haemopoiesis along all cell lines. No overt increase in plasma cells.
Trephine biopsy: No overt osteoblastic activity, thickened vessel walls due to a pink amorphous deposition, marrow
plasmacytosis (~20-30%), prominence of Russell bodies, haemopoiesis along all cell lines. Congo red stain confirmed the
                                                                                                                                         Pa t h o l o g y
presence of amyloidosis.
Final Diagnosis: Light chain associated amyloidosis with smouldering myeloma.
References: 1) Sanchorawala, V., Light-chain (AL) amyloidosis: diagnosis and treatment. Clin J Am Soc Nephrol, 2006. 1(6): p.
1331-41; 2) Cohen, A.D. and R.L. Comenzo, Systemic light-chain amyloidosis: advances in diagnosis, prognosis, and therapy.
Hematology Am Soc Hematol Educ Program, 2010. 2010: p. 287-94; 3) Gertz, M.A., et al., Definition of organ involvement and
treatment response in immunoglobulin light chain amyloidosis (AL): a consensus opinion from the 10th International Symposium
on Amyloid and Amyloidosis, Tours, France, 18-22 April 2004. Am J Hematol, 2005. 79(4): p. 319-28.

                                                               PP 23
                 Surfactant Protein C Deficiency In An Infant, An Ultrastructural Case Study

N Muller1, P Goussard2, R Gie2, P Schubert3, CA Wright3
Department of Anatomical Pathology, NHLS, Tygerberg1, Department of Paediatrics, University of Stellenbosch2, Department of
Anatomical Pathology, NHLS and University of Stellenbosch3

Background: Pulmonary surfactant is a highly surface-active material that lines the alveolar surface of the lung. It is a lipoprotein
product of the type II pneumocyte, which reduces surface tension at the air-liquid interface in the alveolus. The inherited surfactant
disorders prevailing in children under 2 years are surfactant protein B, C and ABCA3 deficiency. Over 35 dominantly expressed
mutations in SFTPC have been identified in association with acute and chronic lung disease in patients ranging in age from newborn
to adult.
Methods: A lung biopsy was received in 3% Glutaraldehyde., post fixed in 3% Osmium tetroxide and processed by standard
procedure with a Leica tissue processor for electron microscopy. Tissue was embedded into Spurr's resin and cured at 60oC
overnight. Toluidine blue sections were cut on a Leica EM ultratome. Ultra-thin sections were cut and placed onto 200 mesh
copper grids. The sections were stained with Uranyl Nitrate and Lead Citrate and then examined with a JOEL JEM1011 electron
Results: Electron microscopy showed that the lamellar bodies in the type II pneumocytes were very small and clustered in
comparison to normal lung. Their diameter was 10 times smaller than that of lamellar bodies in normal lung. Conclusion:
Surfactant Protein C deficiency can be suspected on clinical, radiological and histopathological findings, but confirmation requires
genetic testing which is very costly and largely inaccessible in resource limited countries. Electron microscopy is a very useful cost
effective diagnostic tool which allows differentiation between the various types of surfactant deficiency.

                                                               PP 24
                                               Limb Loss Lessons - An Audit

Dr Riyaadh Roberts, Prof Helen Wainwright
Division of Anatomical Pathology, University of Cape Town and National Health Laboratory Service1,

Background: Limb amputations and limb-sparing bone resections are conducted for a variety of reasons, with the commonest
reason in the adult population being chronic vascular insufficiency and critical limb ischaemia, which predominantly affects elderly
patients. The Western Cape has some of the highest rates of Diabetes mellitus, smoking related disease and hypertension in the
country. All these factors contribute to worsening of the chronic limb vascular insufficiency. Other causes for amputation include
neoplasia, severe loss of function, post-traumatic injury, chronic injury and prosthetic failure.
Methods: A computerised search of our database was undertaken to retrieve all cases of limb resection (i.e. resections of femur,
tibia, humerus, radius and ulna) obtained by the Division of Anatomical Pathology, University of Cape Town and National Health
Laboratory Service, Groote Schuur Hospital for the period 2009 to 2011. These cases were reviewed, audited and the following
parameters compared: age, sex, limb, pathologic diagnosis, correlation between biopsy and resection specimen, correlation with
radiology (when available), adequacy of resection margins, turn-around time
Results: An audit of the cases received by our Division revealed a high proportion of limb resections for malignancy. The
commonest malignancies were high grade sarcomas (e.g. osteosarcoma and synovial sarcomas). Most patients were male and
most were younger than 45 years. There was a strong correlation between the biopsy diagnosis and final diagnosis of the resected
specimen. Adequate resection margins were achieved in the vast majority of cases. The femur was the commonest resection,
occurring in the setting of either an above knee amputation or as a limb sparing femoral resection for neoplasia. Limb sparing
resections were also done for metastatic malignancies.
                                                                                                                                        Pa t h o l o g y
Conclusions: Most amputations and limb sparing bone resections processed by our centre are for malignancy and occur in young
to middle aged patients. This is contrary to common epidemiologic data stating that most adult limb resections are for critical limb
ischaemia occurring in older patients in the setting of peripheral vascular disease. A question that is thus raised is whether all
resected limbs from our hospital coverage area are actually being submitted for pathologic evaluation, especially limbs amputated
for chronic vascular insufficiency.

                                                               PP 25
                    Whole lung sections for the assessment of the severity of emphysema

R Soko, P Back
NHLS, NIOH, Pathology Division, Johannesburg

Background: In terms of the Occupational Diseases in Mines and Works Act, 78 of 1973, compensation is payable to families of
deceased mine workers who have an occupationally acquired lung disease. At the National Institute for Occupational Health (NIOH)
which is part of the National Health Laboratory Service, the lungs of deceased mine workers are examined to assist with the
compensation process. Gold miners in particular are exposed to dust containing silica which can cause silicosis. In addition to
causing silicosis, silica dust also increases the risk of acquiring other lung diseases such as tuberculosis and emphysema.
Therefore, these are compensable diseases in mine workers. For compensation purposes, emphysema is graded as mild,
moderate or severe, either as judged visually or by grid counting of a whole lung section, if available. An insignificant degree of
emphysema (not compensable) has less than 35% of the lung involved, between 35% and 65% is moderate and greater than 65% is
a marked degree of emphysema. The most accurate way to assess severity of emphysema is to examine whole lung sections. The
technique of preparing whole lung sections is illustrated and examples are presented to show how the assessment of emphysema
can be done more accurately.
Materials and Methods: The method used for preparing whole lung sections at the NIOH, is based on the Gough Wentworth
technique. When lungs are removed at autopsy they are inflated and fixed with formalin. Whole lung sections are impregnated with
gelatine and sliced on a giant microtome and mounted on paper. The thickness of the sections is between 100µm to 500µm. A grid
is then used to accurately assess the degree of emphysema.
Results: The technique for producing whole lung sections is labour intensive and time consuming. The details of the technique are
discussed. Examples of mild, moderate and severe disease and their evaluation are presented.
Conclusion: The skills required to produce good quality whole lung sections are in short supply. Whole lung sections remain the
best way of assessing severity of emphysema. They are also of great value in conducting research. Outside of centres of
excellence for lung disease they are rarely seen.

                                                               PP 26
                   Silicosis and pulmonary tuberculosis in deceased South African miners

Julian Mthombeni, N Ndlovu, J Murray
National Health Laboratory Services, National Institute for Occupational Health, Johannesburg

Background: Exposure to silica dust is responsible for the high levels of silicosis seen in gold miners. The rates of pulmonary
tuberculosis (PTB) and HIV/AIDS in miners are high. Both HIV and silicosis are strong risk factors for PTB. This study describes the
data of deceased miners and ex-miners whose lungs were examined for the presence of compensable occupational lung diseases
at the National Institute for Occupational Health (NIOH) in the era of HIV/AIDS; from the beginning of epidemic (1985) and at 5 year
intervals thereafter (1985 to 2010). The study also focuses on two compensable occupational lung diseases, silicosis and active
Materials and Methods: These diseases were studied in gold miners, who are exposed to silica dust, and platinum miners who are
not exposed to silica dust and in miners whose cause of death was reported as AIDS on the death certificate. The pathological
findings on all the lungs of deceased miners and ex-miners are recorded on the computerised PATHAUT database. All cases
submitted in 1985 to 2010 were selected for the study.
Results: A decline in the numbers of autopsies submitted for examination was observed over the years studied probably due to
retrenchments and closure of mines. Most of the cases were black men, from the gold mines. The rates of silicosis among black
gold miners increased but the rates for white miners remained the same in the years studied. The increase was attributed to the
increasing ages of the miners and increasing years of service during the study period. The rates of silicosis in platinum miners were
lower than in gold miners. The rates of PTB increased more than five fold in black gold miners and twelve fold in black platinum
                                                                                                                                            Pa t h o l o g y
miners. Despite the increase in the rates of PTB in platinum miners, the rate is still lower than those in gold miners. No significant
effect of age or duration of service on PTB rates was noted. An increase in the percentage of reported HIV/AIDS cases was
observed. Pulmonary tuberculosis and silicosis were observed in men with AIDS.
Conclusion: The study has shown that there are high levels of silicosis, HIV/AIDS and PTB among South African miners. Silica
exposure was responsible for PTB observed in earlier years i.e. 1985 and 1990 and the increase seen in 1995 to 2010 appears to be
due to both silicosis and HIV.

                                                                 PP 27
                Lung fibre burden of environmentally exposed individuals with mesothelioma

M Nthlane1, E Garton1, S Milne1, Z Ndlovu1, J M teWaterNaude2, J I Phillips3, J Murray4
NHLS, NIOH, Pathology Division, Johannesburg1, Asbestos Relief Trust and University of Cape Town2, NHLS, NIOH, Pathology
Division and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand3, NHLS, NIOH, Pathology Division
and School of Public Health, Faculty of Health Sciences, University of the Witwatersrand4

Background: South Africa was the world's third largest producer of asbestos and the largest producer of crocidolite asbestos.
Because of adverse health effects attributable to asbestos its use is banned in many countries, including South Africa. Despite the
ban, asbestos remains in manufactured products, in the fabric of buildings and in the environment. The Asbestos Relief Trust (ART)
and Kgalagadi Relief Trust were created in out-of-court settlements and compensate qualifying claimants who develop asbestos
related disease as a result of working at or living near a qualifying operation. Exposure to asbestos and in particular crocidolite can
cause malignant mesothelioma of the pleura, a tumour of the lining of the lung. This tumour is very resistant to all forms of treatment
and is invariably fatal. The National Institute of Occupational Health (NIOH) offers an autopsy service which includes the
examination of lungs and their mineral and fibre content. Examination of the fibres retained in the lung allows the identification of the
type of asbestos fibres that a person has been exposed to. Studies of the lungs of patients with mesothelioma due to occupational
exposure to asbestos indicate that in South Africa, crocidolite is the most common type of asbestos associated with mesothelioma.
This study examines the lung content of environmentally exposed individuals.
Methods: Cases of pleural mesothelioma with no occupational exposure history who submitted claims to the ART were selected
for the study. The diagnosis of mesothelioma is made by histopathology aided by immunohistochemistry. A positive stain for
calretinin in tumour cells is considered strong evidence in the diagnosis of mesothelioma. Tissue from each zone of the lung is
weighed and digested. A known volume of the digested lung is passed through a filter before drying and gold coating for electron
microscopy. Gold coated filters were examined in a Jeol SEM. One hundred fields were examined at 2000 times magnification and
fibres were counted, measured and chemically analysed using energy dispersive spectroscopy. Calculations were performed to
obtain fibres per gram of dry weight lung tissue.
Results: Seventy six environmental claims submitted to the ART between 2007 and 2010 were diagnosed as having malignant
mesothelioma. Of these, 18 (12.3%) had their lungs examined. At the NIOH, six of these cases were confirmed to have
mesothelioma with positive staining of tumour cells with calretinin. Asbestos bodies and crocidolite fibres greater than 5µm and in
some cases greater than 10µm were identified in lung tissue with up to 211,260 crocidolite fibres per gram of dry weight of lung
Conclusion: In this study mesothelioma is associated with the presence of asbestos bodies and asbestos fibres in the lung. The
number of asbestos fibres per gram of dry lung tissue is low compared with known prior cases of mesothelioma where
occupational exposure to asbestos has occurred. Relatively small amounts of residual lung asbestos in environmental exposure
may cause malignant mesothelioma of the pleura.

                                                                 PP 28
   Material Safety Data Sheets For Man-made Mineral Fibres Should Include Diameter Distribution

J I Phillips1, J C A Davies2, W Pieterse3, J Murray4
NHLS, NIOH, Pathology Division and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand1, NHLS,
NIOH, Occupational Medicine Division and Professor Emeritus, School of Public Health, Faculty of Health Sciences, University
of the Witwatersrand2, Pretoria3, NHLS, NIOH, Pathology Division and School of Public Health, Faculty of Health Sciences,
University of the Witwatersdarnd4

Background: A worker, responsible for supervising the removal of rock wool insulation from a chemical plant, reported that he had
developed a cough and a sore throat following exposure to dust. Rock wool is a man-made mineral fibre (MMMF). It is widely
accepted that MMMFs are not a serious health hazard. The reason given for this is either that the fibres are too thick to be respirable
or they are cleared rapidly from the lungs. The Pathology Division of the National Institute for Occupational Health – part of the
National Health Laboratory Service – offers a service to characterise inorganic components of material which may be respirable.
Materials and methods: A sample of the rock wool insulation was obtained and prepared for Scanning Electron Microscopy (SEM)
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and energy dispersive spectroscopy (EDS). Representative fields were photographed. The diameters of randomly selected fibres
were measured. A number of rock wool Material Safety Data Sheets were read and the information collated.
Results: By EDS, the fibres present were composed of the chemical elements magnesium, aluminium, silicon, calcium and iron. It
was apparent that there was a mixture of large diameter fibres and much narrower fibres in the material. The narrowest were less
than 1 micrometer in diameter and had a length to diameter ratio exceeding 3:1. These fibres were clearly small enough to be
respirable and capable of reaching the bronchioles and the alveoli. The material data sheets studied do not all present information
on the distribution of the fibre diameters. Information stating that respirable fibres less than 1µm are not available in the MSDSs
Conclusions: The symptoms which followed a short exposure, while not in themselves a serious threat to health, were sufficient to
prompt an informed worker to seek expert advice. The SEM findings suggest that respiratory protection is essential when working
with MMMFs. More attention should be devoted to detailed examination of commercial MMMF products and to the MSDSs that
accompany them. Our preliminary literature search indicates that the jury is still out on the long-term health impact of exposure to
MMMFs in the workplace. The patient is being followed up by a pulmonologist – to date his lung function tests are within normal
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                                                               FP 1
           The role of the medical technologist in autopsy compensation - a unique experience

Julian Mthombeni, P Mbontsi, G Rani, W Mashele, N Ndlovu
National Health Laboratory Service, National Institute for Occupational Health, Johannesburg

Background: Autopsy examinations play an important role in medical practice. A less recognised area is autopsy compensation
for people with occupational disease. South Africa has a system which provides compensation to miners and ex-miners with
compensable occupational lung diseases. Cardio-respiratory organs from all over South Africa are sent to the NIOH for
examination. The involvement of laboratory staff in the provision of this system will be discussed.
Materials and Methods: 1) The autopsy compensation database (PATHAUT) was interrogated to determine where the cardio-
respiratory organs were sent from. 2) The role of technologists in teaching and training was reviewed. 3) The role of technologists
in the outreach program was reviewed.
Results: Most of the cases submitted in 2010 were from the North West (31.9%), Free State (15.7%) and Gauteng (13.0%)
provinces. Very few cases were received from the Eastern Cape (0.6%) and Limpopo (0.5%). In addition to their routine laboratory
duties, staff were involved in a number of outreach activities in 2010. These included visits to undertakers, participation in union
campaigns and training and participation in campaigns sponsored by the Asbestos Relief Trust. Nine prosectors from peripheral
mortuaries were trained in the removal of cardio-respiratory organs.
Discussion and Conclusion: The autopsy service provided by the NIOH is important and results in compensation payments which
go a long way in providing financial assistance to the families of deceased miners. Most of the cardio-respiratory organs received
were those of miners who died while in employment on the mines. Very few of the organs of men who die after leaving employment
are submitted for compensation. This is of concern as many of the diseases, such as, silicosis and lung cancer develop long after
men have left the mines. Technologists and prosectors are provided with a unique opportunity to share their knowledge and skills
with other laboratory staff. In addition, in the process of engaging with miners and the family members of deceased miners, the
staff are able to enhance client perceptions of the autopsy service and increase awareness about occupational lung diseases. In the
Pathology Division, NIOH, opportunities exist for staff to develop other competencies and extend their skills.

                                                               FP 2
                Post-mortem Findings in Maternal Deaths. Retrospective study of 15 years.

Mirta Garcia Jardon, Ernesto Blanco-Blanco
Walter Sisulu University, Mthatha

Background: There have been an alarming raise on maternal death rates in South Africa over the past few years. This change in
pattern has been mostly attributed to the HIV infection. Maternal death rate in 2007 almost doubled the one reported in 2001. In the
light of those changes the 15 Millennium Development Goal target of no more than 38 deaths per 100 000 births seems unlikely to
be attained. The Eastern Cape Province is not an exception to this fact. We have noticed a considerable increase in maternal deaths
in our hospital. In the present study we analysed the results of the post-mortem examinations conducted to maternal deaths over
the last 15 years.
Methods: A retrospective study was conducted in order to correlate the main complaint on arrival with the post-mortem findings in
all maternal deaths autopsies conducted at our Department in the last 15 years. Demographic data was also obtained as well as
some other non-related conditions found. Comparison of different years related to number of post-mortems was conducted.
Analysis of causes of death and underlying conditions was also performed.
Results: A total of 76 autopsies were performed to maternal deaths during the past 15 years with the highest number of cases
handled in 2008 (n=21). In 16 cases (21% of total) there was a confirmed HIV infection. Despite these figures we found that in
62% of all maternal autopsies the primary cause of death was an obstetric complication rather than due to HIV associated
conditions. Only ten patients (13.2%) died due to HIV related causes whereas acute fatty liver of pregnancy was found in three
patients. In one patient clinically regarded as eclampsia a phaeochromocytoma was found.
Conclusion: The pattern of our results does not support the theory that increasing maternal deaths could be due to HIV related
conditions. Obstetric complications are the most common finding in our maternal autopsies. Limitation: The number of maternal
deaths in which postmortem examination was conducted is not representative of the real epidemiological pattern; nor of the actual
number of maternal deaths.
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                                                                     FP 3
     The prevalence of HIV in cases admitted to the Pretoria Medico Legal laboratory, South Africa

NK Morris, L du Toit-Prinsloo, L Webber, G Saayman
University of Pretoria

Introduction: South Africa is at the forefront of the HIV pandemic and in an ideal position to facilitate the war on this pandemic. With
a population of 49 320 500 (Mid 2009), South Africa has a stated HIV prevalence of 17% in the 15-49 year old age group and 10.6%
in the entire population. As of 2007 the World Health Organisation Report states that there are 5.7 million adults and children living
with HIV and that there have been 350 000 HIV related deaths in South Africa. This study is comparative to a study done in 1999 by
Du Plessis et al. where she determined that the prevalence of HIV in the cases admitted to Pretoria's Medico legal laboratory was
11%, which correlated with the statistical models of the time. This study's objective is to determine if there are significant changes
from the 1999 study.
Methods: The study ran for a calendar month and was a prospective cross sectional design study. Post mortem blood samples
were obtained from all other than natural causes of death cases admitted to the Pretoria MLL. The samples were tested by means of
HIV -1/2 Rapid qualitative Immunoassay test kits and positive results were confirmed by AxSYM HIV Ag/ Ab Combo Micro-particle
Enzyme Immunoassay (MEIA) from Abbot Axsym System.
Results: The statistical finalisation of the results is under way. A total of 257 samples were collected of which 195 produced valid
results. Of the 195 samples collected 26% of the samples where HIV positive. Further analysis is under way.
Conclusions: It is envisaged that the study will be able to shed light on the changing dynamics and prevalence of HIV in the cases
admitted to Pretoria's Medico legal laboratory.

                                                                     FP 4
             A study of childhood fatalities at the Pretoria Medico-Legal Laboratory: 2005-2009

Dr L du Toit-Prinsloo1, G Dreyer2
(University of Pretoria ) - Pretoria1,(University of Pretoria) - Pretoria2

Introduction: Children and young adults are of the most vulnerable to both intentional and unintentional injury that can lead to
fatalities. The majority of deaths in Africa in children younger than 5 years of age are due to infectious diseases. Transportation
related fatalities constitute a large proportion of deaths in children and young adults. This study aimed to evaluate the
epidemiological characteristics of children and young adults admitted to the Pretoria Medico-Legal Laboratory.
Methods: A retrospective case audit (2005 – 2009) was conducted at the Pretoria Medico-Legal Laboratory on all children aged 1
– 20 years.
Results: A total of 1190 cases were identified. The majority of the cases were children aged between 16 and 20 years (50.08%)
with the second highest children aged between 1 and 5 years of age (28.99%). The most common cause of death was injuries due
to transportation related accidents (this was present in all age groups). The study is still in progress.
Conclusions: Childhood and early adulthood deaths form and important part in admissions to a medico-legal laboratory.
Identifying the exact cause of death and the profile of the cases can aid in implementation of strategies to prevent childhood

                                                                     FP 5
Establishing a National SUDI investigation protocol in South Africa: Final Frontier, or New Beginning?

Dr. L du Toit-Prinsloo1, JJ Dempers2, J Verster2, Y van der Heyde3, C Hattingh4, VD Brandt5, H Nel6
University of Pretoria1, University of Stellenbosch2, University of Cape Town3, University of KwaZulu Natal4, University of the
Free State5,University of the Witwatersrand6

Internationally Sudden Infant Death Syndrome (SIDS) is the leading cause of death in infants less than 1 year of age in most
WesterniSed countries and in some developing countries. There is however paucity of published research data in South Africa with
regards to the incidence and investigation of SIDS or Sudden Unexplained Deaths in Infants (SUDI). The most reliable method to
evaluate the scourge that is SIDS, is to perform meticulous medico-legal investigations on unexplained infant deaths and to
correlate these data with up to date infant birth and mortality statistics. The death investigation of SUDI cases is standardised
according to a national protocol in most countries, and this standardised method of investigation is the only method by which SUDI,
and therefore SIDS cases can be researched, and statistically evaluated. South Africa does not have a national protocol currently,
and even in large academic centres no specific, evidence based investigation protocols are being used. A multicentre research
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study is currently underway at the Pretoria, Johannesburg, Tygerberg, Salt River, Durban and Bloemfontein medico-legal
laboratories. It is envisaged that these findings will be presented at the conference. A critical discussion with reference to the
available national statistics with regards to infant deaths will follow. We envisage the design and implementation of a national
protocol based on tried and tested models used internationally, but also tapered for the unique South African sociological

                                                                FP 6
 The medico-legal investigation of sudden unexpected infant deaths in South Africa: Lessons learned
                                    from the past to unite in future

Dr L du Toit-Prinsloo1, Dr JJ Dempers2, Dr J Verster2, Dr Y van der Heyde3, Dr C Hattingh4, Dr VD Brandt5, Dr H Nel6, Dr K
University of Pretoria1, University of Stellenbosch2, University of Cape Town3, University of KwaZulu Natal4, University of the
Free State5, University of the Witwatersrand, Johannesburg6

Background: Sudden Infant Death Syndrome (SIDS) is defined as “The sudden and unexpected death of any infant less than one
year of age, with the onset of the lethal episode apparently occurring during sleep that remains unexplained after a thorough
investigation including performance of a complete autopsy, and review of the circumstances of death and the clinical history”.
Several publications emphasise the importance of a standardised protocol in the investigation of these deaths. Currently in South
Africa, no nationalised protocol is available in investigating these deaths.
Methods: Retrospective case audit over a five-year period (2005 to 2009) is currently being conducted at six large medico-legal
mortuaries in Pretoria, Johannesburg, Tygerberg, Salt River, Durban and Bloemfontein. Case files on all infants younger than one
year of age are being reviewed. The outcome measures include number of deaths, demographic details and the nature and final
outcome of the post mortem examinations.
Results: The study is in progress and the results will be discussed at the conference.
Conclusions: It is envisaged that this study will indicate the magnitude of sudden unexpected deaths in infants at the different
mortuaries and will show the discrepancies in the investigative process. The ultimate aim is to propose a standardised national

                                                                FP 7
          A critical review of fatal head injuries in children under the age of 5 years in Pretoria.

Dr L du Toit-Prinsloo, T Phasha, Prof G Saayman
University of Pretoria, Pretoria

Background: Internationally injury is regarded as one of the leading causes of mortality and morbidity in children under the age of
14 years. Mortality rates due to injury are six times higher in developing countries compared to developed countries. In developed
countries such as the UK, falls are the predominant cause of injury in children under five years, particularly household accidents.
This is in contrast to developing countries with a study conducted in Tunisia indicating that increased mortality and morbidity are as
a result of transportation accidents, second to this was falls followed by inflicted injury.
Methods: A retrospective case audit was conducted over a 5 year period (2004 - 2008) at the Pretoria Medico-Legal Laboratory.
All case files of children 5 years and younger where a head injury was ascertained as the cause of death were reviewed.
Results: A total of 107 cases of fatal head injury were identified. The demographic details showed more males (56%), African
racial population (78%) and a peak age incidence of 2 years. The majority of the head injuries were as a result of transportation
accidents (70%). The most frequent encountered pathological findings were skull fractures (80%), followed by scalp injuries
(77.5%) and subarachnoid haemorrhage (72%).
Conclusions: This study showed that fatal head injuries in children accounted for 0.06 – 1.14% of the total case load at the Pretoria
Medico-Legal Laboratory. The majority of the cases were as a result of transportation injuries with minimal injuries resulting from

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