Unusual and Fatal Case of an Undiagnosed Intravascular Large B-cell Lymphoma: The Oncologist’s Great Imitator†

Intravascular lymphoma (IVL) is a rare subtype of extranodal lymphomas that is characterized by the selective growth of neoplastic cells within the lumen of small vessels. Authors document the case of an unexpected death caused by an undiagnosed intravascular large B-cell lymphoma with multi-organ involvement, which had initially manifested as an infection and then as an unclarified central nervous system pathology. Histological examination showed a diffuse intravascular large B-cell brain lymphoma with prominent cerebral involvement. The relevance of the case report reveals the importance of an autopsy of an extremely rare and threatening pathology that in most cases is diagnosed only postmortem. As a result, the role of the forensic pathologist becomes particularly important. When specifically performing an in-depth autopsy evaluation with a specific histologic analysis, it is possible to identify the intravascular lymphoma and declare a more accurate cause of death.     

Kantei diplomacy? Japan's hybrid leadership in foreign and security policy

This article operationalizes Japanese leadership in foreign and security policy, specifically the Abe administrations’ consistent China balancing. It will do so to dispel instances of Premier-centered diplomacy and posit that Abe's diplomatic agenda has rested on a ‘hybrid’ policy-making authority, where the leverage enjoyed by the Prime Minister's office (the Kantei) rested on little-appreciated politicized personnel appointments and demotions within the bureaucratic apparatus, specifically the Ministry of Foreign Affairs. Moreover, successful Japanese leadership has functioned especially when operating within the scope of the US strategic framework towards East Asia. While structural constraints, such as the ever-present influence of the USA and bureaucratic coordination, may constrain options, effective leadership in foreign policy-making can indeed make a difference within those boundaries.     

A fatal case of cocaine poisoning in a body packer

A 27-year-old man was carrying in his digestive tract 99 packages each containing about 10 g of a 86% cocaine powder. The courier died by acute cocaine intoxication due to inflation and rupture of four packages during a flight from Bogotá to Rome. At the autopsy, the external examination was unremarkable. The internal examination showed edema and generalized congestion of the organs. Toxicological analyses were performed by gas chromatography-mass spectrometry after solid phase extraction using Bond Elut Certify columns and derivatization with BSTFA/TMCS. High levels of cocaine and benzoylecgonine were found in blood (4.0 microg/mL and 17.0 microg/mL), urine (152.0 microg/mL and 512.0 microg/mL), bile (99.8 microg/mL and 54.0 microg/mL), vitreous humor (7.1 microg/mL and 5.8 microg/mL), brain (7.5 microg/mL and 3.5 microg/mL), and hair (55.5 ng/mg and 27.7 ng/mg). The presence of the cocaine and its metabolite in the hair suggested that the man was a cocaine user.     

Reshaping State Structure and Strategy: The Reform of Railway Policy in Germany and Italy

For almost four decades, the reform of the state has been a recurrent and relevant topic for social sciences. Has the s.c. positive state been replaced by a regulatory state, or have hybrid configurations emerged? Based on a comparative analysis of German and Italian railway policies, this article aims to contribute to the literature on regulation, considering the possibility of policy mixes in which elements of the positive and the regulatory state are interrelated. Such hybridization is the result of multiple-actor policy arenas, where regulatory tools are used to restructure state’s direct intervention rather than to bring about its retreat.     

Multilevel policy implementation and the where of learning: the case of the information system for school buildings in Italy

Policy Sciences - The paper builds on the case of the design and implementation of the National Information System for School Buildings in Italy. The project is one of digitalisation of the public...     

Skull and Encephalic Injuries Caused by Beach Umbrellas: Case Reports and Review of Literature

This study reports two unusual cases of skull‐encephalic injuries in bathers that were caused by violent impacts with beach umbrellas. The first case concerned a 36‐year‐old man who, while lying on a sun bed, was struck on his left temple by a beach umbrella, which had been blown away by a gust of wind. The second case concerned a six‐year‐old child who was struck on the right temporal region while he was playing on the sand. Both subjects died. A review of the literature was carried out. Various skull and brain injuries caused by several objects were found, but no injuries caused by beach umbrellas were detected. There were only cases of injuries caused by normal umbrellas. These cases showed that several objects can be responsible for traumas causing skull and brain injuries, therefore forensic investigation must be supplemented by circumstantial data.     

Sudden Death Secondary to an Undiagnosed B‐Cell Lymphoma of the Hypopharynx and Infiltration of the Inferior Constrictor Muscle

The aim of this presentation was to share an uncommon form of sudden death, suffered by a 64‐year‐old woman, due to a mechanical obstruction of hypopharynx by an undiagnosed B‐cell lymphoma, infiltrating the inferior pharyngeal constrictor muscle. A forensic approach by means of scene investigation, circumstantial data collection, autopsy, and histological and toxicological investigations led to conclude that the cause of death was asphyxia, correlated with B‐cell lymphoma of the hypopharynx. The autopsy examination highlighted the presence of a wall thickening, infiltrating, and projecting into the hypopharynx lumen. The histological analysis showed the essential finding of a B‐cell lymphoma of the hypopharynx, diffusely infiltrating the inferior pharyngeal constrictor muscle. To conclude, this case demonstrates once more that in the absence of specific data, a thorough forensic investigation including autopsy, histological examination, and circumstantial data collection is mandatory to reach a correct cause of death.