What is Rosai Dorfman Disease ? [Pathology Infographic]

Rosai- Dorfman Disease is a rare benign histiocytic disorder in which patients present with painless cervical lymphadenopathy, fever and leukocytosis. The classical findings include emperipolesis and histiocytes staining positive for S100 protein and CD68 and negative for CD1a.



Visit: Histopathology-india.net.

Are you super busy? Being busy is a contagious disease. Cure yourself now.


“ I have often said that the sole cause of man’s unhappiness is that he does not know how to stay quietly in his room” Blaise Pascal

Did you say you are super busy? I’m sure you are busy. Congrats! You are so important. I am sure your little kids are also very busy. They are following the instructions of a harsh taskmaster to be high achievers and future leaders. Your grandparents are also very busy and active. They are all effectively networking and interacting on social media. Oh they are all so influential !!  Did you say you don’t have a social media account?  Then you are “nobody”.

The world of the doctors is a busy one. It is possible you may not have efficient junior doctors, helpful colleagues and all the resources to help you at work. Large section of doctors are working in remote district hospitals and small towns in various parts of the world. They are managing to take care of the patients with limited resources and are part of a happy and satisfied community.

Yes, I have also worked in District Hospital under high pressure and  it has prepared me for various difficult situations in my own country.

No matter where you work, how much time and effort you put into your daily activities, you will experience stress numerous times.

You may work for many hours and still you can never get everything done on time.

The people who complain less are those who are experienced and know how to maintain a work life balance.

If you can maintain a routine and organize your workload, you will find ample time to enjoy life and finish your urgent work everyday without screaming “I’m crazy busy”.

As a trainee pathologist I was told that those who complain of being too busy, are usually inefficient and don’t know how to prioritize their work. Busyness does not prove that you are important or a productive person. It means you are inexperienced and unable to handle your work. This applies in case of every profession.

If you want to be productive, don’t feel guilty to sit idle. Learn to be lazy. You will be happy, active and an asset to your own country.

Be more present with your family. Enjoy festivals and weekends, without getting distracted.

Find time to play with your kids , laugh and crack silly jokes.

Be a blogger for fun and entertainment without bragging about your expert skills and knowledge. Write enjoyable posts which everyone can understand.

Learn to be modest. There is always someone smarter, more knowledgeable and charismatic than you. Being envious of others is a waste of time and energy.

Social media is a place to interact with like-minded friends and curate interesting educational contents. It is a global platform for  everyone. Follow and interact with those you feel will provide useful contents. You are your best brand advocate. If your reputation depends on the number of  social media followers, likes and retweets, you have a serious personality disorder.

Please don’t continuously spam your friends with your own blog posts. I find it annoying and I think your close friends feel the same way.

Respect is earned not taken. Read and promote books of senior experts in your field, specially those you know and respect.

You will make everyone uncomfortable if you start talking about race, religion, politics, poverty, war and inequality.

Don’t spread false gossips as you may run into some unexpected problem.

Build meaningful positive, long lasting relationships, which is just not based on give and take.

Crazy busy people suffer from depression, anxiety, high blood pressure and cardiac disease, indigestion, obesity and exhaustion.

You don’t have to attend every conference, and meeting. Take a vacation with your family and cherish those special moments.

If you are rushing from one activity to another, you may earn money and fame, but you will not have the time or energy to enjoy a “good life”.

Don’t sit behind a microscope all day reporting trays of  slides. See the urgents first and take your time to study other cases slowly. Appoint someone to report routine cases.

Stay calm. Even if you are an efficient pathologist there can be unexpected situations like mix-up of biopsy specimens , rude clinician repeatedly troubling you for a preliminary report. You should be able to handle these unpleasant situations smartly.

Don’t check your cell phone in the middle of clinical work.

Spend sometime in the nature, everyday. It can be your own little garden.

Don’t take your loved ones for granted. Be ready to be treated the way you treat others.

Next time you call yourself super busy, may be you should change your way of working and do something that will keep you less busy and more HAPPY.

Life is too short to be “crazy busy”. Don’t let your life pass you by.

Try to maintain a healthy relationship not only with others but also with yourself.

King Tutankhamun – What caused his mysterious death?


“Today the traveller on the Nile enters a wonderland at whose gates rise the colossal pyramids of which he has had visions perhaps from earliest childhood.  James Henry Breasted”.

To know the people and a country you have to visit it. Talk to the people, look into their eyes and try to understand their local culture.

Egypt is an enchanting country with many exciting stories and unsolved mysteries from the past.
Some of the most intriguing questions are related to mysterious death of the great Pharoah (king) Tutankhamun.

The most exciting discovery of ancient Egyptian remains was that of the tomb of  Tutankhamun, the last pharaoh of the XVIIIth dynasty.

The tomb was found in 1922 by an Englishman called Howard Carter who was member of an expedition team led by Lord Carnarvon. The tomb was in the Valley of the Kings, where so many Egyptian kings were buried, but this was only one that had not been broken open or robbed of its treasures.

The mummy of  Tutankhamun himself was enclosed in a decorated coffin of gold, which in its turn was inside two wooden coffin and a stone one. The face of the mummy was covered with a gold mask, decorated with precious stones and there were gold ornaments on the head.

According to Dr Saleem SN et al  “Subcutaneous packing procedure was used as part of mummification of royal Ancient Egyptians dated to 18th to 20th dynasties earlier than what was believed in archaeology. The Ancient Egyptian embalmers must have been skilled in dissection and possessed surgical tools that enabled them to perform this fine procedure.”

Tutankhamun became king when he was only 12 and died unexpectedly at the age of 18 years. If his tomb had not been found with all its treasure he would have been forgotten long time ago.

A curious superstition sprang up about the tomb of Tutankhamun. It was said that the people who broke it open were committing an offence against something sacred, and that they would meet sudden death as a result.

Strange incidents happened and several people connected with discovery did die tragically, one of them being Lord Carnarvon, who died  in Egypt, from poisonous mosqito bite and pneumonia, five months after the finding of the tomb.

According to Dr Gandon the mysterious death of Lord Carnavon after entering the tomb of the Egyptian pharaoh Tutankhamun could be explained by an infection with a highly virulent, long living pathogenic agent. “The ‘curse of the pharaoh‘ has been used as a metaphor for the hypothesis that higher parasite propagule survival selects for higher virulence.”

The cause of  King Tutankhamun’s death has been matter of speculation for several decades. Many interesting medical articles have been written on this subject.

It has been suggested that the young king was murdered by a blow to the head based on skull radiographs obtained by a team of researchers in 1968. Professor R.G. Harrison stated, “While examining X-ray pictures of Tutankhamun’s skull, I discovered a small piece of bone in the left side of the skull cavity. This could be part of the ethmoid bone, which had become dislodged from the top of the nose when an instrument was passed up the nose into the cranial cavity during the embalming process. On the other hand, the X-rays also suggest that this piece of bone is fused with the overlying skull and this could be consistent with a depressed fracture, which had healed. This could mean that Tutankhamen died from a brain hemorrhage caused by a blow to his skull from a blunt instrument.”

According to Hussein et al pathological findings included craniofacial dysmorphia, bilateral alterations of the feet, malarial disease and an acute traumatic fracture of the knee.

Hawass et al. used imaging, anatomical and DNA techniques and suggested Plasmodium falciparum malaria, concomitantly with Morbus Köhler-Freiberg, as his probable cause of death. The authors also indicated that there were no signs of gynecomastia and craniosynostoses (eg, Antley-Bixler syndrome) or Marfan syndrome. Genetic testing for STEVOR, AMA1, or MSP1 genes specific for Plasmodium falciparum revealed indications of malaria tropica in 4 mummies, including Tutankhamun‘s. These results pointed to  avascular bone necrosis along with the malarial infection as the most likely cause of death of Tutankhamun. 

According to Timmann et al “The age of 18–19 years attributed to Tutankhamun makes malaria as his primary cause of death rather unlikely, as a certain degree of  semi-immunity may readily be assumed.”   Plasmodium falciparum malaria was endemic in ancient Egypt and probably caused death. Local residents after continuous exposure to plasmodium developed immunity against both parasites and disease. Fatal courses of malaria usually affect young children (6- 9 year) and pregnant women but not adults.

According to Timmann et al  bone lesions of two metatarsals of the left foot and  shortening of the second left toe, indicated  advanced osteonecrosis, osteomyelitis or ulcerative osteoarthritis in the article by Hawass et al.  These radiographic findings are consistent with osteopathological lesions as often noted in sickle cell disease , a haematological condition described to occur in many local residents of Egypt (El-Beshlawy & Youssry 2009). The occurrence of anaemia, other pathological haematologic disorders, and of the haemoglobin mutation that causes sickle cell disease (HbS) has been demonstrated in predynastic Egyptian remains (Marin et al. 1999).

Timmann et al  indicated,  “in contrast to osteonecroses associated with sickle cell disease, Köhler-Freiberg disease is highly unlikely to be a co-cause of death in young adulthood.”

Avascular osteonecroses, inflamed by osteomyelitis and septicaemia  due to pathogenic agents including Salmonella and Staphylococcus,  are known sickle cell disease complications and may be exacerbated by malaria attacks.

Gaucher’s disease (type 1-3) should be considered which may cause painful avascular osteonecroses. Gaucher’s disease is a rare autosomal-recessive lysosomal storage disease and has been described in Egyptians.

Other features considered in the differential diagnosis of avascular osteonecroses in King Tutankhamun’s bones included other inheritable and non-hereditary disorders – trauma, sequelae after osteomyelitis, acute pancreatitis and systemic lupus erythematosus. 

Brandt G.  suggested the theory that Tutankhamun may have suffered from hypophosphatasia, an inherited metabolic disorder that affects especially the musculo-skeletal system in many ways.  The author has compiled both medical and archaeological findings to support his theory and suggests that existing DNA samples of Tutankhamun and other members of his family should be tested for defects on the ALPL gene.

The question on Tutankhamun‘s supposed gynaecomastia cannot be answered as most of mummy’s chest wall was missing.

 All the scientific findings can neither be proved or ruled out.

We do know that the most common diseases of Ancient Egypt were traumatic injuries, malaria and tuberculosis.


King Tutankhamun is one of the most famous  king of Ancient Egypt. It is not surprising that extensive scientific studies have been made to find the actual cause of death. Infectious disease, metabolic disorder, neoplastic lesion, trauma (crash of his chariot causing lethal injury) and even murder have been suggested by various authors.

The cause of death of the great ruler of Egypt will continue to fascinate researchers.  I wrote a similar post about Death of Alexander the great – A medical Enigma. 

The difference between the two cases is that the remains of Alexander the Great was not found, hence anatomical and other scientific examinations could not be done.  In case of King Tutankhamun extensive studies including virtual autopsy, imaging , anatomical and DNA analysis were performed.


Dangers of Trick-or-Treating and Three Bizarre, Scary Diseases


Halloween is an ancient celtic tradition celebrated on 31st October. It is fun time for children and is very popular in many parts of the world.

Dangers of trick-or-treating come in many forms.


  • Halloween diarrhea’ caused by artificial sweetener sorbitol in the candy.
  • Doctors and parents should take special precautions in cases of children suffering from juvenile diabetes.
  • Excessive intake of candy without proper oral care may cause tooth decay or dental caries.
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  • Consumption of processed products with excess amounts of salt, sugar and fat can cause obesity and food allergies.
  • There can be an outbreak of serious foodborne infectious disease.
  • Cases of deliberate tampering, poisoning and insertion of foreign material in the candy have been reported. Example: A case of perforated appendicitis due to intake of pin.
  • There are many cases of  burns and house fires during Halloween celebrations. It seems that pumpkins have a round base and some containing many candles can easily overturn causing fires and burns.
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  • Studies suggest the number of childhood pedestrian deaths increased fourfold among children on Halloween evenings when compared with all other evenings.
  • Face paint may contain toxic levels of lead.
  • A study on behaviour of children showed that when children were told to take only one candy, anonymous kids took more candies compared to those children whose name and address were known to the giver. Self-awareness and transgression in children: two field studies.
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Following safety tips have been suggested : 

The hazards of Halloween. 

“Pedestrian safety
• Parents should establish a route for children in a known neighbourhood.
• Children should use flashlights, stay on the sidewalk, stop at intersections and cross intersections in a group.
• Motorists should drive slowly and look carefully for children on medians and in alleyways and driveways.
• Children should consider wearing makeup instead of masks, or wear masks that do not obscure sight or hearing.
General safety planning
• Parents should establish a curfew for older adolescents.
• Children should travel in small groups, be accompanied by an adult, visit only well-lit houses and remain on porches rather than entering houses.
• Children should know their phone numbers, carry coins for emergency telephone calls and have their names and addresses attached to their costumes.
• Rigid or sharp costume knives or swords should not be used.
• All treats should be brought home so that parents can inspect them.
• Adults should prepare for trick-or-treaters by clearing porches, lawns and sidewalks and placing jack-o‚-lanterns away from doorways and landings.


Three Bizarre, Scary Diseases: 

1. Alien Hand Syndrome: 


2.  Waterhouse–Friderichsen syndrome


3. Hypertrichosis ( “Werewolf Syndrome” )


 Image Courtesy: pixabay.com