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Year : 2022  |  Volume : 65  |  Issue : 3  |  Page : 746-747
Pathology conundrums

Department of Pathology, IGMC, Puducherry, India

Click here for correspondence address and email

Date of Submission25-Aug-2021
Date of Decision20-Oct-2021
Date of Acceptance25-Oct-2021
Date of Web Publication21-Jul-2022

How to cite this article:
Bharathi K V. Pathology conundrums. Indian J Pathol Microbiol 2022;65:746-7

How to cite this URL:
Bharathi K V. Pathology conundrums. Indian J Pathol Microbiol [serial online] 2022 [cited 2022 Dec 4];65:746-7. Available from:


I am a syndrome, inherited not acquired

With heart failure, I present that is typically right-sided

Palmo-plantar skin is tough and thickened

The beat of the heart is wildly quickened

Its right ventricular wall is filled with fat

Rhythm disturbances make the ECG go flat

What Syndrome am I?

   Answer to Riddle 1 Top

Naxos Syndrome


  • Arrhythmogenic right ventricular dysplasia (Loss of myocytes and extensive fatty infiltration of the right ventricular wall)
  • Palmo-plantar Hyperkeratosis


I am an incompetent tricuspid valve

Damaged endocardium I do have

Abounding with Collagen and mucopolysaccharide

Hurting the cardiac chambers on the right side

The person who has me is often seen blushing

Suffering tummy cramps and episodic wheezing

A lesion in the lung precedes my appearance

The plasma level of an amine is the test of relevance

What has hurt me?

   Answer to Riddle 2 Top

Carcinoid heart disease

Lung lesion: Bronchial carcinoid Tumor


I present in an infant as a bleeding abnormality

My lesions are mainly in the skin, liver, or mesentry

The tissue in these lesions is tufted and convoluted

Once I appear, neither surgery nor transfusion is recommended

A triad of tumor, cytopenia, and bleeding define me

Steroids and Vincristine are the first line of therapy

What phenomenon am I?

What lesions am I most often associated with?

   Answer to Riddle 3 Top

Kasabach–Merritt phenomenon/Syndrome:

Often associated with Kaposiform hemangioendothelioma or Tufted Angioma


Transmitted by inoculation, arising from a change in conformation

I stack up in nerve cells, defying protease digestion

I make the brain “spongy,” I cause degeneration

I can even come to exist by a sporadic mutation

I can drive you crazy, I can make you forget

Progressive dementia follows the clinical onset

What am I?

What do I cause?

   Answer to Riddle 4 Top

Prion Protein causing Transmissible spongiform encephalopathy (Prion diseases)

Riddle 5

We are a family 20 members strong

Some things we just get right and some things so wrong

Our functions are many, our activators three

For our presence in your plasma, we charge no fee

Orderly are we, we work in a cascade

Phagocytosis or cell lysis, its part of our trade

What are we?

   Answer to Riddle 5: Top

Complement System

Riddle 6:

I am a bacterium, one-of-a kind

My property is unique, I'm happy to find

Inflammation and atrophy are part of my daily grind

A “pathogenicity island” in me is a tumor entwined

What am I?

   Answer to Riddle 6: Top

Helicobacter pylori

Riddle 7:

I'm a syndrome that makes you wheezy

I tickle your nose and make you sneezy

Your lung X-ray shows infiltrates

Your myocardium, the eosinophil penetrates

Small blood vessels show necrosis

A study about me reveals vasculitis

What syndrome am I?

   Answer to Riddle 7: Top

Churg Strauss Syndrome

Riddle 8:

I am an organ buried in obscurity

Yet I have a starring role in cell-mediated immunity

With 22q deletion I am hypoplastic

With myasthenia gravis, I am hyperplastic

A tumor of my origin leads to red cell aplasia

Impinging on other structures, it could lead to dysphagia

What organ am I?

   Answer to Riddle 8: Top


Riddle 9:

Multiplicity and multifocality are our defining features

To be hyperplastic or neoplastic we have a “consensus”

Our origin may be synchronous or metachronous too

The organs we affect are often more than two

PTH levels often give a diagnostic clue

What are we?

   Answer to Riddle 9: Top

Multiple Endocrine Neoplasia (MEN) Syndromes

Riddle 10:

I come from far away

On another organ, I hold my sway

To a “new growth” I owe my loyalty

Sometimes a hormone, sometimes a mineral

I present to you with variety

What am I?

   Answer to Riddle 10: Top

Paraneoplastic Syndrome

Riddle 11:

The liver is my mother, she's one busy bee

A long-standing illness made her give birth to me

My children are all stacked up, in a pattern so perfect

But in the tissue in which they're found, there's always a defect

Fibrillar and abnormal is what I'll always be

Sometimes a minor component accompanies me

What am I?

   Answer to Riddle 11: Top

Amyloidosis (Serum Amyloid Associated protein, SAA)

Riddle 12:

Many are the modes of my transmission

Transplacental, transplantation, or transfusion

The cell I infect is easy to detect

Its size is gigantic, more than you expect

”Does its nucleus have an inclusion?”

Is what you'll suspect

What am I?

   Answer to Riddle 12: Top

Cytomegalovirus (CMV)

Correspondence Address:
K V Bharathi
Plot. No. 17, Door. No. 3, 4th Cross, Ponnagar, Puducherry - 605 010
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijpm.ijpm_861_21

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