Introduction of autopsy imaging redefines the concept of autopsy: 37 cases of clinical experience

A new autopsy imaging (AI) system was introduced at the Research Center Hospital for Charged Particle Therapy (RCCPT) in January 2000. Autopsy imaging is a postmortem and preautopsy diagnostic procedure using magnetic resonance imaging (MRI). Scanning is performed with a 1.5 Tesla MRI system before autopsy. The AI results are reported to the pathologist and, in light of this information, autopsy is performed with minute precision. Autopsy imaging was performed on 37 cancer cases. In seven cases, AI was less informative than the autopsy, but in 30 cases, more precise reports on the final diagnosis were available with the combined application of autopsy and AI than autopsy alone, particularly in eight limited autopsy cases. Thus, AI provides critical and supplementary information for autopsy; furthermore, AI itself is a unique imaging system of great importance.     

The medicolegal autopsy: when to refer to a forensic pathologist

The system of death investigation in England and Wales is complex, resulting in a distinction between ‘non-forensic’ and ‘forensic’ medicolegal autopsies. This article reviews the medicolegal investigation of sudden death and the actions of the police at the scene, and features in the history, external examination and internal examination that ‘non-forensic’ pathologists should be attune to in their everyday practice.     

Impact of the COVID-19 pandemic on pathological autopsy practices in Japan

During the coronavirus disease 2019 (COVID-19) pandemic, autopsies have provided valuable insights into the pathogenesis of COVID-19. The precise effect of this pandemic on autopsy procedures in Japan, especially in instances unrelated to COVID-19, has not yet been established. Therefore, we conducted a questionnaire survey from December 2020 to January 2021 regarding the status of pathological autopsy practices in Japan during the first year of the COVID-19 pandemic. The questionnaire was sent to 678 medical facilities with pathologists, of which 227 responded. In cases where a confirmed diagnosis of COVID-19 was not made at the time of autopsy, many facilities counted them as suspected COVID-19 cases if pneumonia was suspected clinically. At around half of the sites, autopsies were prohibited for suspected COVID-19 cases. In addition, the number of autopsies of non-COVID-19 cases during the pandemic period was also investigated, and a significant decrease was observed compared with the incidence in the pre-pandemic period. The COVID-19 pandemic has affected not only the autopsies of COVID-19 cases but also the entire practice of pathological autopsies. It is necessary to establish a system that supports the implementation of pathological autopsy practices during the pandemic of an emerging infectious disease.     

Adrenal lipomas: incidental autopsy findings

Two rare cases of lipomas of the adrenal gland are reported. In both cases the tumor was found incidentally at autopsy, in the course of the medicolegal investigation of death. The first case involved a small tumor of the left adrenal gland in a 70-year-old man who died by drowning. In the second case, a previously healthy 45-year-old man died suddenly. At autopsy a lipoma of the right adrenal gland was associated with a pheochromocytoma in the contralateral gland.     

The Johanson-Blizzard syndrome: A second report of full autopsy findings

We report on a second patient with Johanson-Blizzard syndrome with full autopsy. The findings are similar to those of the one other available case, but gross or fine CNS maldevelopment was not present; although small by weight, the brain showed no cytoarchitectural disturbance. Normal intellecutal development does occur in this syndrome and may relate to the variable effects of the deleterious gene on the developing CNS.     

Diffuse pulmonary ossification: an uncommon incidental autopsy finding

AIM: To determine the incidence of diffuse pulmonary ossification (DPO) and its subtypes at autopsy and correlation with clinical and histological features. METHODS: Autopsy reports from our institution over a 64-month period were reviewed for findings of DPO. The pattern of ossification, demographics and clinical data were obtained from both paraffin sections and final autopsy reports. In a selected case, chest radiograph and wet tissue were obtained. RESULTS: Seventeen histologically confirmed cases of DPO were found in 10,426 autopsy cases, representing an incidence of 1.63 cases/1000 autopsies. There was a predilection in males (88%) and underlying pulmonary disease (88%). In contrast to published studies, dendriform DPO was more common than the nodular type in our cohort (11 and 6 cases, respectively). The dendriform type was more commonly associated with marrow elements. CONCLUSIONS: Diffuse pulmonary ossification is uncommon and rarely diagnosed during life, but can easily be identified when sectioning the lungs at autopsy. There is recent renewed interest in diagnosing and determining the significance of DPO using high resolution computed tomography and thoracoscopic biopsy.     

Primary pleural angiosarcoma associated with pneumoconiosis: An autopsy case

We report a case of pleural angiosarcoma in an adult male patient confirmed by autopsy and possibly associated with pneumoconiosis. The lesion was characterized by thickened pleura of both lungs with nodular tumors. Histologically, the tumor was composed of spindle‐to‐polygonal epithelioid cells that were positive for CD31, CD34, vimentin, and cytokeratin on immunohistochemical staining but were negative for calretinin. Further examination revealed mix‐dust pathological findings consistent with the existence of pneumoconiosis; dystrophic ossification, anthracosis, and fractal small dust particles were observed in the lung parenchyma and a hilar lymph node. The current case suggests that pneumoconiosis‐associated pathologies may be risk factors for the development of angiosarcoma in the pleura.     

以皮肌炎样表现为特征的血行播散性结核--附3例尸检

目的：为了避免临床误诊,对结核病的肌肉病变特点进行探讨。方法：复习２５例经尸检证实为急／亚急性血播散性结核的病例,其中３例临床上主要表现为皮肤和肌肉损害,分别在患者生前诊断为皮肌炎（２例）和多发性硬化症（１例）。对其骨骼肌进行详细的镜下观察。结果：四肢肌、膈肌、食道和喉的横纹肌均有程度不同的变性、坏死和淋巴细胞浸润,表现为：（１）肥大或萎缩;（２）嗜酸性、玻璃样和絮状变性;（３）溶解和凝固性坏死;     

Daily application of post-mortem computed tomography digital autopsy in a public mortuary

The digital autopsy has gained increasing attention in the past decade as post mortem computed tomography has become more widely available. Whether conducted with, or without, radiographic contrast, digital autopsies have been shown to be a valuable adjunct to invasive examinations in the investigation of natural and unnatural deaths. This radiology investigation has the potential to reduce the number of full invasive autopsies performed, allowing for more targeted, or limited, invasive examinations. In certain deaths, the digital autopsy may obviate the need for an invasive examination entirely. This article considers the daily use of post mortem computed tomography in routine coronial autopsy practice in a busy public mortuary in England. The integration of the digital autopsy into the investigation of natural deaths (including decomposing and embalmed bodies) is first considered before dealing with commonly encountered unnatural deaths after surgery, industrial disease, trauma, drug overdose and suicides.     

The necessary role of the autopsy in cardiovascular epidemiology

The autopsy rate in the United States today is remarkably low, with proportionally fewer autopsies for natural causes of death. Consequently, most cardiovascular epidemiology studies do not use autopsy data and rely on death certificates, medical records, questionnaires, and family interviews as sources of mortality information. These practices introduce a high degree of variability and uncertainty regarding cause of death. This review illustrates the necessity for increased use of autopsies in cardiovascular epidemiology by critically evaluating other measures of cardiovascular disease (CVD) incidence. We evaluated the literature regarding CVD as cause of death and conducted discussions with cardiologists, pathologists, and epidemiologists. No attempt was made for meta-analysis. This review shows the limited reliability of death certificates, medical records, and interviews as sources of mortality statistics. In addition, the autopsy's role in clearly indicating the presence of CVD is illustrated. The autopsy used in conjunction with medical records is the only reliable means for establishing cause of death from CVD. There is an urgent need to reassess the current dependence of statistical mortality data on death certificates and other inadequate sources of CVD incidence. Death certificates, in general, are inadequately monitored for quality control and appropriate administrative oversight. With an increase in the number of hospitals performing no autopsies to investigate cause of death, a uniform national autopsy database is needed.     

Accessory spleens at autopsy

Accessory spleens (AS) may be formed during embryonic development when some of the cells from the developing spleen are deposited along the path from the midline, where the spleen forms, over to its final location on the left side of the abdomen. An accessory spleen is usually near the spleen's hilum, but it may be embedded partly or wholly in the tail of the pancreas. The aim of this study was to investigate the incidence and distribution of AS during routine forensic autopsies. AS were investigated in 720 consecutive autopsy cases. Fifty-four AS were found in 48 (6.7%) cases. AS were found in hilum of the main spleen in 28 cases, the great omentum in 13 cases, the pancreas in 5 cases, and the pelvis in 2 cases. There were two AS in two cases and three AS in another two cases. Awareness of the possible presence of AS is important because when splenectomy is performed for some conditions such as immune thrombocytopenic purpura, failure to remove the AS may result in the failure of the condition to resolve. Additionally, during medical imaging, AS may be confused for enlarged lymph nodes or neoplastic growths. In conclusion, autopsy series are useful for determining the incidences and the other features of AS in different populations, in addition to those studies using CT scans and those studies obtained during laparoscopic or open surgeries.     

Pituicytoma incidentally found at autopsy

Pituicytoma is a rare benign neoplasm, occurring in the sellar and suprasellar regions. Reported herein is a case of asymptomatic pituicytoma, discovered at autopsy, in a 54-year-old Japanese woman. This is the first case report of pituicytoma, found incidentally at autopsy (incidentaloma), in which whole-mounted sections are available for histological and immunohistochemical studies. Grossly, the bisected pituitary gland revealed a round, white to light tan, 7 mm-diameter nodule. Microscopically, whole-mounted sections revealed a well-circumscribed nodule with no fibrous capsule, located mainly in the neurohypophysis and partially compressing the adenohypophysis. The tumor was composed primarily of bipolar, occasionally unipolar, cells with syncytial fibrillary cytoplasm, arranged in short curvilinear fascicles and/or storiform patterns. Unusual histological features were seen, which included a few groups of large pleomorphic tumor cells with abundant, glassy, eosinophilic cytoplasm, occasionally associated with multinucleated giant tumor cells, and scattered Herring bodies within the tumor. Immunohistochemically, the tumor showed diffuse strong expression of glial fibrillary acidic protein, S-100 protein, and vimentin. Epithelial membrane antigen immunoreactivity was focally observed, mainly in the large tumor cells. Distinction from other intrasellar tumors (granular cell tumor and pilocytic astrocytoma) is important. Because the immunohistochemical profiles of these tumors are similar, histological findings are crucial for distinction.     

105例尸体解剖的病理学分析

目的：剖析不明原因死亡的疾病分布及引起死亡的原因。探讨死亡所发生的病理学特点及猝死的发生机制。方法：收集不明原因死亡的尸体解剖材料105例,进行组织病理学检验,部分做了法医学的毒物分析。结果：在105例尸检中,21-40岁青壮年81例,为第一高峰,其中病理性死亡81例,暴力性死亡24例,猝死35例;89.5%找到死亡的主要疾病,疾病的分布以心血管最常见,共22例,其次呼吸系统,中毒,神经系统以及其他疾病。结论：科学准确地进行尸体解剖。不但可明确死因。而且丰富和发展相关临床学科的内容。对提高诊治水平具有重要意义。     

多发性大动脉炎主动脉破裂尸检及文献复习

目的探讨多发性大动脉炎的临床、病理学特点及鉴别诊断。方法对1例多发性大动脉炎的尸体解剖病例进行病理学检查并复习文献。结果多发性大动脉炎是主要累及主动脉及其主要分支的全血管性非特异性炎症,以动脉管壁增厚、狭窄为主要特征,急性期无特征性症状,可致节段性内膜剥离,形成致命性夹层动脉瘤。结论多发性大动脉炎急性期无特征性症状,容易误诊,对无明显原因胸痛青年患者应提高警惕。     

The value of autopsy in pediatric cardiology and cardiovascular surgery

Autopsy has been considered extremely helpful in determining the accuracy of the premorbid diagnosis. With recent advances in diagnostic imaging, the value of the autopsy has been called into question. The aim of this study was to assess the value of the pediatric autopsy in the current era of advanced diagnostic technology and sophisticated surgical intervention for congenital heart disease (CHD) and also to determine the autopsy's potential impact on clinical management. We compared the data from the postmortem examination of 29 children with CHD with the data obtained before death and evaluated for the accuracy of the diagnosis of the cardiac anatomy as well as the cause of death. The diagnosis of the anatomy was confirmed in 13 cases (45%), additional cardiovascular abnormalities with potential clinical impact were found in 11 cases (38%), and additional abnormalities without clinical impact were found in 5 cases (17%). The cause of death was confirmed in 15 cases (52%), determined by autopsy in 12 cases (41%), and uncertain in 2 cases (7%). We conclude that the pediatric autopsy continues to provide clinically relevant information with a potential impact on patient management and to reveal unexpected causes of death in a significant proportion of patients with CHD.     

先天性腹壁缺损36例尸体解剖和组织学观察

目的：探讨腹壁缺损的病理形态学变化,方法：对36例腹壁缺损进行尸体解剖,按照Hartwig方法分型,并对24例不同组织和胎盘进行组织学观察。结果：36例腹壁缺损多伴有其它畸形,包括肢体,颜面,神经管,泌尿生殖及消化和心血管系统,腹壁缺损皮肤－膜移行区为复层扁平上皮逐渐向意志层上皮过渡,间质由丰富胶原纤维变为疏松的结缔组织,证实了羊膜外胚层过渡带的存在。5例肾脏和1例脑组织中发策钙化病灶,胎盘表现绒毛发育不同步,绒毛间质水肿或纤维化,有血管增生,血栓形成等变化。部分病例提示有绒毛炎,13例孕母曾有TORCH感染,11例胎儿脏器TORCH PCR－DNA扩增检测阳性,结论：在胚胎腹壁形成期,如果受到某些致畸因素的干扰,除发生腹壁缺损外,还将出现多种复杂畸形,腹壁缺损的致畸因素不能除外TORCH如巨细胞病毒等感染的可能。     

无脾综合征与多脾综合征尸检及文献复习

目的：增强对无脾与多脾综合征的认识。方法：报道我院尸检发现的无脾综合征３例、多脾综合征１例，复习文献、对该综合征的临床病理学特征进行讨论。结果：无脾综合征特征：（１）脾脏缺如；（２）心血管畸形；（３）内脏异位（倾象于右侧内脏结构重复）。多脾综合征特征：（１）多个脾脏；（２）心血管畸形。（３）内脏异位（倾象于左侧内脏结构重复）。结论：无脾与多脾综合征是一种复杂的先天性畸形、罕见、预后差     

心源性猝死33例尸检临床病理分析

目的 分析心源性猝死的临床特点以及尸检病理学特征.方法 收集与医疗纠纷有关的不明原因死亡的87例尸体解剖资料进行病理组织学检查.结果 心源性猝死33例,其中,冠心病20例(占64%),主动脉夹层动脉瘤破裂4例,心肌炎5例,肥厚性心肌病2例,冠状动脉炎和肺动脉脂肪栓塞各1例.结论 正确、系统地进行尸体解剖,可以明确猝死原因,提高医疗质量,并为医疗纠纷鉴定提供可靠的鉴定依据.     

The role of perinatal autopsy in the management of pregnancies with major fetal trisomies

We assessed the value of perinatal autopsy following mid-trimester termination of pregnancy due to major fetal trisomies. Singleton fetuses (n=305) that underwent prenatal sonography and karyotyping during the second trimester of pregnancy and that had trisomy 21, trisomy 18, or trisomy 13 constituted the study population. The findings of second trimester sonography and fetal autopsy were compared. Altogether, 611 separate major structural malformations were diagnosed during autopsy. Full agreement was achieved between sonography and autopsy in 35.8% of the malformations. The additional findings at autopsy (64.2%) involved mainly two organ systems: face, including ears and eyes, and extremities, including hands and feet. Some ultrasound findings were not confirmed at autopsy (n=49). Concordance rates between sonography and autopsy findings regarding soft markers were considerably high in cases of increased nuchal fold thickness and short femur/humerus. On the other hand, fetal autopsy was of limited value as far as hyperechoic bowel and echogenic intracardiac foci are concerned. Pathologic examination provides additional information regarding many fetuses with aneuploidy, and may indicate possible directions of sonographic screening for major chromosome aberrations. However, prenatal sonography and perinatal autopsy should be considered as complementary ways of increasing our knowledge about the possible features of fetal aneuploidies.