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August 2003
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, however, the value of the autopsy has been called into
question. The authors conducted a study to assess the value of the
pediatric autopsy in this era of advanced diagnostic technology
and sophisticated surgical intervention for congenital heart disease
and to determine the autopsy's potential impact on clinical management.
They compared data from the postmortem examination of 29 children
with congenital heart disease with data obtained before death and
evaluated for the accuracy of the diagnosis of the cardiac anatomy
and cause of death. The diagnosis of the anatomy was confirmed in
13 cases (45 percent); additional cardiovascular abnormalities with
potential clinical impact were found in 11 cases (38 percent); and
additional abnormalities without clinical impact were found in five
cases (17 percent). The cause of death was confirmed in 15 cases
(52 percent), determined by autopsy in 12 cases (41 percent); and
uncertain in two cases (seven percent). The authors concluded that
the pediatric autopsy continues to provide clinically relevant information
that may affect patient management and reveal unexpected causes
of death in a significant proportion of patients with congenital
heart disease.
Sun C-C, Alonsonzana G, Love JC, et al. The value
of autopsy in pediatric cardiology and cardiovascular surgery. Hum
Pathol. 2003;34:491-496.
Reprints: Dr. Chen-Chih J. Sun, Dept. of Pathology, University of Maryland
Hospital, 22 S. Greene St., Baltimore, MD 21201
Mucosal biopsy criteria combined with endoscopy for predicting ulcerative colitis
Recent mucosal biopsy criteria combined with endoscopy differentiate
patients with ulcerative colitis ultimately requiring surgery (UC-S)
from those receiving medication alone (UC-M). The criteria, however,
are inconvenient because of the need for complicated calculations.
Furthermore, the validity has not been verified in other institutions
where the indications for surgery may differ. The authors conducted
a multicenter study to propose simple criteria for performing calculations
by mental arithmetic and to measure their validity. From the original
criteria, the authors constructed simple criteria, including ulceration,
crypt abscesses, ratio of biopsies involved, segmental distribution,
tissue eosinophilia, and endoscopic extent, in which coefficients
and constant were simplified to integral numbers. The criteria consisted
of the diagnostic categories of highest risk, high risk, unpredictable,
low risk, and lowest risk of surgery. The validity of these proposed
criteria was evaluated in 121 patients with UC-S and 186 with UC-M
from 11 institutions. The categories of high risk and low risk had
sensitivities exceeding 86 percent and specificities exceeding 95.2
percent, and the validities were maintained at high levels in most
institutions. There was little difference in validity between the
proposed and original criteria when testing was conducted with the
same patients. The authors concluded that despite simplified coeffiecients
and constant, the proposed criteria predicted the eventual clinical
outcome of patients with ulcerative colitis and would be helpful
in determining the need for surgery.
Tanaka M, Kusumi T, Oshitani N, et al. Validity
of simple mucosal biopsy criteria combined with endoscopy predicting
patients with ulcerative colitis ultimately requiring surgery: a
multicenter study. Scand J Gastroenterol. 2003;38:594-598.
Reprints: Dr. Masanori Tanaka, Dept. of Pathology,
Hirosaki University School of Medicine, 5 Zaifu-Cho, Hirosaki, 036-8562
Japan; masa@cc.hirosaki-u.ac.jp
Distinguishing between two types of breast carcinoma
Inflammatory breast carcinoma (IBC) and noninflammatory locally
advanced breast carcinoma (LABC) are associated with poor prognosis.
To determine whether IBC and LABC are distinct clinicopathologic
entities, the authors compared tumor characteristics, prognosis,
and age-specific incidence rate patterns in the Surveillance, Epidemiology,
and End-Results Program. Age of 50 years served as a surrogate marker
for menopause. Younger age at diagnosis, poorer tumor grade, and
negative estrogen receptors were more predictive of IBC (n=2,237)
than of LABC (n=7,985). Breast carcinoma survival was worse for
patients with IBC than for those with LABC (log-rank test, P<.001).
Age-specific incidence rates for IBC increased until 50 years and
then flattened, whereas rates for LABC increased for all ages. When
rates for LABC were stratified by estrogen receptor-positive (ERP)
and -negative (ERN) expression, rates for ERP increased with advancing
age and rates for ERN flattened after 50 years of age. When rates
for IBC were stratified by estrogen receptor expression, rates for
ERP and ERN flattened after 50 years of age. The authors concluded
that IBC and LABC seem to be distinct biologic entities, as indicated
by different prognostic factor profiles and age-specific incidence
rate patterns. Rates that increased before 50 years of age and then
stabilized possibly indicated that premenopausal exposures had a
greater effect on maintaining rates for IBC than LABC.
Anderson WF, Chu KC, Chang S. Inflammatory breast
carcinoma and noninflammatory locally advanced breast carcinoma:
distinct clinicopathologic entities? J Clin Oncol. 2003;21(12):2254-2259
Reprints: Dr. William F. Anderson, National Cancer
Institute, Division of Cancer Prevention, EPN, Room 2144, 6130 Executive
Blvd., Bethesda, MD 20892-7317; wanderso@
mail.nih.govn
Anatomic pathology abstracts editors
Michael Cibull, MD, professor of pathology and laboratory medicine
and director of surgical pathology, University of Kentucky Medical
Center, Lexington.
Subodh Lele, MD, assistant professor of pathology and laboratory medicine, University of Kentucky Medical Center.
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