Annual Of Pathological Autopsy Cases Research Articles

Latent prostate cancer among Japanese males: a bibliometric study of autopsy reports from 1980-2016.

Prostate cancer is one of the most common malignancies, but a substantial portion remains latent throughout the patients' lifetime. Analysis of temporal change in the latent prostate cancer pool would be beneficial for clinical decision-making, but longitudinal autopsy studies are rare. We conducted a hand-search of the Annual of Pathological Autopsy Cases in Japan from 1980 to 2016 for cases of latent prostate cancer. Of 570997 males aged 30 or older, latent prostate cancer was detected in 12562 patients (2.2%). Proportion of detected cases correlated strongly with 'aging rate', the percentage of population aged 65 or older (squared Pearson's correlation coefficient r2=0.972, P value <0.0001). Temporal increase in proportion was also seen in each age group as well. This continuous growth reinforces evidence from past Japanese reports on latent prostate cancer. The rapidly rising ageing rate of Japan may forecast further increase in the latent prostate cancer pool moving forward.

Uterine adenosarcoma in Japan: Clinicopathologic features, diagnosis and management.

Uterine adenosarcoma is a rare malignancy with limited cohort data in Asian countries. This study evaluated the clinicopathologic features of Japanese patients with uterine adenosarcoma and their potential treatment challenges. A retrospective chart review was performed at the National Cancer Center Hospital, Japan from 2000 to 2016. A literature search for Japanese cases of uterine adenosarcoma was conducted using PubMed, Japanese Central Review of Medicine, and the Annual of Pathological Autopsy Cases in Japan. Only histologically confirmed cases of uterine adenosarcoma were included. All collected data were analyzed. A total of 110 cases was identified (6 from our hospital and 104 from the literature review). Most baseline characteristics were similar to those reported in western countries. Death due to the disease was observed in 34% (29/86) of patients, whereas patients with stage IA disease showed a 13% (4/30) recurrence rate and a 3.3% (1/30) mortality rate. Preoperative radiological and pathological examinations occasionally failed to help reach the correct diagnosis. In cases of sarcomatous overgrowth, the recurrence and mortality rates were 45% (9/20) and 35% (7/20), respectively. Distant recurrence occurred in 44% (12/27) of cases, 75% of which included lung metastasis. This study showed the clinicopathologic features of Japanese patients with uterine adenosarcoma and suggested potential solutions for improving prognosis including early treatment based on a timely diagnosis, the development of effective adjuvant therapy for patients at high risk of recurrence, and optimal follow-up focusing on late recurrence and lung metastasis.

Epidemiology of Zygomycosis: Analysis of National Data from Pathological Autopsy Cases in Japan.

To identify recent trends in the frequency of zygomycosis in autopsy cases, we conducted epidemiological analysis every four years from 1989 to 2009 using national data reported in the "Annual of Pathological Autopsy Cases in Japan." 153,615 cases were autopsied, of which 6622 (4.3%) were found to have had mycosis. Among these, there were 243 cases (3.7%) of zygomycosis, which was the fourth most predominant causative agent of mycoses among the monopathogen mycoses. Of the complicated mycoses, zygomycosis accounted for 56 cases. A total of 299 cases with zygomycoses were observed. The frequency of zygomycosis appeared to be generally stable over the twenty-year period from 1989 to 2009, at around 4% of autopsy cases having mycosis. Younger patients tended to have severe and complicated infections that were characteristic of zygomycosis, compared with non-zygomycosis. The pulmonary and gastrointestinal (GI) systems were the most common foci in our analysis, reflecting the severity of zygomycosis in these sites. Hematological disease was the most frequent underlying disease, but there was a peak of neonatal infections in 2009, which was the first time that this was observed in our studies. These results of the epidemiological analysis of autopsy cases with mycosis demonstrate that clinicians should promptly recognize and treat zygomycosis.

Analysis of multiple primary cancer autopsy cases associated with breast cancer: 2002-2010.

Breast cancer patients have a generally increased risk of developing second cancers. The object of this study was to clarify the increased as well as decreased incidence of cancers in breast cancer patients using autopsy cases. 164 211 autopsy cases in the Annual of Pathological Autopsy Cases in Japan from 2002 to 2010 were analyzed for multiple primary cancer (MPC). Female MPC cases (4222 cases) were selected. We investigated the cancer incidence observed in breast cancer associated MPC. The Chi-squared test was used for analysis. All P-values were two-sided, and differences at P < 0.05 were considered significant. Breast cancer associated MPC showed a significantly increased incidence of ovarian, pancreatic, and skin cancer (Odds Ratio [95 % confidence interval (CI)]) = 1.464 [1.03, 2.08], 1.414 [1.08, 1.85] and 2.092 [1.28, 3.41]), and a decreased incidence of colorectal and cervical cancer (OR [95 % CI]) = 0.732 [0.60, 0.90], 0.605 [0.38, 0.96]). Our findings of an increased incidence of malignancies in breast cancer associated MPC cases were consistent with the results of previous population-based studies. This study is the first study to analyze massive autopsy data on MPC which provide new evidence clinically and pathologically.

Epidemiology of visceral mycoses in autopsy cases in Japan: the data from 1989 to 2009 in the Annual of Pathological Autopsy Cases in Japan

To identify recent trends in the frequency of mycoses in autopsy cases, we analyzed, on a four-year basis, the 1989-2009 data in the Annual of Pathological Autopsy Cases in Japan. Of the 13,787 (9235 males) autopsies conducted in 2009, 4.5% (633/13,787) involved fungal infections and of the latter, 60.3% (368/633) were found to have severe clinical manifestations. Among the 610 (96.4%) cases involving a single etiologic angent, the predominant pathogens were Aspergillus (299 cases; 49%) and Candida (184 cases; 30.2%). However, it should be noted that the prevalence of severe aspergillosis and candidiasis has been decreasing. Although the frequency of cases involving zygomycetes seemed to be generally remaining stable from 1989-2009, we noted for the first time a peak in 2009 in such infections in patients less than one year old. Finally, deep-seated infections caused by unidentified fungi would appear to be decreasing over the time of the survey. Our finding, it is hoped, will encourage physicians to actively pursue viscerial fungal infections.

A Half-Century of Autopsy Results

The objectives of this study were to clarify the details of pediatric vasculitic diseases on the basis of Japanese autopsy reports and determine whether there were cases of probable Kawasaki disease (KD) even before KD came to be widely recognized as a disease entity. Systemic vasculitis autopsy cases aged 15 years or less were selected from the total of 1,335,045 autopsy cases listed in the Annual of Pathological Autopsy Cases in Japan from 1958 through 2008. Those cases were classified into 14 disease groups and then analyzed with regard to various details. There were 380 autopsy cases of vasculitis in children (0.03% of the total autopsy cases). More than half were KD, and other diseases included unclassified vasculitis, polyarteritis nodosa, purpuric vasculitis, Takayasu arteritis, etc. The first recorded case of KD autopsy occurred in 1969. Up until 1976 there was a great difference in the number of autopsies between pediatric vasculitis and KD. However, after 1977 their numbers were in close agreement. The autopsy findings for 24 of 125 child vasculitis autopsies performed before 1976 and diagnosed as non-KD were consistent with KD. Although autopsies of pediatric vasculitis cases are extremely rare, the majority consists of KD. Moreover, it is likely that autopsy cases that were probably KD first appeared in the early 1960s.

Benign and malignant tumors in Down syndrome: Analysis of the 1514 autopsied cases in Japan

Down syndrome is known for its association with neoplasms. The aim of this study was to examine this association. We surveyed the association with benign and malignant neoplasms in Down syndrome patients registered in the Annual of Pathological Autopsy Cases of Japan (1974-2000), a database of autopsied cases operated by the Japanese Society of Pathology. In a total of 1514 cases with Down syndrome, there were eight cases with 10 benign tumors (four male and four female) and 104 cases with malignant disorders (61 male, 42 female and one case with unrecorded sex), in which 87 cases with hematopoietic malignancies (83.7%) and 17 cases with solid tumors (16.3%), were identified. The association of gallbladder adenocarcinoma with a benign tumor of the colon was noted in one case, while a further two cases with double benign tumors were confirmed as well. No case with a double malignancy was found. Hematopoietic malignancies (87 cases) included 31 cases (35.6%) with acute myelocytic leukemia, 10 (11.4%) with acute lymphocytic leukemia and two (2.3%) with chronic myelocytic leukemia. The ratio of acute myelocytic leukemia to acute lymphocytic leukemia was 3.1 in the present study. A peak in the age distribution was at 0 years in our data in contrast to the previous data (at 1 year) for myelocytic leukemia. The 17 solid tumors identified included three hepatocellular carcinomas, three extrahepatic cholangiocarcinomas, two gallbladder adenocarcinomas, three brain tumors, and three seminomas. We present new associations of benign and malignant tumors with Down syndrome.

Epidemiology of Visceral Mycoses in Autopsy Cases in Japan: Comparison of the Data from 1989, 1993, 1997, 2001, 2005 and 2007 in &lt;I&gt;Annual of Pathological Autopsy Cases in Japan&lt;/I&gt;

The data on visceral mycoses reported in the " Annual of Pathological Autopsy Cases in Japan " were analyzed epidemiologically every four years from 1989 to 2005, and in 2007. The frequency rates of visceral mycoses dropped sharply between 1989 (4.5%) and 1994 (3.2%), but by 2001 had risen again and have remained (4.4-4.6%) generally stable since then. The predominant causative agents were Candida and Aspergillus. Although the rate of candidosis showed a gradual decrease, the rate of aspergillosis showed an increase by degrees. Furthermore, the rate of aspergillosis exceeded that of candidosis in 1994, and the difference in the rates between the two conditions apparently further increased until 2001. After 2005, however no changes in this difference were observed. For complicated infections, the incidence of coinfection with Aspergillus and Candida showed a decreasing, and that with Aspergillus and Zygomycetes showed an increasing tendency. Severe infections with Zygomycetes showed a clear increase from 57.4% in 1989 to 88.9% in 2007. Comparing underlying diseases with mycoses in 1989 and 2007, leukemia (including myelodysplastic syndrome) decreased from 26.1% to 18.8% and bacterial infections (including interstitial pneumonia) increased from 11.1% to 22.1%. By age, the highest frequency rate of mycoses was observed in the range of 60-79 years, and the frequency rate of exogenous fungal infections such as aspergillosis, cryptococcosis, zygomycosis and trichosporonosis showed an increasing trend in the less than one-year old group.

Maternal death analysis from the Japanese autopsy registry for recent 16 years: significance of amniotic fluid embolism

To clarify the cause of maternal deaths, an autopsy is essential. However, there has been no systemic analysis of maternal death in Japan based on autopsy cases. Maternal death reports were retrieved from a large amount of registered autopsy data on maternal death in the series of 'Annual of pathological autopsy cases in Japan'. These files contain 468,015 autopsy records from 1989 to 2004. We collected 193 cases of maternal death due to direct obstetric causes. We recorded all the data into Excel files. Then we analyzed the causes of death and classified them into 11 categories. The causes of maternal death were as follows: amniotic fluid embolism (AFE), 24.3%; disseminated intravascular coagulation (DIC) related to pregnancy-induced hypertension, 21.2%; pulmonary thromboembolism, 13.0%; injury to the birth canal, 11.4%; medical and surgical complications, 9.8%; and atonic bleeding or DIC of unknown cause, 8.3%. A discrepancy between the clinical diagnosis and pathological diagnosis was frequently observed in cases of AFE, septic DIC and injury to the birth canal. AFE diagnosed by autopsy was often clinically diagnosed as atonic bleeding or DIC of unknown cause before death. Half of the cases of AFE diagnosed by autopsy were associated with DIC. We found that AFE, DIC related to pregnancy-induced hypertension, pulmonary thromboembolism and injury to the birth canal were the major causes of maternal death in Japan. AFE had various clinical features such as uterine atony and DIC in addition to pulmonary cardiac collapse.

Statistical study of lung cancer cases in the Annual of Pathological Autopsy Cases in Japan (1958–1997)

Statistical study of lung cancer cases in the Annual of Pathological Autopsy Cases in Japan (1958–1997)

Lung cancer cases analysis in the annual of pathological autopsy cases in Japan (1958–1989)

Lung cancer cases analysis in the annual of pathological autopsy cases in Japan (1958–1989)

A Statistical Analysis of Lung Cancer Registered in the Annual of Pathological Autopsy Cases in Japan between 1958 and 1987, with Special Reference to the Characteristics of Lung Cancer in Japan

Autopsy cases of lung cancer, 41,988 in males and 13,818 in females, consecutively registered between 1958 and 1987, were analysed statistically and compared with other case materials and mortality statistics. Cases of malignant tumor showed a gradual increase, and now comprise 60% of the total male and 55% of the total female autopsy cases. The percentage of lung cancer cases among the total autopsy cases was 9% for males and 5% for females. The percentage of lung cancer cases among total cases of malignant tumor was about 17% for males and 9% for females. Among fatal malignant tumors, gastric cancer and lung cancer showed the highest frequency. The relative incidence of gastric cancer was seen to decrease, whereas that of lung cancer increased. Of the histological types of lung cancer in both sexes, adenocarcinoma was the most frequent, followed by squamous cell carcinoma. During the period studied the peak age of patients with lung cancer shifted from the seventh to eighth decade, and a significant elevation of mean age was demonstrated for all of the major histological types in both sexes. The male:female ratio for all lung cancer cases was 3.0, which was much lower than those for the United States and Europe, but very similar to the ratios of mortality statistics in Japan and other Asian countries. As a result of a previous autopsy study at the University of Tokyo, it was also confirmed that the male:female ratio relative to age in each country reflects very well the histological distribution.

こう原病の死亡に関する疫学的研究 病理剖検輯報よりみた死亡例の解析

Epidemiological study of autopsy cases of systemic lupus erythematosus (SLE), systemic sclerosis (SS), poly- and dermato-myositis (PD), and periarteritis nodosa (PN) was done by reviewing The Annual of Pathological Autopsy Cases (Nippon Boken Shuho) in Japan during a 7-year period (1972-1978). The result was summarized as follows . 1) Age and sex distribution of autopsy cases of SLE, SS, PD, and PN were well correlated to those of death cases in Vital Statistics Japan from 1972 until 1978 . 2) The total number of autopsy cases reviewed in these 7 years was 180, 350 (107, 931 male, 71, 256 femme; sex not described in 1, 163). Number of cases of collagen disease was calculated as follows. SLE; 90 males (0.08% in total autopsy cases), 667 females (0.94%), SS; 52 males (0.05%), 174 females (0.24%), PD; 99 males (0 .09%), 139 females (0.20%), PN; 72 males (0.07%), 75 females (0 .11%). 3) SLE was the highest in incidence among four groups. The second one was PD . PN was the lowest in incidence. 4) The female to male ratio was 7.9 for SLE, 4.7 for SS, 1.8 for PD, and 1.04 for PN, respectively. 5) The ratio of incompatibility between clinical and pathological diagnoses was the highest in PN. At autopsy, 35 cases (18 males, 17 females) (50.0%) were diagnosed of PN in 70 cases (39 males, 31 females) which were clinically diagnosed of PN. On the contrary, only 35 cases (18 males, 17 females) 23.8%) were clinically diagnosed of PN in 147 cases (72 males, 75 females) which were pathologically diagnosed of PN at autopsy. This result revealed that it was difficult to obtain an accurate clinical diagnosis of PN. 6) The highest incidence of cancer was found in PD, as a complication among all of four groups of collagen disease. Cancer was detected in 53.5% (53/99 males) and 25 .9% (36/139 females) of cases of PD, respectively. In patients older than 50 years of age cancer was recognized in the autopsies of 65.7% of males and 38.2% of females with PD. Secondly, patients with SS showed 9.6% (5/52 males) and 9.2% (15/174 females), respectively. 7) As side effect of steroid administration, atrophy of adrenals was frequently seen at autopsy, particularly in cases of SLE (19%). Opportunistic infection including miliary tuberculosis and fungus infection, also was found in a high incidence.

Cancer in collagen disease. A statistical analysis by reviewing the Annual of Pathological Autopsy Cases (Nippon Boken Shuho) in Japan.

Cases of systemic lupus erythematosus, systemic sclerosis, periarteritis nodosa, and dermato- and polymyositis autopsied in Japan during a recent, 7-year period (1972-1978) were studied to assess the incidence of cancer as a complication. In comparison with the other three groups, cases of dermato- and polymyositis (DP) showed quite a high incidence of malignancy: 53 of 99 for males (53.5%) and 36 of 139 for females (25.9%). In patients older than 50 years of age cancer was recognized in the autopsies of 65.7% of males and 38.2% of females with DP. The stomach was both the primary site and had the highest incidence of cancers in DP (62.3% males, 27.8% females). It was concluded that DP has a strong association with the development of cancer, particularly gastric carcinoma, in Japan.

心筋梗塞と職業の関係

Six hundred and thirty three autopsy cases of acute myocardial infarction (aMI) and same numbers of sex-, age-and residence-matched nonselected control cases of other diseases than MI (non MI) were picked up for their occupational survey, from the 23 vol, annual of pathological autopsy cases in Japan. Eleven kinds of occupations which consisted of A: specialist, B: executive and manager, C: desk worker, D: merchant and salesman, E: farmer, woodman and fisherman, F: miner and constructor, G: porter and postman, H: blue-collar worker, I: police and guardman, J: service worker and K: unclassified according to the Population Census in Japan, and 2 others including unemployed or retired and housewife, totaling 13 kinds were used for analysis. The 13 occupations were further divided into 6 groups as follows, I: mental workers including A and B, II: intermediate workers including C, D, G, I, and J, III: physical workers including E, F and H, IV: unemployed or retired, V: unclassified and VI: housewife, St3tistical analysis of significant difference between 2 groups were applied for the evaluation of the occupational trend in aMI and non MI. The result were as follows:(1) The incidence of aMI in physical workers especially in the farmer, woodman and fisherman is significantly low (p<0.001).(2) The incidence of aMI of unemployed or retired is significantly high in 30-69 year-old group. (p<0.005).(3) The incidence of aMI in the porter and postman, police and guardman is low but there is no statistical significance.(4) The incidence of aMI is high in merchant and salesman, unemployed or retired, executive and manager and service worker but it has no statistical significance.(5) The incidence of aMI·non MI in specialist, desk workers, blue-collar workers, unclassified and housewife is just average.

Histopathologic study of the oral squamous cell carcinoma. VIII. A clinicopathologic study of autopsy cases of carcinoma of the tongue

Forty-two autopsy cases of squamous cell carcinoma of the mobile portion (anterior 2/3) of the tongue was reviewed clinicopathologically and the causes of the failure were studied retrospectively. Thirteen primary lesions (31.0%), even of the T3, T4 stage, were controlled by radiation therapy alone or with chemotherapy, and the effectiveness of the radiation therapy was evaluated. The recurrent tumor, frequently developing from regional lymph node metastases, was resistant to the theray and tended to manifest continuous and diffuse extention, forming a bullky neck tumor. The management of the neck tumor was the most important problem. Rupture of the neck vessels (7.1%) was one of the most serious complications. The incidence of the metastases was higher than that reported in literature. The metastases to the lymph nodes below the level of the clavicle were seen in 42.9% and the hematogenous metastases occurred in 61.9%. Pulmonary infection was the most common complication, being the main direct cause of death in the cachetic state. Five hundred and eighty-four autopsy cases of squamous cell carcinoma of the mobile portion and the base of the tongue collected from the Annual of Pathological Autopsy Cases in Japan were also analyzed.

Indications of an increase of occupational pleural mesothelioma in Japan.

In order to obtain an epidemiological picture of occupational pleural malignant mesotheliomas in Japan, the author surveyed the Annual of Pathological Autopsy Cases (published by the Japanese Pathological Society) from 1974 through 1980. Two hundred and twenty-two malignant mesotheliomas (0.114% of all autopsy cases) were found in that period. One hundred and forty-five cases (0.074%) of them were of pleural origin. Until 1977, there were no pleural malignant mesotheliomas associated with asbestosis, but there were one in 1978, three in 1979 and two in 1980. Two of them were housewives and the others were a ship builder, a welder, a ceramist and a steel factory worker. Two lived in Sakae City, and the others in Kure City, Kaizuka City, Nagasaki City and Kanagawa Prefecture, where large shipyards are located. Compared to the Western countries, there is a time lag of 10 to 20 years in the increase of consumption of asbestos in Japan, where the increase has occurred rapidly after World War II. The epidemiological picture obtained by this study clearly states that the number of occupational pleural malignant mesotheliomas began to increase in the past few years in Japan.

Survey of Thorotrast-Associated Liver Cancers in Japan&lt;xref ref-type="fn" rid="FN2"&gt;2&lt;/xref&gt;

Data on 93 autopsy cases (group A) of thorotrast-associated liver cancers were obtained from the "Annual of Pathological Autopsy Cases in Japan" from 1958 to 1979, and data on 78 autopsy cases (group B) of thorotrast-associated liver cancers were obtained from the Japanese literature from 1953 to 1980. Cholangiocarcinoma (CLC) constituted 58% of group A and 55% of group B. The curve of the cumulative numbers of patients with CLC versus year in group A was almost linear, showing an increasing risk per surviving patients with advancing time. Angiosarcoma (AGS) occurred in 25% of group A and 24% of group B. The number of patients with AGS increased significantly after 1969 in both groups (P less than 0.05). In group B, age and years after thorotrast injection of patients with AGS were statistically higher than those of patients with CLC (age: P less than 0.05; years after thorotrast injection: P less than 0.0001). Hepatocellular carcinoma (HPC) accounted for 17 and 21% of groups A and B, respectively. When yearly distribution, age, and time after thorotrast injection of patients with HPC were correlated with those of patients with other liver cancers, the only statistically significant difference between patients with HPC and patients with CLC (P less than 0.02) was in the years after thorotrast administration. Since 1977 multiple primary liver cancers including AGS developed in thorotrast-administered patients in both groups.

Present state of fungal infections in autopsy cases in Japan.

In order to clarify the present state of opportunistic fungal infections increasing in incidence in autopsy cases, all autopsy cases from 1966 to 1975 reported in the Annual of Pathological Autopsy Cases in Japan were reviewed. Of the total 233,130 autopsy cases, mycoses were present in 4,340 (1.86%). The incidence of mycoses has strikingly increased during the recent five-year period. In Japan, the mycoses most frequently occurring in autopsy cases were candidiasis (32.28%), aspergillosis (23.08%), cryptococcosis (9.63%), and mucormycosis (2.90%). These occurred more frequently in younger persons and were most commonly secondary and deep-seated infections (95.78%). Among the primary diseases associated with mycoses, aplastic anemia (14.36%), leukemia (9.89%), malignant lymphoma (5.73%), multiple myeloma (4.68%), and systemic lupus erythematosus (4.62%) were most frequent. The incidence of the primary diseases associated with mycoses is increasing extraordinarily, and this seems to be strongly related to the modern therapy of using high doses of anticancer or immunosuppressive agents.

Phycomycosis (So-called Mucormycosis)

There are three main problems in the treatment of mucormycosis. First, it is not easy to make a diagnosis while the patient is alive. Second, therapy virtually is impossible because it is mainly found in patients with underlying diseases and it is therefore hard to notice mucormycosis in the terminal stage. And third, there are no good antifungal drugs except Amphotericin B. It should always be administered with care taking side effects into consideration.386 cases of mucormycosis reported in Japan and foreign countries and 76 noted in the Annual of Pathological Autopsy cases in Japan plus our own cases are discussed. Particularly, 81 of those patients showing “good response” showed that the treatment of mucormycosis is not always hopeless if diagnosed in the early stage; treated by Amphotericin B concurrently with the therapy for the underlying disease; and if local and surgical therapy can be performed as long as there are no such lethal underlying diseases as leukemia and malignant carcinoma. But, it is actually difficult to treat most mucormycosis and the problems mentioned above will still remain in the future.