Clinical Histopathological Correlation Research Articles

The innovation of AI-based software in oral diseases: clinical-histopathological correlation diagnostic accuracy primary study

BackgroundMachine learning (ML) through artificial intelligence (AI) could provide clinicians and oral pathologists to advance diagnostic problems in the field of potentially malignant lesions, oral cancer, periodontal diseases, salivary gland disease, oral infections, immune-mediated disease, and others. AI can detect micro-features beyond human eyes and provide solution in critical diagnostic cases.ObjectiveThe objective of this study was developing a software with all needed feeding data to act as AI-based program to diagnose oral diseases. So our research question was: Can we develop a Computer-Aided Software for accurate diagnosis of oral diseases based on clinical and histopathological data inputs?MethodThe study sample included clinical images, patient symptoms, radiographic images, histopathological images and texts for the oral diseases of interest in the current study (premalignant lesions, oral cancer, salivary gland neoplasms, immune mediated oral mucosal lesions, oral reactive lesions) total oral diseases enrolled in this study was 28 diseases retrieved from the archives of oral maxillofacial pathology department. Total 11,200 texts and 3000 images (2800 images were used for training data to the program and 100 images were used as test data to the program and 100 cases for calculating accuracy, sensitivity& specificity).ResultsThe correct diagnosis rates for group 1 (software users), group 2 (microscopic users) and group 3 (hybrid) were 87%, 90.6, 95% respectively. The reliability for inter-observer value was done by calculating Cronbach’s alpha and interclass correlation coefficient. The test revealed for group 1, 2 and 3 the following values respectively 0.934, 0.712 & 0.703. All groups showed acceptable reliability especially for Diagnosis Oral Diseases Software (DODS) that revealed higher reliability value than other groups. However, The accuracy, sensitivity & specificity of this software was lower than those of oral pathologists (master’s degree).ConclusionThe correct diagnosis rate of DODS was comparable to oral pathologists using standard microscopic examination. The DODS program could be utilized as diagnostic guidance tool with high reliability & accuracy.

Failing categorization of severe COVID-19 ARDS into ventilatory subphenotypes studied via the clinical-histopathologic relationship

BackgroundCategorization of severe COVID-19 related acute respiratory distress syndrome (CARDS) into subphenotypes does not consider the trajectories of respiratory mechanoelastic features and histopathologic patterns. This study aimed to assess the correlation between mechanoelastic ventilatory features and lung histopathologic findings in critically ill patients who died because of CARDS. MethodsMechanically ventilated patients with severe CARDS who had daily ventilatory data were considered. The histopathologic assessment was performed through full autopsy of deceased patients. Patients were categorized into two groups according to the median worst respiratory system compliance during ICU stay (CrsICU). ResultsEighty-seven patients admitted to ICU had daily ventilatory data. Fifty-one (58.6%) died in ICU, 41 (80.4%) underwent full autopsy and were considered for the clinical-histopathological correlation analysis. Respiratory system compliance at ICU admission and its trajectory were not different in survivors and non-survivors. Median CrsICU in the deceased patients was 22.9 ml/cmH2O. An inverse correlation was found between the CrsICU and late-proliferative diffuse alveolar damage (DAD) (r = −0.381, p = 0.026). Late proliferative DAD was more extensive (p = 0.042), and the probability of stay in ICU was higher (p = 0.004) in the “low” compared to the “high” CrsICU group. Cluster analysis further endorsed these findings. ConclusionsIn critically ill mechanically ventilated patients, worsening of the respiratory system compliance correlated pathologically with the transition from early damage to late fibroproliferative patterns in non-survivors of CARDS. Categorization of CARDS into ventilatory subphenotypes by mechanoelastic properties at ICU admission does not account for the complexity of the histopathologic features.

Etiology of Kidney Diseases With Proteinuria in the Gambia/West Africa.

In West Africa, kidney diseases are frequently seen, but diagnostic and therapeutic options are poor due to limited access to specialized facilities. To unravel the etiology and develop clinical guidelines, we collected clinical data and results of kidney biopsies in 121 pediatric and mostly young adult patients with edema and proteinuria in The Gambia. Workup included clinical examination, urine and serum analysis, and kidney biopsy findings. Selected cases were treated with steroids.ResultsThe median age was 14.9 years (range 1.8–52.0) at presentation. The most frequent underlying histologies were post-infectious glomerulonephritis (PIGN) in 38%, focal-segmental glomerulosclerosis (FSGS) in 30%, minimal change nephrotic syndrome (MCNS) in 15%, and membranous glomerulonephritis (MGN) in 10% of cases. Patients with PIGN were significantly younger and had less proteinuria and higher serum albumin levels than the other three. Infected scabies was seen more often in cases with PIGN. Clinical parameters could not distinguish patients with FSGS, MCNS, and MGN. Steroid response was prompt in patients with MCNS (remission in 10/10 cases) compared to FSGS (4/19) and MGN (0/4). In summary, the clinical histopathological correlation allows a better approach to therapy and can be the basis for urgently needed interventional studies in steroid-resistant cases.

From SARS-CoV-2 hematogenous spreading to endothelial dysfunction: clinical-histopathological study of cutaneous signs of COVID-19

BackgroundTo date, very few studies on clinical-histopathological correlations of cutaneous disorders associated with COVID-19 have been conducted.Case presentationThe Case 1 was a 90-year-old man, who tested positive for SARS-CoV-2 from a nasopharyngeal swab. Two days later, he was hospitalized and after eleven days transferred to Intensive Care Unit. A chest CT showed bilateral ground-glass opacities. Just that day, an erythematous maculo-papular rash appeared on trunk, shoulders and neck, becoming purpuric after few days. Histological evaluations revealed a chronic superficial dermatitis with purpuric aspects. The superficial and papillary dermis appeared edematous, with a perivascular lympho-granulocytic infiltrate and erythrocytic extravasation. At intraepithelial level, spongiosis and a granulocyte infiltrate were detected. Arterioles, capillaries and post-capillary venules showed endothelial swelling and appeared ectatic. The patient was treated with hydroxychloroquine, azithromycin, lopinavir-ritonavir and tocilizumab. Regrettably, due to severe lung impairment, he died.The Case 2 was a 85-year-old man, admitted to Intensive Care Unit, where he was intubated. He had tested positive for SARS-CoV-2 from a nasopharyngeal swab two days before. A chest RX showed bilateral atypical pneumonia. After seven days, a cutaneous reddening involving trunk, upper limbs, neck and face developed, configuring a sub-erythroderma. Histological evaluations displayed edema in the papillary and superficial reticular dermis, and a perivascular lymphocytic infiltrate in the superficial dermis. The patient was treated with hydroxychloroquine, azithromycin, lopinavir-ritonavir and tocilizumab. Sub-erythroderma as well as respiratory symptoms gradually improved until healing.ConclusionsThe endothelial swelling detected in the Case 1 could be a morphological expression of SARS-CoV-2-induced endothelial dysfunction. We hypothesize that cutaneous damage could be initiated by endothelial dysfunction, caused by SARS-CoV-2 infection of endothelial cells or induced by immune system activation. The disruption of endothelial integrity could enhance microvascular permeability, extravasation of inflammatory cells and cytokines, with cutaneous injury. The Case 2 developed a sub-erythroderma associated with COVID-19, and a non-specific chronic dermatitis was detected at histological level. We speculate that a purpuric rash could represent the cutaneous sign of a more severe coagulopathy, as highlighted histologically by vascular abnormalities, while a sub-erythroderma could be expression of viral hematogenous spreading, inducing a non-specific chronic dermatitis.

Comparison of major appendicitis scoring systems on the clinical-histopathological correlation

Aim: We aimed to investigate the predictive value of the four most popular scoring systems, such as Modified Alvarado, Raja Isteri Pengiran Anak Saleha Appendicitis, Tzanakis, and Lintula, for histopathologically proven acute, phlegmonous, and gangrenous/perforated appendicitis. Materials and Methods: We retrospectively reviewed the results of 239 patients who underwent appendectomy between 2016 and 2019 in our department. The patients' demographic data, surgery method, histopathological results of the specimens (uncomplicated acute appendicitis, phlegmonous, and gangrenous/perforated appendicitis) were recorded. The predictivity of Modified Alvarado, Raja Isteri Pengiran Anak Saleha Appendicitis, Tzanakis, and Lintula scoring systems according to the histopathological results was compared.Results: The modified Alvarado scoring system showed statistically significant efficacy in the preoperative distinction of acute, phlegmonous, and gangrenous/perforated appendicitis. Although the Raja Isteri Pengiran Anak Saleha Appendicitis and Tzanakis score systems are effective in acute and gangrenous/perforated differentiation, they did not show statistically significant efficacy between acute and phlegmonous appendicitis. The Lintula scoring system was the weakest among the four and did not show statistically significant efficacy in the distinction of all three diagnoses.Conclusion: The diagnosis of acute appendicitis is easier with the use of scoring systems. Scoring systems can also help signal advanced stage and complicated forms of acute appendicitis, such as phlegmonous and gangrenous/perforated appendicitis. The modified Alvarado was the most correlated scoring system with histopathological results.

Erythroderma: a clinico etiological study of 77 patients in a tertiary care centre in Kerala

<p class="abstract"><strong>Background:</strong> Erythroderma is defined as generalized erythema and scaling of the skin affecting more than 90% of body surface area. Identification of the underlying disease process represents one of the most complex challenges in proper patient care.</p><p class="abstract"><strong>Methods:</strong> A retrospective study was done in Department of Dermatology in a Tertiary Care Centre. History, clinical findings and investigations of erythroderma patients were recorded and clinic-histopathological correlation was analyzed by kappa coefficient (К).<strong></strong></p><p class="abstract"><strong>Results:</strong> Erythroderma was more prevalent in elderly males with a mean age of 64.56 years and a male to female ratio of 3:1. A clinical evidence of pre-existing dermatoses was found in 65 patients, commonest being eczema (41.3%) followed by psoriasis (40.3%). Evidence of a trigger was seen in 54.54% patients, commonest being the use of ayurvedic medications (42.8%). Clinico-histopathological correlation was seen in 53.9% cases.</p><p class="abstract"><strong>Conclusions:</strong> Although the clinical presentation of erythroderma is similar, etiological factors are varied and it depends largely on the population studied. Most commonly, erythroderma is due to generalization of pre-existing dermatoses as seen in our study. Hence careful evaluation of clinical clues and histopathological correlation plays a pivotal role in diagnosis of the primary cause and the effective management of erythroderma.</p>

The history of an eye-Investigation of enucleated eyes

Avariety of findings can be obtained from enucleated eyes, which provide the ophthalmologist with information with respect to the effectiveness, improvement options and of course also the possible complications of surgical interventions. Representative for many important findings, relevant clinical and ophthalmopathological findings are presented and discussed on the basis of three enucleated eyeballs. Clinical histopathological correlation of three enucleated eyeballs. Enucleated eyeballs typically exhibit advanced changes in different tissues making it sometimes difficult to draw direct conclusions about the original surgical interventions. Nevertheless, many findings on the pathophysiology of different diseases, on wound healing and also on the surgical procedures can be deduced, as shown here in three different cases of epithelial invasion, historical retinal surgery and an endogenous fungal endophthalmitis. Each enucleated eye should be histopathologically examined and under consideration of the clinical history in order to understand the course of the disease and to use the knowledge gained for the treatment of future patients.

Histopathological features of thrombotic microangiopathies in renal biopsies

Background: Thrombotic microangiopathy (TMA) is a morphologic lesion characterized by thrombi occluding microvasculature related to endothelial injury. Objectives: This study aimed to assess the association between histopathological findings and etiology of TMA. Patients and Methods: This cross-sectional study comprised a sample of 34 patients who underwent renal biopsy and received an initial TMA diagnoses resulting in 29 definitive TMA cases. We evaluated the TMA features and clinical histopathological correlation. Results: The most frequent etiologies were atypical hemolytic uremic syndrome (aHUS) (n= 10; 34.5%), hemolytic uremic syndrome caused by Shiga toxin-producing Escherichia coli (STECHUS) (n=6; 24.1%) and secondary causes of TMA (n= 12; 41.4%). We found the following histological features; patients with aHUS had thrombi in 60% of biopsies, membranoproliferative glomerulonephritis (MPGN)-like pattern in 20% and ischemia in 20%; patients with STEC-HUS had thrombi (14.3%), MPGN-like pattern (14.3%), endothelial swelling (14.3%) and ischemia (57.1%); patients with secondary etiologies had thrombi (58.3%), endothelial swelling (16.7%), ischemia (16.7%) and MPGN-like pattern (8.3%). Conclusions: The distribution of classic TMA findings was not related to etiology in spite of microthrombi having been found mostly in aHUS and secondary etiologies, whereas ischemia was found mainly in STEC-HUS. We did not find a histopathological pattern to each etiology of TMA.

Clinical and epidemiological profile of patients with early stage mycosis fungoides

Background:Mycosis fungoides is the most common form of primary cutaneous lymphoma, with an indolent, slowly progressive course and 88% five-year survival rate. The diagnosis is challenging, especially in the early stages, and usually relies on a good clinical-histopathological correlation. Objective:The aim was to establish the clinical and epidemiological profile of patients with early-stage mycosis fungoides. Methods:This was a retrospective cross-sectional observational study with an exploratory analysis. Outcome variables were disease progression and mycosis fungoides-related death. Results:One hundred and two patients were included. The majority were white males, with a mean age of 55.6 years. Mean time from onset of lesions to diagnosis was 51.08 months. The majority of patients were classified as IB stage according to TNMB. Mean follow-up time was 7.85 years. Disease progression was seen in 29.4% of the patients. Death related to the disease occurred in 7.9% of patients. Plaque lesions, involvement of more than 10% of the body surface, altered lactate dehydrogenase and beta-2-microglobulin, and stage IB were significantly associated with disease progression, and altered lactate dehydrogenase and beta-2-microglobulin also correlated with higher frequency of deaths. Study limitations:Small sample and retrospective design. Conclusions:The clinical and epidemiological profile of patients with early-stage mycosis fungoides in our sample corroborates reports in the literature. Diagnostic delay in our series is also consistent with previous findings, but the rate of disease progression, despite treatment, was higher than reported in the literature.

Are classification criteria for vasculitis useful in clinical practice? Observations and lessons from Colombia.

IntroductionIdiopathic systemic vasculitis represents a group of clinical entities having non-specific etiology with the common characteristic of acute or chronic inflammatory compromise of the small and large vessels walls, associated with fibrinoid necrosis.ObjectivesTo describe the most common inflammatory vascular diseases in a long historical cohort of patients from San Juan de Dios Hospital located in Bogota, Colombia using two different systems and a clinical histopathological correlation format, and to make a comparison between them.MethodsWe reviewed all previously ascertained cases of vasculitis confirmed by biopsy processed between 1953 and 1990, and systematically collected data on all new cases of vasculitis from 1991 to 1997 at the Hospital San Juan de Dios (Bogota – Colombia). The cases were classified in accordance with the Chapel Hill Consensus criteria, and the system proposed by J.T. Lie.ResultsOf 165,556 biopsy tissue specimens obtained during this period from our hospital, 0.18% had vasculitis, perivasculitis or vasculopathy. These included 304 histopathological biopsies from 292 patients. Cutaneous leukocytoclastic vasculitis (64 histological specimens) was the most frequently encountered type of "primary" vasculitis followed by thromboangiitis obliterans (38 specimens), and polyarteritis nodosa (24 specimens). Vasculitis associated with connective tissue diseases (33 specimens) and infection (20 specimens) were the main forms of secondary vasculitis, a category that was omitted from the Chapel Hill consensus report. We found that 65.8% of our histopathological diagnoses could not be classified according to the Chapel Hill classification, and 35.2% could not be classified according to the classification of Lie. Only 8.9% of cases remained unclassified by our system after clinical and histological correlation.ConclusionCurrent vasculitis classification schemes are designed for classification, rather that diagnosis of disease and do not adequately address some common forms of inflammatory vascular diseases, including those of infectious etiology and unusual etiology seen in clinical practice. Based on our clinical experience, we suggest a classification outline which practitioners can use which emphasizes correlation of the clinical picture to the histopathology findings for diagnosis and therapy, which may promote better clinical practice and standardization for clinical trials.

Granular parakeratosis – a clinical-pathological correlation of 10 cases

Granular parakeratosis describes chronic skin lesions within the intertriginous areas that demonstrate microscopically parakeratosis together with retention of keratohyalin granules within a thickened stratum corneum. Granular parakeratosis is rarely diagnosed, since it is still relatively unknown within the differential diagnoses of intertriginous eruptions, and a skin biopsy is required for diagnosis. In order to gain insight into the clinical-histopathologic correlation, we present 10 cases of granular parakeratosis. The files of the DermatoHistologisches Labor Dr. H. Laaff, Freiburg, were searched for the diagnosis of granular parakeratosis. Identified cases were evaluated for clinical information and histopathologic characteristics. From 2004 to 2007 10 cases (7 women, 3 men) of granular parakeratosis were found corresponding to a frequency of 0.004%. The average age was 62 (33-82). In women lesions occurred in submammary region (4), axillae (2) and popliteal fossa; in men, groin (2) and genital region. Clinically two different patterns are recognized--lichen planus-like red-brown slightly hyperkeratotic or scaly papules, and larger plaques which are either bright red shiny or grey-brown with lichenification. Histologically the typical granular parakeratosis was seen in a prominently thickened stratum corneum. It remains unclear whether granular parakeratosis is a disease entity or whether it reflects a reaction pattern to unknown stimuli.

Juvenile pityriasis rubra pilaris: Report of 28 cases in Taiwan

Pityriasis rubra pilaris (PRP) is a papulosquamous dermatosis uncommon in juveniles. Large-scale studies are limited, especially from Asian countries. We sought to analyze the clinical manifestations of juvenile PRP in Taiwanese patients and compare them with reported series in the literature. The diagnosis of juvenile PRP was made based on clinical-histopathologic correlation. The therapeutic response and disease course were followed up by re-examination of the patients or by telephone. A total of 47 patients were identified, with histopathologic confirmation of the clinical diagnosis of juvenile PRP in 28 cases. A preponderance of Griffiths' type IV PRP (85.7%) rather than type III PRP (14.3%) was found. Palmoplantar hyperkeratosis appeared to be a cardinal feature. In patients with type IV PRP, skin lesions in areas other than the elbows/knees and palms/soles were common. Treatment with systemic acitretin in 6 patients failed to effect a dose- or time-dependent improvement. In contrast with other studies, two thirds of our patients with type III and IV juvenile PRP had a protracted course lasting more than 3 years. This study was a retrospective review. Patient compliance with treatment was frequently poor. Type IV juvenile PRP predominated but our cases showed a wider distribution of skin lesions than is typically described. When children present with an acute onset of diffuse palmoplantar hyperkeratosis, a diagnosis of juvenile PRP should be considered. Because of the divergent clinical manifestations of juvenile PRP in different populations, there is a need to modify and re-evaluate classification systems based on regional differences.

Actinic Keratoses and the Incidence of Occult Squamous Cell Carcinoma

BACKGROUND The ability to clinically diagnose actinic keratoses (AKs) lesions has been taken for granted for some time. The importance of the malignant potential of these lesions is well known. However, a recent Phase IV, multicenter study assessing the long-term benefit of aminolevulinic acid–based photodynamic therapy provided a unique opportunity to prospectively examine the clinical histopathologic correlation of AKs. OBJECTIVE The objective was to characterize the histopathology of clinically diagnosed AK lesions in the study population. METHODS Punch biopsies of 220 clinically diagnosed untreated AKs were performed at baseline plus 51 lesions unresponsive to treatment (total, 271). RESULTS Clinical diagnosis and histopathologic findings agreed in 91% (246/271) of the lesions biopsied. The balance of the biopsied lesions were: (1) benign changes 4% (11/271) and (2) occult cutaneous malignancy in 5% (14/271) of the cases, 12 squamous cell carcinomas and 2 basal cell carcinomas. CONCLUSIONS In this study, about 1 in 25 clinically diagnosed AK lesions identified by board-certified dermatologist investigator(s) were occult early-stage squamous cell carcinomas on histologic assessment, a fact surmised by the medical community that until now had not been well quantified. These findings should be considered when clinicians decide how to treat and manage AK patients.

Actinic Keratoses and the Incidence of Occult Squamous Cell Carcinoma: A Clinical?Histopathologic Correlation

The ability to clinically diagnose actinic keratoses (AKs) lesions has been taken for granted for some time. The importance of the malignant potential of these lesions is well known. However, a recent Phase IV, multicenter study assessing the long-term benefit of aminolevulinic acid-based photodynamic therapy provided a unique opportunity to prospectively examine the clinical histopathologic correlation of AKs. The objective was to characterize the histopathology of clinically diagnosed AK lesions in the study population. Punch biopsies of 220 clinically diagnosed untreated AKs were performed at baseline plus 51 lesions unresponsive to treatment (total, 271). Clinical diagnosis and histopathologic findings agreed in 91% (246/271) of the lesions biopsied. The balance of the biopsied lesions were: (1) benign changes 4% (11/271) and (2) occult cutaneous malignancy in 5% (14/271) of the cases, 12 squamous cell carcinomas and 2 basal cell carcinomas. In this study, about 1 in 25 clinically diagnosed AK lesions identified by board-certified dermatologist investigator(s) were occult early-stage squamous cell carcinomas on histologic assessment, a fact surmised by the medical community that until now had not been well quantified. These findings should be considered when clinicians decide how to treat and manage AK patients.

Clinical-histopathological correlation in a case of Coats' disease

BackgroundCoats' disease is a non-hereditary ocular disease, with no systemic manifestation, first described by Coats in 1908. It occurs more commonly in children and has a clear male predominance. Most patients present clinically with unilateral decreased vision, strabismus or leukocoria. The most important differential diagnosis is unilateral retinoblastoma, which occurs in the same age group and has some overlapping clinical manifestations.Case presentationA 4 year-old girl presented with a blind and painful right eye. Ocular examination revealed neovascular glaucoma, cataract and posterior synechiae. Although viewing of the fundus was impossible, computed tomography disclosed total exsudative retinal detachment in the affected eye. The eye was enucleated and subsequent histopathological evaluation confirmed the diagnosis of Coats' disease.ConclusionGeneral pathologists usually do not have the opportunity to receive and study specimens from patients with Coats' disease. Coats' disease is one of the most important differential diagnoses of retinoblastoma. Therefore, It is crucial for the pathologist to be familiar with the histopathological features of the former, and distinguish it from the latter.

013 Clinical-histopathologic correlation of ovarian tumors of probable endometriotic etiology

013 Clinical-histopathologic correlation of ovarian tumors of probable endometriotic etiology

Clinical-Histopathologic Concordance of Tumors of the Nervous System at the Manuel Velasco Suárez National Institute of Neurology and Neurosurgery in Mexico City

When making a diagnosis, the main purpose of clinicians should not be to achieve certainty, but to decrease diagnostic uncertainty in order to make optimal therapeutic decisions. Diagnostic concordance is an essential characteristic if a measurement is to be considered scientific. In the case of tumors of the nervous system (TNS), one of the most accurate diagnostic tests is magnetic resonance imaging. However, histopathologic analyses are essential, because they refine the diagnosis, benefit the patient, and improve our understanding of the disease. By determining the clinical-histopathologic correlation of TNS in one of the main neurologic centers in Mexico, we sought to project reliable morbidity and/or mortality statistics. To assess clinical and histopathologic diagnostic agreement in cases involving TNS admitted to the Manuel Velasco Suárez National Institute of Neurology and Neurosurgery between 1990 and 1999. Cross-sectional diagnostic concordance study, including all clinical hospital records of patients with histopathologically diagnosed TNS, classified according to World Health Organization criteria. Among 2041 TNS cases, the 3 most frequent types were those affecting the neuroepithelial tissue (32.9%), tumors of the sellar region (29.2%), and tumors of the meninges (25.6%). We found that, overall, clinical-histopathologic concordance for these 3 categories was substantial and statistically significant. Tumors of the nervous system constitute a heterogeneous group of neoplasms. In the present study, clinical diagnoses substantially agreed with pathologic diagnoses. The a priori clinical diagnosis allowed prompt treatment even before diagnostic confirmation by histopathologic analysis, which is the best way to confirm, clarify, and correct a diagnosis.

Five cases of calciphylaxis and a review of the literature

Calciphylaxis is a rare phenomenon of cutaneous necrosis that typically occurs in association with renal failure and has a poor prognosis. We report 5 new cases of calciphylaxis that illustrate the important clinical and histopathologic features of the disease. All patients had end-stage renal failure at the time that purpuric plaques and nodules were noted; these subsequently progressed to necrotic ulcers with eschars. All skin biopsy specimens showed varying degrees of calcification of the medial layer of blood vessel walls in the dermis and subcutaneous fat. Neither the product of serum calcium and phosphorus concentrations nor parathyroid hormone levels correlated temporally with the clinical observations in every case, emphasizing the importance of clinical-histopathologic correlation. Although certain features of calciphylaxis in humans resemble the animal model originally proposed, there are also some crucial differences. We review the pathogenesis, epidemiology, clinical and histopathologic features, and treatment of this disease. (J Am Acad Dermatol 1999;40: 979-87.)

Clinical-histopathological correlations of pitfalls in middle ear surgery.

Significant anatomical variations within the middle ear are described as well as atypical histopathological findings in 13 selected human temporal bones. Bones studied included such vascular and bony abnormalities as carotid artery canal dehiscence, a high jugular bulb, persistent stapedial artery and facial nerve canal dehiscences. Bones also included obliterative otosclerosis, malleus head fixation and a variety of chronic inflammatory changes and/or sequelae. Those features considered to render cases prone to complications are detailed.

Piffalls in middle ear surgery: A clinical histopathological correlation

Piffalls in middle ear surgery: A clinical histopathological correlation