Value Of Histological Examination Research Articles

The Utility and Scope of Forensic Histopathology.

Forensic histopathology is the use of histology to aid in the identification of disease and injuries in forensic pathology practice. The value of routine microscopy has been challenged in various studies and discussions have taken place in forensic journals about how useful microscopic diagnosis is in medicolegal autopsies. This paper reviews the literature on the value of histological examination in forensic practice and discusses routine histochemical stains that can be used in postmortem examinations to aid in the diagnosis and add value by confirming or refuting macroscopic findings.

CIN III Diagnosed following Surgical Termination of Pregnancy.

We present a case of a 30-year-old mother of four who was incidentally diagnosed with cervical intraepithelial neoplasia (CIN) III following surgical termination of pregnancy. Five years previously a routine smear test had shown mild dyskaryosis but was never repeated. She was referred to colposcopy and, underwent loop excision of the transformation zone (LLETZ) and subsequently vaginal hysterectomy. Without this incidental finding she would have undoubtedly developed cervical cancer. We discuss the deficiencies in current cervical cancer prevention strategies and termination of pregnancy services. We emphasise the importance of ensuring that patients with dyskaryosis are not lost to follow-up and we consider whether there should be clearer guidance on the value of histological examination of products of conception following termination of pregnancy.

Infection fœtale à cytomégalovirus de diagnostic autopsique : à propos d’un cas

The cytomegalovirus (CMV) is the most common maternal-fetal transmission infectious disease. The diagnosis of this infection is rarely made on antenatal sonographic signs. Pathological examination could, in this case, make etiologic diagnosis. We report the case of a terminated pregnancy, at the term of 19 weeks of gestation, occurring in a 31-year-old woman. The sonography found a terminated pregnancy with anamnios. Histological examination of samples of fetal internal organs showed intranuclear inclusions, compatible with CMV infection. The main objective of our work is to emphasize the value of histological examination in the diagnosis of fetal death etiology. Moreover, we will discuss the benefit of antenatal screening of CMV maternal infection.

Sudden Cardiac Death due to Giant Cell Inflammatory Processes*

Granulomatous inflammation of the myocardium may occur in a number of systemic disease processes including those with infectious etiologies such as fungal, mycobacterial and parasitic infections, as well as hypersensitivity reactions, and rarely autoimmune disorders. In many of these disorders, giant cells are components of the inflammatory infiltrate. Systemic granulomatous processes of unknown pathogenesis, most notably sarcoidosis, may also be associated with involvement of the myocardium. Occasionally, these disorders are associated with sudden death due to pathologic involvement of the heart. In contrast, giant cell myocarditis, also known as idiopathic myocarditis, a rare, frequently fulminant and fatal disorder of unknown etiology, is isolated to the heart and lacks systemic involvement. This disorder is most commonly diagnosed at autopsy. We present two cases in which sudden death resulted from a giant cell inflammatory process affecting the myocardium. Both individuals lacked antemortem diagnoses and collapsed at their respective places of employment. These cases compare and contrast the clinical and pathologic issues involved in the differential diagnoses of the subgroup of sudden cardiac deaths resulting from giant cell inflammatory processes that affect the myocardium, as well as the value of histologic examination and immunohistochemical studies.

The value of histological examination in the audit of hospital autopsies: A quantitative approach

The aims of this study were to compare the clinical with autopsy diagnoses, to evaluate the role of histological examination in the pathological diagnoses and to assess the new pathological diagnoses uncovered by autopsy. We aimed to obtain quantitative assessment of the sensitivity, specificity and accuracy of clinical diagnoses. The guidelines for postmortem reports by the Royal College of Pathologists (1993) were implemented for reports used in this study. These guidelines are similar in intent to those of the College of American Pathologists. Complete macroscopic and histological studies of 108 (53 females) autopsies were analysed. The mean age was 78.0+/-9.0 (SD) years (range 54-94 years). The interquartile range (25%ile 75%ile) was 72-84 years, with a median of 79.5 years. Seventy per cent of all causes of death were confirmed by macroscopical and histological examination. Sixty-one clinical diagnoses were inconsistent with the pathological findings. Histological examination contributed significantly to the final diagnosis in major (5%) and minor (6%) clinicopathological as well as new pathological findings (23%). The most common causes of death not suspected clinically were pulmonary embolism (23%), bronchopneumonia (22%), ischemic heart disease (13%) and malignancies (10%). The clinical sensitivity of antemortem diagnoses was 25% for peritonitis and 24% for pulmonary embolism. The overall clinical sensitivity was 54% and specificity 92%. The accuracy of positive diagnosis was 69% and accuracy of negative diagnosis 88%. Unexpected causes of death represented a third of all causes of death reported. Histological examination is an important tool in hospital autopsy audit. A quantitative approach can be used to assess the accuracy of postmortem clinical diagnoses, to identify the possible source of clinical diagnostic weakness, and provide data that may be of use for diagnostic precision in the more difficult clinical subjects.

Cerebral Infarction and Intracranial Arterial Dissection in Closed Head Injury

This report describes the autopsy findings in three cases of closed head injury dying of cerebral infarction, with brain swelling and herniation. In each instance the cause of the infarct was found to be subintimal dissection involving intracranial anterior circulation arteries. The autopsy findings underscore the value of histological examination of vessels that macroscopically appear thrombosed. We discuss factors that impact on the reported incidence and make brief mention of problems surrounding the true pathogenesis of this lesion.

Microscopic Age Changes in the Human Occipital Bone

The value of histological examination of the human occipital bone for estimation of age-at-death was assessed. Undecalcified sections of occipital bone from eighteen male Caucasian subjects between the ages of 21 and 70 years were prepared for analysis using polarized light microscopy. The fractional volumes of primary osteons, secondary osteons, osteon fragments, and lamellar bone in both the outer and inner cortical tables were determined. It was found that with increasing age there is a decrease in the fractional volume of primary osteons and a significant decrease in the fractional volume of lamellar bone. The fractional volume of secondary osteons was not found to change significantly with age, while the fractional volume of osteon fragments significantly increases. The microscopic results reflect the continuous process of bone remodeling that is responsible for the variation in cortical parameters with age and is the primary basis for age predicting methods. While observable changes in the occipital bone do occur with increasing age, the amount of random variation in the parameters examined preclude their use for accurate age estimation.

A clinico-pathological study of cutaneous leishmaniasis in British troops from Belize

Thirty-four cases of cutaneous leishmaniasis contracted by British soldiers in Belize were studied. Pre- and post-treatment biopsies were taken from all patients. The range of histological appearances is described and the value of histological examination (including Giemsa staining and immunohistochemistry), cytological preparations and microbiological culture in diagnosis and clinical management assessed. Histology and culture were found to be complementary techniques in reaching a positive diagnosis, whilst cytological preparations were of no additional value. Histological examination of post-treatment biopsies merely confirmed the clinical impression of healing or non-healing whilst culture identified viable organisms in apparently healed lesions, which were subsequently re-treated.

Evidence of Human Papillomavirus Deoxyribonucleic Acid in Vulvar Squamous Papillomatosis

Squamous papillae of the vulva represent a controversial lesion. Forty-six women with histologically confirmed vulvar squamous papillae and koilocytosis were studied at Chang Gung Memorial Hospital. Vulvar washings were analyzed by the filter in-situ technique using biotin-labeled probes for typing human papillomavirus DNA. Forty of 46 women (87%) were symptomatic. Human papillomavirus (HPV) DNA was detected in 76% (35 of 46) of women, including type 6/11 in 21.7%, type 16/18/31/33 in 45.6%, and both types in 8.6%. Furthermore, intraepithelial neoplasia was found in the epithelium of squamous papillae in two women. This study suggests the potential value of histologic examination and HPV DNA typing in separating anatomic variation from pathologic squamous papillae. We suggest that those squamous papillae with histologic evidence of koilocytosis be designated as squamous papillomatosis.