College of American Pathologists
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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;

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.