Search

Zakladnim patologickým projevem covid-19 je intersticialni pneumonie charakteru difuzniho alveolarniho poskozeni. Od DAD/ARDS z jiných přicin ma vsak několik zvlastnich histopatologických rysů: v plicnim parenchymu se casto nachazeji soucasně vsechna stadia DAD - akutni, subakutni i chronicke; ve vsech typech plicnich cev (mikrocirkulaci, tepnach i žilach) bývaji destickove a fibrinove tromby s tvorbou plicnich infarktů; zanět ma výraznou hemoragickou složku - prokrvaceni plic; jsou přitomny atypicke pneumocyty II. typu; v kapilarach se nachazeji zvlastni megakaryocyty; elektronmikroskopicky lze prokazat v buňkach viry; je výrazna tendence k bakterialni ci mykoticke superinfekci. V srdci jsou při covid-19 patologicke nalezy caste, zatim vsak nebyla prokazana žadna specificka reprodukovatelna histopatologie covid-19 myokardialniho poskozeni. Fatalni myokarditida je vzacna. Přicinou myokardialniho postiženi je nejspise toxický a kardiodepresorický vliv mediatorů zanětu, ktere jsou excesivně zvýsene při těžkem průběhu onemocněni.

A group of 279 adult autopsy patients (66 obese with BMI 30, versus 213 nonobese with BMIlt; 30) was retrospectively studied for the relation between body weight and coronary artery atherosclerosis. In the obese group, there was slightly higher grade of coronary narrowing than in the nonobese (2.31/2.5 versus 2.12/2). With increasing BMI in the obese, there was a statistically significant trend for milder coronary atherosclerosis, with least involvement in the extremely obese (BMIgt; 50). It seems that increased body weight by itself has little impact on coronary atherosclerosis, and extreme obesity may even by protective from it.

The aim of this paper is dual — to review the relevant literature on pathology of radiation induced heart disease (RIHD), and to present an illustrative case of our own. Therapeutic ionizing radiation, such as that used in the treatment of Hodgkin´s lymphoma and cancers of left breast, lungs, esophagus, and thymus, can cause cardiac damage that may take several years to manifest. The spectrum of RIHD is broad and includes [1] pericarditis and pericardial effusion; [2] endocardial fibrosis and valvular dysfunction; [3] nonischemic myocardial fibrosis; [4] obstructive coronary artery disease with resultant myocardial ischemia; [5] damage to the great vessels; and [6] conduction system dysfunction. Pericardial disease, however, is the most common manifestation of mediastinal irradiation. A case is described of a typical RIHD in a 52-year-old female who died from heart failure with a history of mediastinal neuroblastoma operated and irradiated at the age of 9 years. Her autopsy heart lesions comprised chronic and acute pericarditis with constrictive features, myocardial fibrosis with features of restrictive cardiomyopathy and fibrosis with calcification of the left heart valves. As a unique lesion, there were small calcifications in the mural endocardium and in the large arterial intima. This finding seems to be diagnostic for RIHD.

The authors present results of our center retrospective study comparing autopsy findings from years 1929 (n=275) and 1989 (n=974). The male to female ratio was very similar in both cohorts (1.3:1 in 1929 and 1.4:1 in 1989). The age range in 1929 was 0-88 years with median of 50 years, whereas in 1989, the age range was 0-98 year and median was 65 years. Among lethal diseases in 1929 were namely infections and infectious complications - 61 % of all patients (out of these, 18 % were tuberculosis cases), neoplasms (12 %) and cardiovascular disorders (6.5 %). In 1989, malignant neoplasms were most frequent (31 %), followed by cardiovascular disorders (21 %) and infections (4.6 % - out of these, tuberculosis represented only 0.6 %). Our study is unique by comparing two well documented autopsy cohorts in a single center from two years being 60 years apart. The study clearly demonstrates dramatic changes in healthcare achieved during the 20th century.

During the entire 19th century, Czech lands (Bohemia and Moravia) were part of the Austrian Empire (from 1867, Austrian-Hungarian Monarchy). Obviously, there used to be quite frequent migration of Czechs of all social groups towards Austria, particularly to the capital Vienna. It is estimated that in the year 1900, from the 1.6 million inhabitants of Vienna, there were 250-300 thousand Czechs. And this tendency concerned also medicine. In this paper, the most important Czech-born medical personalities working in Vienna in the 19th century will be briefly presented-in pathology Wagner, Rokitansky, Kolletschka, and Dlauhy; in internal medicine Skoda, Oppolzer, Duchek, and Chvostek; in surgery Pitha and Albert; in physiology and ophthalmology Prohaska; in pediatrics Bednar; and in dermatology Hebra.

Background Calcific aortic valve stenosis (CAVS) is the most frequent acquired heart valve disease in the developed world and the most common cause of heart valve replacement, particularly in older adults. It is considered a form of atherosclerosis and, like the latter, of inflammatory pathogenesis. Methods The incidence and severity of features of chronic inflammation (vascularization, cellular infiltration, bone metaplasia, calcification) in surgically resected semilunar cusps of a tricuspid aortic valve in 100 patients with CAVS were assessed. A novel method of placing metal clips during the operation by the surgeon to distinguish individual cusps was implemented, allowing the pathologist to associate lesions to particular cusps. The findings were evaluated statistically. Results The median age of the cohort was 73 years. There was a male predominance of 3.5:1. Almost all the patients had a medical history of risk factors – hypertension (92x), diabetes (51x), and dyslipidaemia (85x). Statistical evaluation of the pathological findings showed that the left cusp was least affected by calcification, vascularization, and chronic inflammation, compared to both the right and non-coronary cusps. On the other hand, the left cusp was the most common site of bone metaplasia. The reason for these differences is unknown. We speculate about mechanobiological effects of abnormal hemodynamics. Conclusions Chronic inflammation plays a significant role in pathogenesis of CAVS. Distinguishing the resected aortic valve cusps by placing metal clips is a useful method to study potential differences (topography) in the pathology of individual cusps.

Iatrogenic hydrophilic polymer embolization (HPE) is an underrecognised complication of endovascular procedures. In certain instances, HPE and related complications may lead to patiens death. Incidence of this phenomenon is not known. We evaluated retrospectively all autopsies of patients with a history of endovascular intervention performed by one pathology resident during a period of 8 months. There were 10 cases, which were examined histochemically and in polarized light. We detected HPE in 2 of the 10 cases. In both cases the involved organ were lungs. Hydrophilic polymer embolization is a potential and easy-to-miss complication of endovascular procedures. It must be considered during histological examination of autoptic material.

Deep venous thrombosis and pulmonary thrombembolism are referred to as venous thrombembolism. Pulmonary thrombembolism affects the right ventricle. Two morphologically and clinically distinct conditions are distinguished according to change of blood pressure and speed of blood pressure increase in the pulmonary artery - acute and chronic cor pulmonale. Acute cor pulmonale develops during rapid increase (within seconds) of blood pressure in the pulmonary artery. Morphologically, the condition leads to dilatation of the right ventricle and clinically to sudden cardiac death or severe circulatory instability. Chronic cor pulmonale represents myocardial hypertrophy of the right ventricle as a response to the gradually increasing pressure in the pulmonary artery. Herein, we demonstrate a rare case report of right ventricular myocarditis in a 51-year-old woman with pulmonary thromboembolism and morphological signs of chronic pulmonary hypertension. This non-infectious myocarditis is histologically characterized by myocardial damage (myocytolysis) and dominant histiocytic and neutrophil infiltration accompanied by scanty T-lymphocytes. These inflammatory changes differ from those associated with myocardial infarction. The possible pathological mechanisms of right ventricular myocarditis induced by pulmonary thrombembolism are discussed.

Herein we present a single institution 5-year experience with ascending aorta dissection biopsies depicting the clinicopathological features of 62 cases. To detect microscopic abnormalities in the aortic wall beside the dissection itself, we applied a new histopathological classification scheme from the consensus documents issued by The Society for Cardiovascular Pathology and The Association for the European Cardiovascular Pathology in 2015 and 2016. The most common finding was medial degeneration (MD) - 61 cases (98.4%); atherosclerosis (AS) was found in 19 aortae (30.6%), and chronic aortitis- giant cell pattern described in one aorta (1.6%). The medial degeneration constituents included mucoid matrix accumulation, smooth muscle cells and elastic fibers abnormalities, and medial fibrosis. The consensus document application led to increased MD reporting compared to older studies and to our previous experience, probably due to assessing more subtle and focal changes such as intralamellar fibrosis, intralamellar mucoid matrix accumulation, and loss of smooth muscle cell nuclei- these changes being also the most common MD abnormalities we are reporting. We have compared the results in patients with bicuspid (n = 7; 11.3%) versus tricuspid (n = 55; 88.7%) aortic valve, suggesting no significant differences except for translamellar fibrosis, which appeared to be more severe in the bicuspid valve group (p = 0.0397). The results might imply similar histopathological findings regardless of the aortic valve cuspidity in aortic dissection. These findings are in contrast to ascending aorta dilation (aneurysm), where more severe medial degeneration changes have been described in patients with the tricuspid aortic valve.

In developed countries, calcific aortic stenosis (CAS) has become the most common acquired valvular disease and reason for aortic valve replacement. It is considered a form of atherosclerosis and, like the latter, of inflammatory origin, with presence in the calcified aortic valves of blood vessels, lymphatics, lymphocytes, plasma cells, histiocytes, and sometimes also of metaplastic bone tissue. This study is aimed at examining the presence of CD117 - positive mast cells in CAS. In 56 examined calcified aortic valves excised by cardiac surgery, mast cells were constantly present as a part of the polymorphous cellular infiltrate; in individual cases, their numbers were 1-90 (median 24). The numbers were significantly higher in the congenitally malformed/bicuspid valves (median 40) than in the tricuspid ones (median 20). In valves with presence of metaplastic bone, mast cells were significantly more numerous (median 42) than in those without metaplasia (median 20). In 12 normal aortic valves obtained at autopsies, the numbers of mast cells were 4-21 (median 11). Discussed is a possible role of mast cells in pathogenesis of CAS.

Background The composition of intra-arterial clots might influence the efficacy of mechanical thrombectomy (MT) in ischemic stroke (IS) due to the acute occlusions within large cerebral arteries. The aims were to assess the factors associated with blood clot structure and the impact of thromboembolus structure on MT using stent-retrievers in patients with acute large artery IS in the anterior circulation.Methods and Results:In an observational cohort study, we studied the components of intra-arterial clots retrieved from large cerebral arteries in 80 patients with acute IS treated with MT with or without i.v. thrombolysis (IVT). Histology of the clots was carried out without knowledge of the clinical findings, including the treatment methods. The components of the clots, their age, origin and semi-quantitative graded changes in the architecture of the fibrin components (e.g., "thinning") were compared via neuro-interventional, clinical and laboratory data. The most prominent changes in the architecture of the fibrin components in the thromboemboli were associated with IVT (applied in 44 patients; OR, 3.50; 95% CI: 1.21-10.10, P=0.02) and platelet count (OR, 2.94; 95% CI: 1.06-8.12, P=0.04). Conclusions In patients with large artery IS treated with the MT using stent-retrievers, bridging therapy with IVT preceding MT and higher platelet count were associated with significant changes of the histological structure of blood clots.

Multiple giant aneurysms involving the coronary arteries are uncommon and rarely reported. In the presented case, a 63-year-old man with poorly controlled hypertension died suddenly. Gross autopsy examination showed multiple giant thrombus-filled coronary artery aneurysms, atherosclerotic coronary artery disease, and cardiomegaly. Histological sections of the coronary aneurysms showed atherosclerotic changes with both organized and fresh thrombus. Giant coronary aneurysm is defined as a segmental enlargement of a coronary artery with a diameter exceeding 20 mm or more. The main etiology of this nebulous entity is attributed to atherosclerosis and inflammatory or inherited connective tissue disorders with the remainder being congenital, infectious, or idiopathic. Before its cataclysmic presentation, when ruptured or thrombosed, giant coronary aneurysm usually has a silent clinical course. Sudden death owing to giant multiple coronary aneurysms is rare and mandates careful classification of the aneurysms and prudent search for autoimmune-mediated or genetically based factors for subsequent ancillary autopsy studies.

In this paper, we report the autopsy findings of a 42-year-old White male who was found deceased at his home by his brother in the early morning hours with a history of excessive alcohol consumption 1 day before his death. A medical record review revealed chronic alcohol use with alcohol dependence syndrome, hypertension, and cardiac arrhythmias by electrocardiogram 2 years prior. External examination revealed only a single bruise on the forehead. Internal examination revealed changes associated with chronic alcohol abuse and mild atherosclerosis. The lack of a cause of death at autopsy resulted in a dissection of the cardiac conduction system and the detection of a small cystic lesion at the atrioventricular node region. Microscopic examination revealed a cystic tumor of the atrioventricular node and fibromuscular dysplasia of the coronary artery branches near the sinoatrial and atrioventricular nodes. Based on the case history and autopsy findings, death was attributed to a fatal cardiac arrhythmia due to cystic tumor of the atrioventricular node with fibromuscular dysplasia of the coronary artery branches near the sinoatrial and atrioventricular nodes a possible contributing factor.

Reinhard Heydrich died on 4 June, 1942, eight days after assassination attempted on him in Prague by two members of the Czechoslovak army in Great Britain. The text of his autopsy report became available only in 2004. From the pathologist's view, the autopsy and the report show several unusual features: - The autopsy was performed early, only some 4 hours after death. - It was performed not in an autopsy room, but in the hospital director's office. - There was only a partial autopsy; the head and the neck organs were not examined. - The report lacks description of external examination; only the operation wounds are described. - The weights of the organs are not given. - And particularly: The autopsy did not reveal the cause of death.

Isolated thoracic aortitis (ITA) is diagnosed in a variable proportion of patients operated on for dilation/aneurysm of ascending aorta. The etiopathogenesis of ITA remains unclear. We studied 11 cases of ITA in order to determine the role of IgG4-mediated immune responses in its pathogenesis. The series included nine women and two men aged 52–79 years. All patients developed aortic incompetence due to dilation/aneurysm of ascending aorta. None of the patients had a history of IgG4-related disease neither did they develop features of such disease during the follow-up period. The microscopic findings included the presence of lymphoplasmacellular fibrosing infiltrate of varied intensity involving the adventitia and media of aorta. This inflammation was associated with severe medial elastic fiber defects. Obliterative phlebitis of the vasa vasorum was absent. Immunohistochemically, the inflammatory infiltrate comprised T- and B-lymphocytes as well as plasma cells. The plasma cell population was polyclonal with a predominance of IgG-producing cells. In all the cases, IgG4-producing plasma cells were detected. In five cases, the count exceeded 20 cells per high-power field. The IgG4/IgG ratio ranged from 0.07 to 0.98 (median 0.55). In six cases with the ratio >0.50, severe adventitial fibrosis was present. To the best of our knowledge, ours is the first study focused on investigating the role of IgG4-positive plasma cells in the development of ITA. Our results suggest that a subset of ITA may represent aortic manifestation of IgG4-related disease. Further research is necessary in order to clarify this issue.

A unique case of myocardial infarction due to coronary artery tumor embolism from colonic adenocarcinoma is described. A 79-year-old man with a history of rectal carcinoma with lung metastases 15 years and 9 years before, respectively, was subjected to primary percutaneous coronary intervention for myocardial infarction with aspiration of a thrombus from the occluded artery. The retrieved material contained fragments of adenocarcinoma tissue. To the best of our knowledge, this is the first reported case of adenocarcinoma coronary embolism diagnosed during life from coronary artery aspirate.

Eur J Clin Invest 2011; 41 (5): 487–497 Abstract Background Despite the importance of myocardial vasculature in many pathological conditions, little information is available about cardiac and coronary lymphatic vessels in normal and pathological conditions. Materials and methods Vasculature was assessed by immunohistochemistry with CD 31 and lymphatic endothelium with markers podoplanin and LYVE-1 in 16 children and 20 adult autopsy hearts. Valve biopsies were collected from eight adults. Results The highest number of lymphatics was found in valves in infective endocarditis, where they accounted nearly 100% of all vessels in certain areas. An increased number of lymphatics was also found in degenerative calcified stenosis, whereas the number was reduced in myxoid degeneration. Lymphatics grew in areas rich in extracellular matrix, whereas inflammatory cell–rich areas were more prone to angiogenesis. Progressive atherosclerotic lesions rich in calcium and cholesterol crystals revealed increased lymphangiogenesis in media. The highest number of myocardial lymphatics was found in epicardium of ischaemic hearts in both acute and chronic phase. Additionally, an increased number of lymphatics accompanied myocarditis and acute myocardial infarction. Conclusions The highest number of lymphatics was found in valves in infective endocarditis. Increases in lymphatics also accompanied major cardiac pathological changes, such as acute and chronic ischaemia, progressive atherosclerosis, myocarditis and hypertrophy. Thus, blocking of excess lymphangiogenesis might be useful in progressive atherosclerosis, whereas stimulation of lymphatic vascular growth and function might be useful in cardiac hypertrophy and heart failure.

Pulmonary hypertension is clinically defined as a pulmonary arterial pressure greater than 25 mmHg at rest or greater than 30 mmHg during exercise. We report a unique case of an infant with congenital heart disease causing pulmonary hypertension and necrotizing pulmonary arteritis but affecting only one lung. In conclusion, in pulmonary valve atresia, the lungs may be supplied via aortopulmonary collaterals. Necrotizing pulmonary arteritis is a severe lesion seen in irreversible pulmonary hypertension.

Objective: Isolated atrial amyloidosis (IAA) is associated with atrial tachyarrhythmias. However, only a few studies have appraised atrial tachyarrhythmias and atrial depolarization abnormalities in connection with high-grade IAA. We conducted a collaborative retrospective study to assess this association. Methods: One hundred consecutive autopsied hearts were studied histologically for IAA. To increase the specificity for atrial depolarization abnormalities in this preliminary study, we excluded those specimens with intermediate amyloid involvement, i.e. IAA grades 1 and 2 (grade 0 = absent or trivial deposits; grade 1 = small deposits; grade 2 = moderate deposits; grade 3 = dense, large deposits). We then screened for baseline, premortem electrocardiograms (ECGs) to assess rhythm. In those with sinus rhythm, the P wave axis, duration, dispersion and terminal force in V1 were determined under magnification. Results: Of the 27 premortem ECGs corresponding to the autopsy specimens with grades 3 (sample) or 0 (controls) IAA, 9 showed sinus rhythm, 13 showed atrial fibrillation, 1 showed atrial flutter and 4 were uninterpretable. Fourteen autopsied hearts (52%) were positive for grade 3 IAA. Ten of those had atrial tachyarrhythmias (9 atrial fibrillation and 1 atrial flutter) compared to 4 of the 13 hearts with grade 0 IAA (72 vs. 31%, respectively; p = 0.03). Although there was excellent interobserver agreement using intraclass correlation coefficients, there were no significant differences in P wave measurements among the small number of patients with sinus rhythm for grade 3 versus grade 0 IAA. Conclusion: In a collaborative, preliminary, pilot assessment of autopsied hearts for which premortem ECGs were necessarily screened retrospectively, significantly more hearts with high-grade IAA were associated with atrial tachyarrhythmias compared to those with low-grade IAA. A larger study with an appropriately matched autopsy control group is needed to confirm these and previous observations.

Background The clinical diagnosis of pulmonary thromboembolism (PE) is notoriously inaccurate, with many cases either wrongly diagnosed (overdiagnosed) or missed (underdiagnosed), and autopsy is still regarded as the diagnostic “gold standard.” Unfortunately, statistics from recent, larger autopsy studies are scarce and, moreover, the results of such studies are often controversial. Methods The autopsy incidence of PE from 1960 to 2005 was retrospectively reviewed. Results In the six reference years 1960, 1970, 1980, 1990, 2000, and 2005, a total of 3877 adult autopsies were performed. PE was found in 628 patients; the overall incidence of PE in the six reference years was 16.2%. The incidence showed a steady decline, from 19.2% in 1960 to 10.0% in 2005. It was higher in women (19.4%) than in men (13.7%). The average age at the time of death for all 628 patients with PE was 65.9 years (64.3 in men; 67.3 in women). It showed a tendency to increase over the period studied, from 63.7 years in 1960 to 69.6 years in 2005. We also assessed variation of PE deaths throughout the year. The incidence was highest in November (21.4%) and lowest in May (11.1%) and in March (12.1%). Conclusions Our results confirm those of most pathological studies, in that the autopsy incidence of PE is declining. In patients dying with PE, the underlying causes have been more or less the same over the 45 years covered by this study. Despite the progress in clinical diagnostic approaches, PE remains an ill-diagnosed condition.

Isolated atrial amyloid (IAA), one of the most common members of the family of age-related ("senile") amyloids, seems to play a role in the pathogenesis of atrial fibrillation. Patterns of IAA deposition were histologically studied in the hearts of 100 elderly patients. The incidence (%) and severity (grade 0-3) of atrial IAA deposits increase with age, from 75% incidence and 0.50 average grade in patients aged 51-60 years, to 86% incidence and 1.49 average grade in those aged 81-90 years. Deposits are more pronounced in females (88% incidence, 1.45 average grade) than in males (68% incidence, 0.79 average grade). Left atrial deposits are more pronounced (78% incidence, 1.25 average grade) than right atrial deposits (67% incidence, 1.09 average grade). The distribution of IAA in the walls of the left atrium is uneven, with deposits being more pronounced in the anterior wall than in both the posterior wall and the left appendage. IAA deposits are heavier (1.34 average grade) in patients with chronic atrial fibrillation than in those with sinus rhythm (1.01 average grade); the difference, however, lacks statistical significance. Hypertension, diabetes mellitus, hypertrophy of the heart, coronary atherosclerosis, and dilatation of the atria show no significant relationship to the incidence or severity of atrial amyloidosis.

A 54-year-old lady presented with a mass in the left atrium causing an acute mitral valve pseudo-stenosis. The tumour mass was assumed to be a myxoma. The patient was scheduled for tumour mass extirpation to clear the obstruction of the mitral orifice. Histological finding from the acquired specimen showed a leiomyosarcoma, as a rare primary malignant cardiac tumour.

Karl Rokitansky was born on 19th February 1804 in the historic Czech town of Hradec Králové (Königgrätz). During 1821–1824 he studied for 3 years at the medical faculty of Prague University. In the archives of Charles University there is a record of Rokitansky’s performance during these three years. At the university he met J. E. Purkyně who was teaching anatomy at that time. Relationship between the two world – renowned medical scientists of Czech origin is discussed.

Thrombus aspiration in the setting of primary percutaneous coronary intervention is a recently recommended technique that facilitates thrombus removal from the culprit lesions in acute myocardial infarction (AMI) patients. Thrombectomy specimens from 50 patients with symptoms of AMI lasting usually not more than 12 h were examined by methods of routine histology, immunohistochemistry (IHC), and electron microscopy (ELMI). In 36 patients, there were fresh thrombi, in 10 older thrombi (8 of them with simultaneous presence of a fresh thrombi) and in 3 atheroma material only (in additional 7 patients atheroma material was admixed to the thrombi), and in one patient, there was carcinoma embolus. To help to distinguish between fresh and older thrombi, we recommend IHC (presence of macrophages and endothelia) and ELMI (loss of density of the erythrocyte matrix and presence of macrophages). On the other hand, changes of neutrophils (IHC degranulation/lysis) and of platelets (ELMI degranulation) appear early and thus contribute little to distinguishing between fresh and older thrombi. It could be concluded that, in a substantial proportion of patients with AMI, there is a discrepancy between duration of the symptoms and microscopic picture of the coronary thrombus. The thrombus may apparently be symptomless for a period of days or even weeks.

Background and aim: Isolated thoracic aortitis (ITA) is a newly-defined pathological entity with a still-unknown etiopathology and with some potential relationship to IgG4-related systemic dis- ease. We investigated patients on whom the ascending aorta was operated to identify the clinical and histopathological features of ITA and its relationship to IgG4-related systemic disease. Methods: Two hun- dred fifty-one patients underwent replacement of the ascending aorta. Retrospective review of all his- tological reports was done to identify noninfectious aortitis. Immunohistochemical analysis of resected specimens was performed in all cases. Results: We found 11 (4.4%) patients with noninfectious aorti- tis aged 52 to 79 years; nine of the patients were female. All patients underwent ascending aorta re- placement. The 30-day mortality was 0. During the follow-up period (median 12 months) four patients died (two of them because of progression of aortic disease). None of the seven living patients devel- oped any IgG4-related diseases, and all had normal serum levels of IgG and IgG4. Conclusions: Surgi- cal treatment of ITA has acceptable short- and mid-term results. Because follow-up serum levels of IgG and IgG4 were normal in survivors, postoperative corticosteroid therapy may not be indicated in pa

Calcific aortic valve disease is considered a form of atherosclerosis and, like the latter, possibly of inflammatory origin. The aim of our work was to study the pattern of cellular infiltrate in calcific aortic valve stenosis (CAS). Fifteen operatively excised calcified aortic valves were examined by histology and immunohistochemistry (CD20, CD79α, CD3, CD4, CD8, CD68, CD138, CD117, BJK, BJL, IgA, IgD, IgG, IgG4 and IgM). The findings revealed that in CAS, there were chronic inflammatory features with infiltrates comprising lymphocytes, polyclonal plasma cells, histiocytes and mast cells. In T-lymphocytes, CD4 prevailed over CD8. In B-lymphocytes, there was a slight preponderance of CD20 over CD79α. The BJL (lambda)-positive plasma cells prevailed over the BJK (kappa) ones. The CD138-positive plasma cells comprised 24% IgA-, 20% IgD-, 41% IgG- (including 11% of IgG4-) and 15% IgM-positive cells. CAS did not fulfill the criteria of the recently described clinicopathological entity IgG4-related sclerosing systemic disease. The inflammatory process was the same in both subsets of CAS - those with trileaflet (normally formed) valves and those with congenitally bicuspid valves.

Summary Background Knowledge about the distribution of human papillomavirus (HPV) genotypes in invasive cervical cancer is crucial to guide the introduction of prophylactic vaccines. We aimed to provide novel and comprehensive data about the worldwide genotype distribution in patients with invasive cervical cancer. Methods Paraffin-embedded samples of histologically confirmed cases of invasive cervical cancer were collected from 38 countries in Europe, North America, central South America, Africa, Asia, and Oceania. Inclusion criteria were a pathological confirmation of a primary invasive cervical cancer of epithelial origin in the tissue sample selected for analysis of HPV DNA, and information about the year of diagnosis. HPV detection was done by use of PCR with SPF-10 broad-spectrum primers followed by DNA enzyme immunoassay and genotyping with a reverse hybridisation line probe assay. Sequence analysis was done to characterise HPV-positive samples with unknown HPV types. Data analyses included algorithms of multiple infections to estimate type-specific relative contributions. Findings 22 661 paraffin-embedded samples were obtained from 14 249 women. 10 575 cases of invasive cervical cancer were included in the study, and 8977 (85%) of these were positive for HPV DNA. The most common HPV types were 16, 18, 31, 33, 35, 45, 52, and 58 with a combined worldwide relative contribution of 8196 of 8977 (91%, 95% CI 90–92). HPV types 16 and 18 were detected in 6357 of 8977 of cases (71%, 70–72) of invasive cervical cancer. HPV types 16, 18, and 45 were detected in 443 of 470 cases (94%, 92–96) of cervical adenocarcinomas. Unknown HPV types that were identified with sequence analysis were 26, 30, 61, 67, 69, 82, and 91 in 103 (1%) of 8977 cases of invasive cervical cancer. Women with invasive cervical cancers related to HPV types 16, 18, or 45 presented at a younger mean age than did those with other HPV types (50·0 years [49·6–50·4], 48·2 years [47·3–49·2], 46·8 years [46·6–48·1], and 55·5 years [54·9–56·1], respectively). Interpretation To our knowledge, this study is the largest assessment of HPV genotypes to date. HPV types 16, 18, 31, 33, 35, 45, 52, and 58 should be given priority when the cross-protective effects of current vaccines are assessed, and for formulation of recommendations for the use of second-generation polyvalent HPV vaccines. Our results also suggest that type-specific high-risk HPV-DNA-based screening tests and protocols should focus on HPV types 16, 18, and 45. Funding Spanish grants from Instituto de Salud Carlos III, Agencia de Gestio d'Ajuts Universitaris i de Recerca, Marato de TV3 Foundation, and unrestricted grants from GlaxoSmithKline Biologicals, Sanofi Pasteur MSD, and Merck.

A case is presented of a 43-year-old man who died suddenly and unexpectedly from cardiac malignant arrhythmia. Autopsy revealed isolated coronary arteritis involving primarily the left coronary stem and extending into the proximal half of its anterior descending branch. The most striking feature of the disease was marked fibrous periarteritis. Similar changes were present segmentally in the peripheral third of the right coronary artery, and also as small isolated foci of adventitial fibrosis in the aortic base. With some hesitation, we classify the case as coronary Takayasu's arteritis.

Nonbacterial thrombotic endocarditis (NBTE) is a well-known complication of hypercoagulable states, particularly in patients with malignancies. Its complications comprise thrombembolism rather than valvular dysfunction. We present a case of a 71-year-old man treated for colonic carcinoma, who died 1 month after tumor resection with clinical signs of respiratory failure. Ante mortem, there was no suspicion of cardiac disease. The autopsy revealed NBTE affecting all four cardiac valves simultaneously, as well as multiple systemic and pulmonary thrombemboli. Microscopically, neither microorganisms nor inflammation were found in the thrombi and/or valve tissues. To the best of our knowledge, this is the fourth case of quadri-valvular NBTE reported in the English-written literature so far.

In a series of 1,177 patients with surgical valve resection, there were 128 (10.9%) patients with the histological finding of bone and/or cartilage formation (bony metaplasia; heterotopic ossification) in the excised valve (119 aortic, 9 mitral). The incidence was higher in men (12.8%) than in women (8.5%). The bony metaplasia was always associated with valvular calcification. The metaplastic changes were encountered in all types of calcific aortic valve disease (senile, bicuspid valve, post-rheumatic). The marrow of the heterotopic lamellar bone was mostly composed of adipose tissue. Frequently, it showed chronic inflammation with polyclonal plasmocytic infiltration. Complete haematopoiesis was present only rarely.

Atrial fibrillation (AF) is triggered by ectopic beats originating from extensions of the left atrial myocardium over the pulmonary veins (PVs), so-called myocardial sleeves. A total of 100 hearts (393 PVs) obtained at autopsy were studied. Of these, 50 were from patients with chronic AF and 50 from controls in sinus rhythm. Out of a total of 393 PVs studied, a sleeve was present in 349 PVs (88.8%). The myocardial sleeves frequently harboured senile atrial amyloid and scarring. These two changes were evaluated semi-quantitatively (grade 0-3). Amyloidosis was found in 68% of all hearts and in 55% of all sleeves. It was more frequent in patients with AF (58.5%) than in those without (51.7%), however, without statistical significance (p values 0.948, 0.306, 0.166 and 1). Scarring was present in all 349 sleeves studied. It was significantly more severe in patients with AF (average grade 2.44) than in those without (average grade 2.00) (p values

A case is presented of a 70-year-old man treated for 3 months for necrotizing pancreatitis with multiorgan failure. The autopsy revealed enterococcal endocarditis affecting all eleven valvular cusps of the four heart valves.

Gross presence of the embryonic pattern of myoarchitecture and of a sinusoid blood supply was found in the apical part of the left ventricle in a man who had been diagnosed with nonobstructive hypertrophic cardiomyopathy during life and who died suddenly at age 21 years. This is a first description of this finding in an adult with an otherwise normal heart and coronary arteries. The features of the cardiac lesions provide support for the current embryological views on ontogenesis of human myocardial structure and blood supply.

The precise relationship between nonbacterial thrombotic endocarditis (NBTE) and infective endocarditis (IE) remains to be clearly established, some believing that IE might develop from NBTE once the latter becomes secondarily infected during bacteremia. To compare the features of the two lesions, 175 cases of NBTE and 145 cases of IE encountered in more than 25,000 autopsies performed over a period of 24 years (1970-1993) were reviewed, and the relevant clinical, pathological, and bacteriological findings assessed. The results show that IE is a genuine suppurative infection of cardiac valves ab initio, whereas, in NBTE, inflammation is lacking and the lesion is a result of a usually paraneoplastic disturbance of thrombosis/thrombolysis.