Search

This study is based on the bronchial tumors biopsied and later examined between 1971 and 1986 at the Institute of Pathology, Lausanne. In each case the diagnosis based on the initial biopsy material is compared with the final surgical or autopsy diagnosis (Reference: Histological typing of lung tumours, second edition, WHO, 1981, 2). The series studied is constituted by 163 cases: 144 men (88.3%) and 19 women (11.7%). In 136 cases (83.4%), the biopsy diagnoses are identical to the diagnoses based upon surgical or autopsy material; in 27 cases (16.6%) these diagnoses differ. The positive predictive value of bronchial biopsy appears to be excellent (100%) for small cell and epidermoid carcinoma (CA). It is satisfactory for adenocarcinoma (85.7%) but insufficient for large cell CA (42.3%) and the tumors grouped under "others" (50%). The diagnosis of large cell CA, in situ CA, papillary tumor, undifferentiated CA, or carcinomatous lymphangitis should be considered with caution and in some cases it is advisable to repeat the biopsy. The discrepancies between the initial and final diagnoses can, in all cases, be attributed either to the biopsy specimen being too small and therefore nonrepresentative or, less frequently, to crushing and necrosis of the tissues.

In a 22-year old man plasma calcitonin was normal in the basal state but elevated to 2.6 ng/ml after stimulation with calcium and pentagastrin. Two other family members had had bilateral pheochromocytoma accompanied by medullary carcinoma of the thyroid in one case and by adenomas of the parathyroid glands in the other. The literature of Sipple's syndrome, the value of calcitonin assay and the grounds for screening in affected families are reviewed. Surgery (total thyroidectomy) confirmed the clinical suspicion of C-cell hyperplasia and medullary microcarcinoma of the thyroid gland. Hyperplasia of the parathyroid glands was also found.

While over the past decades tuberculous morbidity and mortality have steadily declined in Switzerland, tuberculosis has not been eradicated. The present study investigates tuberculosis in an autopsy material. From 1961 to 1985 severe active tuberculosis was seen in 1.9% of autopsies performed; pulmonary tuberculosis accounted for 54% and miliary tuberculosis 35.3%. The majority of cases of severe active tuberculosis were seen in the elderly. Clinically undiagnosed cases made up 44% of the cases. A constant decrease in severe active tuberculosis has been seen over the years, but clinically undiagnosed cases are on the increase.

In a retrospective study 159 cases (1.8%) of myocarditis--7 pediatric--were found among 8663 consecutive autopsies. In 5 cases the diagnosis had been suspected clinically. In 68 cases (42%) it was possible to determine the etiology: 61 cases of septic myocarditis were found, including 4 mycotic, and 4 cases of toxoplasmosis. In 91 cases (58%) the myocarditis was idiopathic. Idiopathic myocarditis was firmly established as cause of death in 10 cases. In the other cases there appeared to be a relation between the extent of the myocardial infiltrate and probable involvement of the process as cause of death.

The criteria for the use of liver biopsy as a diagnostic tool were retrospectively analyzed over a ten-year period in 390 consecutive patients. The four principal conditions in which this procedure was employed were alcoholism (33%), hepatitis (18%), abnormal hepatic tests (16%) and tumors (10%). The development of new, "non-invasive", investigative methods such as echography and tomodensitometry has led to an decrease in the number of liver biopsies performed annually, but no change in the relative frequency of the various indications. In this paper, evidence is presented which demonstrates that hepatic biopsy confirmed the clinical diagnosis in 62.4% of the cases reviewed and fundamentally modified the diagnosis in 20.2%. Based upon these findings, it can be concluded that liver biopsy remains an indispensable diagnostic procedure in the field of hepatology, since it can result in modification of the clinician's diagnosis in one out of five cases.