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A simple technic that is useful in clinicopathologic correlation studies is described. It permits postmortem estimation of the amount of myocardium involved in an infarct. Results can be expressed in terms of percentage of the whole heart or percentage of the left ventricle infarcted, or in Gm. of muscle infarcted.

(1958). Clinicopathologic Correlation of Dysfunctional Uterine Bleeding. Postgraduate Medicine: Vol. 24, No. 4, pp. 393-399.

The histologic features of tumor cells before and after hypophysectomy for advanced carcinoma of the breast are presented with concurrent clinical and laboratory data in seven patients. The hormonal influences affecting remission and recurrence are discussed. Changes in the thyroid glands of seventeen patients who had had hypophysectomy are also reviewed.

1. 1. Forty-five cases of “oral white plaque” were studied, correlated as to clinical, cytologic, and microscopic impressions, and divided into groups according to their apparent stimuli. 2. 2. When an apparent etiological agent can be discerned and when the lesion does not present an atypical clinical appearance, there exists a unanimity of impression and histopathologic tissue alteration. 3. 3. When the lesion is atypically located and/or macroscopically irregular in appearance and is associated with an undetermined stimulus, there is a lower percentage of positive consistency of impression as well as a statistically high incidence of dysplasia or carcinoma. 4. 4. The incidence of “leukoplakia” in the oral cavity as confirmed by microscopic diagnosis is low; therefore, it is suggested that the term “leukoplakia” should be reserved for those cases in which the lesion is clinically abnormal in appearance and/or occurs at an unusual site. 5. 5. We believe that a term such as “nonspecific leukokeratosis,” when applied to a clinical impression, should denote a clinical “white plaque” suspected of exhibiting microscopic alterations consistent with a hyperplastic type of response.

An analysis is presented of the histopathologic, clinical, and prognostic features in a series of 405 previously untreated patients with non-Hodgkin’s lymphomas referred to Stanford University Medical Center between 1960 and 1971. .411 biopsies were histologically classified according to the criteria of Rappaport et al. and clinical extent of disease was thoroughly evaluated prior to treatment and staged according to the Ann Arbor Classification. Nodular lymphomas constituted 44% of the group and diffuse lymphomas 56%. Patients under the age of 35 years and those over 60 tended to have diffuse lymphomas. Although 39% of the patients had Stage IV disease at presentation, localized forms (Stage I, I,., 11, 11,) were observed in 37%. Localized extralymphatic involvement occurred more often in patients with diffuse than nodular lymphomas (11 < 0.001). Systemic symptoms occurred in 24% of patients with diffuse and 17% of those with nodular lymphomas; however, their presence did not adversely affect survival. Mediastinal adenopathy was noted in 24% of diffuse and 18% of nodular lymphomas (P = NS), and mediastinal “skipping” was observed in 20% of diffuse and 40% of nodular lymphomas (p < 0.05). By the criteria used, 81% of evaluable patients (Stages I1 through 111,) with nodular lymphoma and 90% of those with diffuse lymphoma had contiguous sites of involvement (p = 0.07). Two frequently observed sites of initial extralymphatic involvement were bone marrow and gastrointestinal; the former was observed more often in advanced lymphocytic lymphomas, whether nodular or diffuse, and the latter in advanced, diffuse lymphomas. Actuarial survival correlated strongly with the histopathologic type of lymphoma; in each cellular category, patients with nodular lymphomas survived significantly longer than those with diffuse lymphomas (1’ < 0.05). Age at presentation also influenced survival in relation to certain histologic patterns. Patients with diffuse lymphocytic or mixed lymphomas who were less than 40 years of age had a worse prognosis than those over 40 (p = 0.02). In contrast, older patients with nodular lymphocytic and mixed lymphomas fared worse than those under 40 (p < 0.01). Patients with either initial bone marrow or gastrointestinal involvement survived longer if their lymphoma had a nodular pattern. It is concluded that histopathologic classification proposed by Rappaport et al. and the Ann Arbor Staging Classification are both useful guides to the management and prognosis of the non-Hodgkin’s lymphomas.

1.1. The experimental aspects of the effect of radiation on the kidneys are briefly reviewed. A summary of the reported cases of radiation nephritis in the literature is presented and the typical clinical syndrome is summarized. 2.2. Three cases of radiation nephritis in which the patients survived are reported. Two adults were studied by means of renal needle biopsy. The third case was a child in whom nephrectomy was performed when a non-functioning left kidney and hypertension developed following massive radiation. 3.3. The pathologic study of end-stage radiation damage to the kidney is reviewed and the earlier, more mild changes are described. 4.4. It is suggested that the apparent rarity of this syndrome is due to a lack of awareness of its existence by the clinician and roentgenologist. It is important to establish the true incidence of this hazard of radiation therapy in order that steps may be taken to prevent its occurrence.

SUMMARY A clinicopathologic correlation with microbiologic observations was performed on resected tuberculous lesions from 19 patients. Four of the 19 patients were considered as controls. Fourteen of the remainder had received from 4 to 12 months of chemotherapy preoperatively and showed morphologic evidence of cavity closure. One had received 11 months of chemotherapy preoperatively and showed evidence of an open cavity with healing. The recovery of viable tubercle bacilli from the 4 control patients and also from 11 of the 15 original and retreatment patients has been reported. No correlation between the presence of viable tubercle bacilli in tuberculous lesions and duration of chemotherapy, drug regimens used, duration of the preoperative period, noninfectiousness, or the anatomic nature of the lesions could be demonstrated in this study. Based on the findings reported herein, inspissated cavities with communicating bronchi, after prolonged chemotherapy on regimens universally used today, are potentially dangerous in a high percentage of cases. We should like to express our thanks to Mr. Massy M. Nakamura, for the illustrations in this article.

1. 1. The criteria used for clinical and histopathologic changes in leukoplakia are given in detail. 2. 2. This is a 5-year follow-up study of 3,785 men out of an initial group of 4,734 who were examined in 1959. 3. 3. A detailed clinicopathologic correlation is presented. 4. 4. A correlation of the clinical appearance of the lesions with the habits indulged in is presented. 5. 5. No malignant transformation of leukoplakia lesion was reported after a 5-year follow-up study, and no lesions diagnosed as clinical leukoplakia were found to be carcinoma in situ. 6. 6. Of 161 leukoplakia cases, twenty cases were histologically diagnosed as atypias. 7. 7. The homogeneous type of leukoplakia accounted for only 3.7 per cent of the atypias, while the speckled accounted for 8.6 per cent. 8. 8. Bidi smoking, pan chewing, and mixed habits are significantly responsible for leukoplakias, in the descending order of importance.

Accurate localization of muscle damage at the autopsy is of fundamental importance for clinicopathologic correlation in coronary disease. Routine autopsy tehnique is unsuitable. Precise localization of muscle lesions requires not only thorough gross and microscopic scrutiny of the ventricular myocardium, but multiple cross-sectioning of the epicardial coronary arteries and reference to relevant clinical and electrocardiographic findings while dissecting the heart. Examinations less systematic than this fail to protect against serious errors which account for much inconsistency and confusion in the literature. Although the number of clinicopathologic studies of coronary disease is large, adequate, detailed information about the state of the heart muscle is seldom provided. Studies in which the myocardial examination has a central place, however, consistently report more lesions and show better correlation with clinical and electrocardiographic data. This investigation attempted to combine scrutiny of the ventricular myocardium with multiple precordial lead electrocardiograms and adequate clinical data in a series of 200 autopsied patients. Attempts to modify existing pathologic methods have led to a technique, deserving of wider use, whereby the ventricular myocardium is explored by serial slices. Carefully located and oriented blocks of tissue removed from gross lesions and areas under suspicion are examined microscopically to determine the extent and nature of muscle changes and the state of the coronary vessels. While unsuited to routine use, this type of examination is a necessity for every case to be included in a clinicopathologic series aimed at electrocardiographic correlation. The present paper is concerned with the principles of an adequate pathologic examination in coronary disease and with description of the method used in our studies.

Case records of infants and children with hepatic abscesses have been reviewed inrespect to clinical, necropsy, and postmortem bacterial data. Clinicopathologic correlation was tested by comparing cases observed prior to January 1, 1940, with those observed after that date.

Tuberculous meningitis may have an insidious onset with headaches resembling those of a posterior fossa tumor, or it may begin with depressed, confused, or psychotic behavior. The clinical course is often punctuated by strokes or strokelike episodes caused by tuberculous arteritis. Spinal fluid changes are variable, particularly if antibiotics have been given, although xanthochromia and increased pressure are frequent. Increases in cell count and decreases in spinal fluid sugar, while helpful when present, may be overlooked or absent. Due to the basilar exudate, inequalities in pupillary size resembling those with subdural hematoma may occur. The tuberculin test can be negative, and the body temperature is not necessarily elevated significantly. In this clinical setting errors in diagnosis and radiologic interpretation are frequent, and the resultant delay leads to increased morbidity and mortality. Eight patients with tuberculous meningitis have been examined angiographically at Bellevue Hospital since 1...

This report presents the characteristics of a variety of reaction patterns of the glomerulus to injury. Although each component of the glomerulus has a limited response potential, certain reactions either alone or in combination are pathognomonic of specific clinical entities. Identification of the reaction patterns provides a sound working basis for pathologic diagnosis and for clinicopathologic correlation.

A clinically silent multiple sclerosis (MS) plaque in the midcervical spinal cord was found unexpectedly at autopsy in a 66-year-old man who died of bronchogenic carcinoma. The patient's history revealed a transient episode of neurological symptoms compatible with an attack of MS more than 30 years prior to death, with no appreciable residual deficits. The discrete anatomical location of this plaque with well-preserved axons emphasizes that the retention of functional integrity of demyelinated axons may be an important factor underlying the poor clinicopathologic correlation in MS.

The cerebellum is affected by a wide variety of toxic agents, resulting in lesions that sometimes show striking anatomic specificity. This report describes the range of these degenerations, highlighting those with characteristic patterns. The need for properly oriented sections as a prerequisite for meaningful clinicopathologic correlation is stressed. Sporadic cases of clinical cerebellar dysfunction, if well documented in complementary fashion by clinicians and pathologists, may provide more precise evaluation of environmental toxicologic phenomena.

A woman had bilateral ptosis and rightsided ophthalmoplegia as prominent signs of a midbrain infarct. The lesion involved the third and fourth cranial nerve nuclei on the right. The lesion extended to the left side only at the caudal extent of the infarct, in the dorsal tegmentum of the mesencephalon. This midline lesion may be responsible for the bilateral ptosis, since this finding is consistent with current models of oculomotor organization in monkeys. To our knowledge, this is the first time such correlation has been demonstrated in man.

The histologic picture in the sympathogenic or exciting eye * in sympathetic ophthalmia is a characteristic one that has been studied extensively and described frequently. On the other hand, the opportunity to examine sympathizing eyes histologically has arisen rather rarely. This is understandable in view of the fact that it has been customary in the past to enucleate the exciting eye when signs of sympathetic ophthalmia developed in the fellow eye, and psychological reasons usually have militated against removing the patient's only remaining eye even though it might be blind. Fuchs' opinion1that the histologic picture in the sympathizing eye is identical with that in the exciting eye has been generally accepted through the years. There have, however, been conflicting opinions in the few histologic studies on this subject. Loewenstein,2in 1945, reviewed the literature and was able to find only 19 sympathizing eyes that had been examined histologically

Excerpt Death in uncomplicated bronchial asthma is a shocking experience. Recently such a death at this hospital provoked an inquiry into the cause of such fatalities and their possible prevention....

A clinical and pathologic study was made in 20 cases of pulmonary atresia with intact ventricular septum proved at necropsy. The hearts usually could be divided readily into two groups, namely, those with a small or tiny right ventricle (Type 1) and those with a right ventricle of normal size or larger (Type 2); 13 hearts were of Type 1, and 7 were of Type 2. In cases of Type 2 the tricuspid valve presented gross anatomic malformations, namely, nonspecific shortening and thickening of the chordae tendineae and leaflets in 3 instances, and malinsertion of the leaflets in 3 others—a defect similar to that encountered in Ebstein's disease. In cases of Type 1 the tricuspid valve was small but well formed; 9 of these hearts had anomalous coronary vessels which connected the right ventricular myocardial sinusoids with the coronary arterial system. When the patients were more than 1 week of age, these two types usually could be differentiated on the basis of radiologic and electrocardiographic findings. This is of considerable importance because of the possibility of direct surgical treatment when the right ventricle is of normal size or larger.

1. 1. Thirty-four case records of histologically active rheumatic heart disease in patients over 40 years of age were studied. 2. 2. The histologic manifestations of rheumatic activity in these patients were compared with the clinical histories. Contrary to our expectations, this study did not result in a good clinicopathologic correlation (Table II). Only in our arbitrary Group I was clinicohistologic correlation satisfactory. 3. 3. Three groups of patients have been described as to their clinical manifestations. In general, their counterpart can be found in the younger age groups. 4. 4. It is suggested that the occurrence of active rheumatic carditis in older patients should be considered more frequently so that the clinical diagnosis will be made more often. Unexplained fever and unusual responses to digitalis may be clues to this end.

Excerpt Inductive reasoning supported by experimental study and clinicopathologic correlation has yielded electrocardiographic criteria for the diagnosis of various combinations of block within the...

This book presents a clinicopathologic correlation study emphasizing the importance of ophthalmoscopy and is based on material exhibited at the eighty-ninth annual session of the American Medical Association in San Francisco in 1938. This exhibit received the Frank Billings' Gold Medal. The study is the combined work of the departments of pathology (Smith, Kronzelmann and Gault), of medicine (Weiss) and of ophthalmology (Lillie) at Temple University, Philadelphia. This correlation of available information on cardiovascular-renal disease must be greeted as a step forward and in the right direction and as a means of advancing the knowledge of important problems in medicine. It emphasizes the close relation between the various branches of medicine, a point which cannot be too often insisted on. It is fortunate that at Temple University a group was found interested enough to work out this problem. The subject matter is considered under the following chapter headings : I, "Hypertensive

This clearly written, well-organized monograph consists of an extensive review of the literature on this subject and a critical analysis of the conclusions reached by many students in this field. It is particularly valuable for two reasons. In the first place, all previous reports and hypotheses are carefully evaluated in the light of the author's own well-documented experience with renal biopsies in 92 patients. Secondly, it surpasses previous surveys in the extensive and detailed clinicopathologic correlation. It is a book not to be read from cover to cover but to serve as a reliable source of references. In such areas in which the author's opinion differs from that of others, clear evidence for his reasons is presented. It is unfortunate that almost three years had to pass between the time the collection of the literature was closed and the printed book could be offered to the public. It is during

This book is designed for use in a medical school course in neuropathology. About equal space is devoted to brief discussions of a wide variety of neurologic conditions and to an atlas illustrating them. It is planned for a course which has 20 or more lecture-laboratory periods, such as exists at Harvard Medical School but at few others. The presentation of topics is largely from the morphologic approach, with some emphasis on clinicopathologic correlation. It is assumed that the bones of the text will be given flesh and sinew by lectures and by laboratory study. Treatment of individual conditions is superficial even from the purely structural viewpoint, and the occasional excursions into neurophysiology and chemistry are even more so. One surprising omission is a bibliography, for surely one prime function of a teaching manual is to stimulate the student to use primary sources. It is a considerable advantage for a

Clinical and pathologic evidence of "rheumatic activity" —as defined by strict, independent criteria—have been correlated in 47 patients who died with rheumatic disease at or below age 30. Pathologic evidence of activity was found in 11 of the 12 patients with clinically active disease, and in 19 of the 33 with clinically inactive disease. Clinical activity was noted in four of the nine patients with Aschoff bodies and in 11 of the 30 with any type of inflammatory histologic infiltrate. Long-term steroid therapy showed no demonstrable effect on the pathologic findings. Although the frequency of clinical and pathologic evidence of "rheumatic activity" was highest in the younger patients and declined with advancing age, the two types of evidence often did not coexist in the same patient.

Excerpt The importance of calcific aortic valve stenosis is manifest when one considers that it occurs in any age group, produces symptoms which are not common to other valvular lesions and may res...

WE FEEL rather privileged to have been asked to participate in a symposium held by dermatologists. We are general pathologists, but it is abundantly clear that many of the key contributions to the understanding of the histologic nature of pigmented tumors have been made by dermatologists, especially by those great and pioneering dermatologists, Unna and Bloch. However, it must also be evident that the problems of nevi and malignant melanomas transcend party lines, as you obviously agree, and it would be well if this example were followed frequently and bilaterally. Certainly, there is no place for professional chauvinism in the interpretation of scientific data. This presentation is concerned, first, with a recapitulation of clinicopathological impressions based on data from a recent study of these lesions at the Memorial Cancer Center3and, secondly, with a fairly detailed ledger and evaluation of the evidence for the major concepts

The conception of cerebral localization has been evolved from many methods of investigation, such as the myelogenetic (Flechsig), embryologic, physiologic (Hitzig, Fritsch, Ferrier), pathologico-anatomic (Tiirck), clinicopathologic and histologic methods (Brodman, Campbell, Vogt and von Economo). Undoubtedly each method has certain shortcomings peculiar to itself, but when all the facts are gathered from these various forms of investigation a structure is built which cannot be shaken. Ours is essentially a clinicopathologic method, limited to cerebral lesions due to vascular insults. We are fully aware that our method of approach may deservedly meet with many criticisms. Strict schematization and attempts at simplification of the anatomic basis of cerebral function are out of accord with present-day conceptions of neurophysiology. Nor have we dismissed lightly the obstacles in the way of clinicopathologic correlation in vascular disease. Just as studies of localization in cases of cerebral neoplasm are hazardous because of the inability to differentiate

Phytobezoars are infrequently encountered in the study of diseases of the gastrointestinal tract and are therefore considered to be of minor importance. Their rarity does not detract from, but rather enhances, the interest which has been focused on the subject for many years. The purpose of this paper is to comment upon the history and pathogenesis of this disease and to describe 6 clinical cases currently on file at the Armed Forces Institute of Pathology. Review of Literature The term "bezoar" originated from either an Arabic ("badzehr") or a Persian ("padzahr") root meaning "antidote" or "counterpoison."1In ancient times, the concretions found in the stomachs of various animals and in man were believed to be endowed with magical or mystical powers to cure illnesses. Therefore, they were considered to be counterpoisons or antidotes. An excellent account of the origin and history of bezoars can be found in an article