OBJECTIVETo analyze retrospectively the quantity and activation status of the tumor infiltrating cytotoxic lymphocytes in breast cancer and the draining lymph nodes, and its relation to the clinical pathological significance.

METHODSSeventy-four breast cancer samples with their corresponding axillary lymph nodes were histologically typed and staged. Cytotxic lymphocytes were analyzed by immunohistochemistry with the monoclonal antibodies against CD8, CD56, granzyme B and perforin.

RESULTSThe number of infiltrating CD8(+) T cells in the cancerous interstitial tissue were much higher than that in the tumor parenchyma. Compared with the metastatic tumor samples, the CD8(+) T cells were more intensive in the primary tumors (35.7 +/- 16.0 vs. 23.7 +/- 9.6). The tumor infiltrating CD8(+) T cells of patients with 5 years survivals were more than that of the dead cases in this follow-up series death (32.9 +/- 14.1 vs. 20.1 +/- 9.9). There was no significant difference of activated tumor infiltrating cytotoxic T cell analyzed by using the activation marker granzyme B(+) and there was also no significant correlation between the intensity of CD8(+), CD56(+) cells and the clinicopathological stages. However, percentages of the activated cytotoxic lymphocytes in Stage I groups were significantly higher than those in stage III and IV. Moreover, the number of perforin(+) cells was significantly less than that of granzyme B(+) cells, particularly in the cancerous tissue, indicating a dysfunctional status of tumor infiltrating cytotoxic lymphocytes.

CONCLUSIONSActivated cytotoxic lymphocytes may play a significant role against the tumor progression and is associated with a favorable prognosis to some extent. However, a putative dysfunctional status of cytotoxic lymphocytes at tumor site may compromise the host immunity against cancer.

Adult ; Aged ; Axilla ; Breast Neoplasms ; metabolism ; pathology ; CD56 Antigen ; metabolism ; CD8 Antigens ; metabolism ; Female ; Follow-Up Studies ; Granzymes ; metabolism ; Humans ; Immunohistochemistry ; Lymph Nodes ; metabolism ; pathology ; Lymphatic Metastasis ; Lymphocytes, Tumor-Infiltrating ; metabolism ; pathology ; Middle Aged ; Neoplasm Staging ; Perforin ; metabolism ; Retrospective Studies ; Survival Rate ; T-Lymphocytes, Cytotoxic ; metabolism ; pathology

OBJECTIVETo study the pathologic findings seen in lethal cases due to accidental electrocution.

METHODSThe macroscopic and microscopic findings in 16 autopsy cases died of electrocution encountered during the period from January, 2001 to July, 2008 were retrospectively reviewed.

RESULTSTypical electric marks were found on gross examination in 5 of the 16 cases studied. Histologically, 11 of the 16 cases showed evidence of electric burn. The morphologic features of atypical electric marks varied. Simple epidermal exfoliation and color changes were relatively common. Pathologic changes in internal viscera included disarray of myocardial fibers. Rupture of myocardial fibers was readily identified than in non-electrocution death. Sometimes, focal interstitial hemorrhage and polarization of endothelial cells were seen.

CONCLUSIONSThe electric marks on the skin, as confirmed by histologic examination, remain important sequelae of electrocution. The pathologic changes seen in myocardium provide additional clues to the diagnosis.

Adolescent ; Adult ; Autopsy ; Burns, Electric ; pathology ; Child ; Child, Preschool ; Electric Injuries ; pathology ; Female ; Humans ; Male ; Middle Aged ; Myocardium ; pathology ; Retrospective Studies ; Skin ; pathology ; Young Adult

OBJECTIVETo study the expression of COX-2 and pregnancy associate plasma protein A (PAPP-A) in coronary arteries and their relationship with acute coronary syndrome.

METHODSTwenty-one autopsy cases with acute coronary syndrome encountered during the period from 2002 to 2007 were enrolled into the study. Another 21 autopsy cases without evidence of acute coronary syndrome were used as the controls. The right and left coronary arteries of each group were dissected, embedded and processed as paraffin sections. Immunohistochemical study for CD68 and alpha-actin was performed to highlight the presence of macrophages and smooth muscle cells, respectively. The expression of COX-2 and PAPP-A was evaluated.

RESULTSIn the acute coronary syndrome group, COX-2 was localized mainly in the cytoplasm of endothelial cells, macrophages and smooth muscle cells. COX-2 expression in the cytoplasm of smooth muscle cells (28.60%) was significantly higher than that in the control group (4.76%, chi(2) = 14.13, P< 0.05). There was a positive correlation on COX-2 and PAPP-A expression in smooth muscle cells of the media layer of coronary arteries in acute coronary syndrome group (r = 0.88, P < 0.05). The expression of PAPP-A in smooth muscle cells of the media layer in coronary arteries not associated with plaque formation, was higher than that when there were atherosclerotic plaques (chi(2) = 10.36, P < 0.05).

CONCLUSIONIn coronary arteries, COX-2 and PAPP-A play certain roles in the pathogenesis of acute coronary syndrome.

Acute Coronary Syndrome ; metabolism ; pathology ; Adult ; Aged ; Autopsy ; Coronary Vessels ; metabolism ; pathology ; Cyclooxygenase 2 ; metabolism ; Female ; Humans ; Middle Aged ; Myocytes, Smooth Muscle ; metabolism ; Plaque, Atherosclerotic ; metabolism ; Pregnancy ; Pregnancy-Associated Plasma Protein-A ; metabolism ; Young Adult

OBJECTIVETo study the characteristics of autopsies in medical dispute cases, with respect to class of hospitals, clinical units concerned, age of deceased and cause of death.

METHODSTwo hundred and seventy-five autopsies performed on medical dispute cases during the period from January 1, 2002 to September 30, 2008 at the Department of Pathology, Health Science Center, Peking University, China were retrospectively reviewed.

RESULTSDuring the period of study, the number of autopsies performed on medical dispute cases gradually increased. Medical dispute cases happened more often in surgical, obstetric and gynecology departments of grade II and III hospitals, as well as emergency departments of grade I hospitals. Perinatal death in infants of less than 1 year old more frequently caused medical dispute than death occurring in other age groups. According to the International Classification of Diseases (ICD10), disorders of the circulatory system, perinatal illnesses, external injury or iatrogenic conditions represented the major categories of cause of death. In general, the vast majority was due to natural causes and only 13.5% were related to iatrogenic reasons or medical negligence. Pathologic diagnosis of sudden coronary death, myocardial infarction and viral myocarditis should only be made with strict diagnostic criteria.

CONCLUSIONSAutopsies for medical dispute cases can help to delineate the cause of death and provide evidence for further clarification. Meticulous autopsy techniques, application of strict diagnostic criteria and detailed analysis of cause of death are key steps in achieving a high quality service in this area.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Autopsy ; Cause of Death ; Child ; Child, Preschool ; Dissent and Disputes ; Female ; Fetal Diseases ; pathology ; Humans ; Infant ; Infant, Newborn ; Male ; Malpractice ; Middle Aged ; Myocardial Infarction ; pathology ; Retrospective Studies ; Young Adult

OBJECTIVETo analyze the discrepancies between clinical and autopsy diagnoses in hospitals of different grades and with respect to duration of hospitalization.

METHODSA total of 188 autopsy cases collected from hospitals of different grades were retrospectively reviewed and the discrepancies between clinical and autopsy diagnoses were analyzed.

RESULTSThe overall rate of misdiagnosis was 48.9% (92/188). The misdiagnosis rate in grade I hospitals (75.8%, 25/33) was significantly higher than that in grade III (39.6%, 38/96; chi(2) = 12.861, P = 0.000) and grade II hospitals (49.2%, 29/59; chi(2) = 6.179, P = 0.016 ). The misdiagnosis rate of patients beyond 24 hours of admission was lower than that admitted within 24 hours (chi(2) = 20.991, P = 0.000). The overall rate of missed diagnosis was 34.6% (65/188). The rate of missed diagnosis in grade I hospitals was remarkably higher than that of the grade III hospitals (chi(2) = 8.241, P = 0.006). There was no difference between grades I and III hospitals on the rate of missed diagnosis within 24 hours of admission, however, this rate was lower in grade III hospitals in comparing with that of grade I hospitals in patients admitted beyond 24 hours (chi(2) = 5.181, P = 0.047). The distribution of disease entities commonly encountered in patients of both misdiagnosis and missed diagnosis were heart problems, infections, arterial diseases and pulmonary embolism.

CONCLUSIONSThe rate of discrepancies between clinical and autopsy diagnoses is relatively high. The misdiagnosis and missed diagnosis rate in grade I hospitals was significantly higher than that in grade III hospitals and was closely related with the duration of hospitalization. Autopsy study thus still remains an important measure in clinical audit.

Adult ; Aged ; Aortic Aneurysm ; diagnosis ; pathology ; Autopsy ; Cause of Death ; Diagnostic Errors ; statistics & numerical data ; Female ; Hospitals, Community ; Hospitals, General ; Hospitals, Teaching ; Humans ; Infection ; diagnosis ; pathology ; Length of Stay ; Male ; Middle Aged ; Myocardial Infarction ; diagnosis ; pathology ; Myocarditis ; diagnosis ; pathology ; Pulmonary Embolism ; diagnosis ; pathology ; Retrospective Studies ; Young Adult

Breast Neoplasms ; epidemiology ; metabolism ; pathology ; Cadherins ; metabolism ; Carcinoma, Lobular ; epidemiology ; metabolism ; pathology ; Catenins ; metabolism ; Diagnosis, Differential ; Female ; Humans ; Keratins ; metabolism ; Lymphoma ; metabolism ; pathology ; Mastitis ; metabolism ; pathology ; Plasmacytoma ; metabolism ; pathology

Autopsy ; legislation & jurisprudence ; standards ; Cause of Death ; Dissent and Disputes ; Forensic Pathology ; Humans ; Malpractice ; legislation & jurisprudence ; Medical Errors ; legislation & jurisprudence

Antineoplastic Agents ; therapeutic use ; Autoimmune Diseases ; pathology ; Benzamides ; Cell Differentiation ; Cell Movement ; Cell Survival ; Eosinophilia ; chemically induced ; pathology ; Eosinophils ; cytology ; physiology ; Helminthiasis ; pathology ; Humans ; Hypereosinophilic Syndrome ; drug therapy ; pathology ; Hypersensitivity ; pathology ; Imatinib Mesylate ; Piperazines ; therapeutic use ; Pyrimidines ; therapeutic use

Adenocarcinoma ; pathology ; Carcinoma, Acinar Cell ; pathology ; Carcinoma, Adenosquamous ; pathology ; Carcinoma, Basal Cell ; pathology ; Carcinoma, Endometrioid ; pathology ; Carcinoma, Small Cell ; pathology ; Carcinoma, Squamous Cell ; pathology ; Carcinosarcoma ; pathology ; Humans ; Immunohistochemistry ; Male ; Prostatic Neoplasms ; classification ; pathology

Adenocarcinoma ; metabolism ; pathology ; Aged ; Ampulla of Vater ; pathology ; Carcinoid Tumor ; pathology ; Carcinoma, Hepatocellular ; metabolism ; pathology ; Diagnosis, Differential ; Duodenal Neoplasms ; metabolism ; pathology ; Endodermal Sinus Tumor ; pathology ; Humans ; Male ; alpha-Fetoproteins ; metabolism