Info

If roentgenographic study is intended, see p. 57.

pancreatic duct with fibrosis and dilatation.

1. Case Records of Massachusetts. General Hospital. Clonorchis sinensis [Opisthorchis sinensis] infection of biliary tract. N Engl J Med 1990;323: 467-475.

Reference

1. Case Records of Massachusetts. General Hospital. Clonorchis sinensis [Opisthorchis sinensis] infection of biliary tract. N Engl J Med 1990;323: 467-475.

Coagulation (See "Coagulation, disseminated intravascular," "Disease, Christmas," "Disease, von Willebrand's," "Hemophilia," and "Purpura,...")

Coagulation, Disseminated Intravascular

Synonyms and Related Terms: Consumption coagulopathy; hypofibrinogenemia; intravascular coagulation and fibrinolysis syndrome (ICF).

NOTE: Disseminated intravascular coagulation (DIC) often is a complication of obstetrical mishaps such as abruptio placentae or amniotic fluid embolism,* or it complicates malignancies (such as adenocarcinomas or leukemia*) or bacterial, viral, and other infections. Other conditions such as aortic aneurysm* or hemolytic uremic syndrome* are known causes also. If the nature of the underlying disease is known, follow the procedures under the appropriate heading also.

Organs and Tissues

Procedures

Possible or Expected Findings

External examination and skin Heart

Large blood vessels Other organs

Prepare sections of skin of grossly involved and of uninvolved areas.

Submit tissue samples from grossly involved and uninvolved areas. Organs involved include brain, heart, kidneys, lungs, adrenal glands, spleen, gastrointestinal tract, pancreas, and liver, approximately in this order. Skin, testes, and choroid plexus also are frequently involved. Special stains such as phosphotungstic acid hematoxylin (p. 173) are not particularly helpful. Postmortem determination of fibrin split products is not helpful either.

Petechiae, purpura, hemorrhagic bullae, gangrene, and other skin lesions. Nonbacterial thrombotic endocarditis.* Thromboses, predominantly around indwelling catheters. Fibrin or hyaline thrombi in capillaries, venules, or arterioles, and occasionally in larger vessels. Hemorrhages and ischemic infarcts may occur.

For common underlying diseases or conditions, see above under "Note."

Coarctation, Aortic

Related Term: Aortic isthmus stenosis.

Possible Associated Conditions: Anomalous origin of right subclavian artery; atresia or stenosis of left subclavian artery; biscuspid aortic valve;* congenital mitral stenosis;* double aortic arch with stenosis of the right arch and coarctation of the left; stenosis of right subclavian artery; Turner's syndrome;* ventricular septal defect;* Shone's syndrome.

Organs and Tissues

Procedures

Possible or Expected Findings

External examination

Blood Heart

Aorta and adjacent arteries

Prepare chest roentgenogram.

Submit sample for microbiologic study (p. 102).

If endocarditis is suspected, follow procedures described on p. 103. For general dissection techniques, see p. 33.

For coronary angiography, see p. 118. Record size and location of coarctation (relation to ductal artery and great vessels).

If bacterial aortitis is suspected, obtain sample for microbiologic study through sterilized window in wall of aorta. For arteriography, clamp proximal and distal thoracic aorta before injecting contrast medium.

Pressure atrophy of ribs with enlargement of costal grooves or focal erosions at inferior and ventral aspects of main body of ribs (rib notching).

Septicemia associated with endocarditis* or endarteritis (see below).

Infective endocarditis* (of bicuspid aortic valve); endocardial fibroelastosis.

For associated malformations, see above under "Possible Associated Conditions."

Premature coronary atherosclerosis.

Preductal coarctation (isthmus stenosis) is often classified as "infantile type of coarctation." "Adult type" is at insertion of duct or distal to it. Rarely, coarctation occurs proximal to left subclavian artery, in lower thoracic aorta, or at multiple sites. Bacterial aortitis. For ductal artery, see below.

Dilatation of subclavian, internal mammary, intercostal, scapular, and anterior spinal arteries. Among the intercostal arteries, the fourth through seventh pairs are predominantly affected.

Organs and Tissues

Procedures

Possible or Expected Findings

Aorta and adjacent arteries

(continued)

Ductal artery Abdominal arteries

Other organs Brain

Record width of left subclavian artery and compare with contralateral vessel; record width of aorta and of vessels proximal and distal to coarctation. Request Verhoeff-van Gieson stain (p. 173).

Probe duct and record width of lumen.

After surgical correction of coarctation, search for infarcts and sample arteries for histologic study.

For removal and specimen preparation, see p. 65. For cerebral arteriography, see p. 80.

Subclavian artery is considerably dilated if proximal to coarctation. Other complications include poststenotic dilatation of aorta, mycotic or noninfectious saccular aneurysm distal to coarctation (with or without rupture), and dissecting hematoma of aorta* (with or without rupture).

Ductal artery may be patent or closed. Dilatation of epigastric and lumbar arteries. Rarely, coarctation of abdominal aorta. Abdominal hypertensive arteritis and visceral infarctions after correction of coarctation.

Manifestation of congestive heart failure.* Rupture of aneurysm, circle of Willis.

Cocaine (See "Dependence, cocaine.") Coccidioidomycosis

Synonyms and Related Terms: Coccidioides immitis infection; San Joaquin fever; valley fever.

NOTE: (1) Collect all tissues that appear to be infected. (2) Request fungal cultures. (3) Request Grocott methenamine silver stain (p. 172). (4) Special precautions are indicated (p. 146). (5) Serologic studies are available from many reference and state health department laboratories (p. 135). (6) This is a reportable disease in some states.

Organs and Tissues

Procedures

Possible or Expected Findings

External examination and skin

Blood Lungs

Other organs

Prepare chest roentgenogram.

Prepare histologic sections of skin lesions. For a special stain, see above under "Note." Submit sample for serologic study. Prior to sectioning lungs, culture for fungi and bacteria any areas of consolidation (p. 103). Prepare smears from fresh, grossly infected pulmonary tissue. For special stain, see above under "Note."

Perfuse one lung with formalin (p. 47). Submit samples of hilar lymph nodes for histologic study.

Submit samples of material for culture and histologic study wherever extrapulmonary lesions are suspected.

If involvement of central nervous system is suspected, submit sample of cerebrospinal fluid for culture and serologic study (p. 104).

Pulmonary infiltrates; pulmonary cavitations; hilar lymphadenopathy. Erythema nodosum or multiforme,* various types of skin rashes; skin ulcers.

Chronic pulmonary cavitation; pulmonary fibrosis.

Bronchiectasis.*

Lymphogenous and hematogenous dissemination to almost all organs may occur, causing abscesses and sinuses of skin, subcutaneous tissue, bones, and joints. Meningitis* and encephalitis.*

Codeine (See "Dependence, drug[s], all types or type unspecified.") Cold (See "Exposure, cold.")

Colitis, All Types or Type Unspecified (See "Enterocolitis, Other Types or Type Undetermined.") Colitis, Chronic Ulcerative (See "Disease, inflammatory bowel.")

Colitis, Collagenous

Related Terms: Lymphocytic colitis; microscopic colitis. NOTE: This is a cause of diarrhea. The colon is grossly normal but microscopically, increased lymphocytes in the lamina propria and a subepithelial band of collagen is found. If only the lymphocytic infiltrate is found, the term "lymphocytic colitis" or "microscopic colitis" should be applied. A trichrome stain should be ordered in all instances, because the collagen band may be difficult to see without the special stain.

Coma, Hepatic

NOTE: See under name of suspected underlying hepatic disease, such as "Cirrhosis, liver" or "Hepatitis, viral."

Complex, Eisenmenger's (See "Defect, ventricular septal.")

Complex, Taussig-Bing (See "Ventricle, double outlet, right.")

Craniopharyngioma (See "Tumor of the pituitary gland.")

Organs and Tissues Procedures

Cerebrospinal fluid

Brain and spinal cord

Eyes

Other organs

References

1. Kanjanavirojkul N, Sripa C, Puapairoj A. Cytologic diagnosis of Cryp-tococcus neoformans in HIV-positive patients. Acta Cytol 1997;41: 493-496.

2. Benard G, Gryschek RC, Duarte AJ, Shikanai-Yasuda MA. Cryp-tococcosis as an opportunistic infection in immunodeficiency secondary to paracoccidioidomycosis. Mycopathologia 1996;133:65-69.

3. Marwaha RK, Trehan A, Jayashree K, Vasishta RK. Hypereosino-philia in disseminated cryptococcal disease. Pediatr Inf Dis J 1995;14: 1102-1103.

Cretinism (See "Hypothyroidism.") Crisis, Sickle Cell (See "Disease, sickle cell.") Croup (See "Laryngitis.")

Cryptococcosis

Synonyms: European Blastomycosis; torulosis.

NOTE: Cryptococcosis may follow or complicate AIDS (1) and other immunodeficient states, bronchiectasis,* bronchitis,* diabetes mellitus,* leukemia,* lymphoma,* sarcoidosis,* and tuberculosis.* (1) Collect all tissues that appear to be infected. (2) Request fungal cultures. (3) Request Grocott's meth-enamine silver, periodic acid Schiff, and mucicarmine stains (p. 172). (4) No special precautions are indicated. (5) Serologic studies are available from many reference laboratories and from state health department laboratories (p. 135). (6) This is not a reportable disease.

Possible or Expected Findings

Meningitis;* meningoencephalitis; hydrocephalus;* cysts in cortical gray matter and basal ganglia. Note that inflammation may be minimal. Endophthalmitis; optic neuritis. Infiltrates and abscesses in skin, endocardium, pericardium, liver, kidneys, adrenal glands, prostate, bones, and joints. Other infections may coexist (2). Hypereosinophilia may be noted (3).

Cryptosporidiosis

Synonym: Cryptosporidium parvum infection.

Possible Associated Conditions: AIDS (1) and other immu-nodeficient states.

NOTE: (1) Collect feces, intestinal wall tissue, bile ducts, and pancreas. (2) Cultures are not available. (3) Request Kinyoun stain (p. 172). (4) No special precautions are indicated. (5) Serologic studies are unreliable. (6) This is not a reportable disease.

Submit sample for fungal culture (p. 104). Use India ink or a nigrosin preparation for direct examination.

For removal and specimen preparation, see pp. 65 and 67, respectively. Submit material for Gram stain and fungal culture. For special stains, see above under "Note." For removal and specimen preparation, see p. 85. See above under "Note." Procedures depend on expected findings or grossly identified abnormalities as listed in right-hand column.

Organs and Tissues Procedures Possible or Expected Findings

External examination Record body weight and length and extent Evidence of dehydration following chronic of rigor. diarrhea in immunosuppressed hosts.

Vitreous Submit sample for sodium, chloride, and urea Dehydration.* (See p. 247).

nitrogen determination (pp. 85 and 115).

Lungs Perfuse one lung with formalin (p. 47) Bronchopulmonary cryptosporidiosis in and submit samples of bronchi and lung for HIV (2). histologic study.

Organs and Tissues

Procedures

Possible or Expected Findings

Intestinal tract

Bile ducts, gallbladder, and pancreas

Record volume and appearance of intestinal contents. Submit samples of feces prepared with saline or iodine solution. Submit samples for determination of sodium, potassium, and chloride content.

Submit samples of small bowel for histologic and electron microscopic study. For cholangiography, see p. 56.

Submit samples for histologic study and electron microscopic study.

Cryptosporidiosis may complicate inflammatory bowel disease (3).*

Parasites attached to mucosa.

Changes resembling sclerosing cholangitis in patients with AIDS or other immunodeficiency states complicated by cryptosporidiosis (4).

Cryptosporidium parvum may be found on mucosal surfaces.

References

Ramratnam B, Flanigan TP. Cryptosporidiosis in persons with HIV infection. Postgrad Med J 1997;73:713-716. Poirot JL, Deluol AM, Antoine M, Heyer F, Cadranel J, Meynard JL, et al. Broncho-pulmonary cryptosporidiosis in four HIV-infected patients. J Eukaryotic Microbiol 1996;43:78S-78S. Manthey MW, Ross AB, Soergel KH. Cryptosporidiosis and inflammatory bowel disease. Dig Dis Sci 1997;42:1580-1586. Davis JJ, Heyman MB, Ferrell L, Kerner J, Kerlan R Jr, Thaler MM. Sclerosing cholangitis associated with chronic cryptosporidiosis in a child with a congenital immunodeficiency disorder. Am J Gastroenterol 1987;82:1196-1202.

Cyanide (See "Poisoning, cyanide.")

Cyst(s), Choledochal

Synonyms and Related Terms: Choledochocyst; congenital cystic dilatation of the common bile duct; idiopathic dilatation of the common bile duct.

Possible Associated Conditions: Biliary atresia;* Caroli's disease;* congenital hepatic fibrosis.*

Organs and Tissues

Procedures

Possible or Expected Findings

External examination and skin Abdominal cavity Gallbladder and extrahepatic bile ducts

Liver

Prepare sections of skin lesions.

Submit peritoneal exudate for culture. Follow procedures described under "Cholecystitis." Record size and location of cyst(s) and relationship to surrounding organs, particularly to the portal vein. Puncture cyst(s) and submit contents for aerobic and anaerobic bacterial cultures. Dissect and photograph in situ.

Record size and weight. Submit samples for histologic study.

Jaundice; xanthomas. Bile peritonitis.

Cyst may displace stomach, duodenum, and colon. Portal vein may be compressed, which may cause portal hypertension.* Cyst may perforate or contain stones or a carcinoma. Congenital anomalies such as double gallbladder, double common bile ducts, absence of gallbladder, biliary atresia, or annular pancreas may co-exist. Abscesses. Fibropolycystic disease of the liver.* See also above under "Possible Associated Conditions."

Reference

1. Crittenden SI, McKinley MJ. Choledochal cyst—clinical features and classification. Am J Gastroenterol 1985;80:643-647. Cyst(s), Liver (See "Disease, fibropolycystic, of the liver and biliary tract.")

Cyst(s), Pulmonary

Related Terms: Congenital cystic adenomatoid malformation; congenital pulmonary lymphangiectasis; intralobular bronchopulmonary sequestration.

Possible Associated Conditions: Polycystic kidney disease;* renal cysts* or cysts of other organs.

Organs and Tissues

Procedures

Possible or Expected Findings

External examination Chest organs

Other organs

Prepare chest roentgenogram. Search—in situ or after en bloc removal of chest organs—for anomalous arterial supply from aorta. Prepare pulmonary (see below) and thoracic aortic arteriograms. If infection of cyst is suspected, submit cyst contents or portions of the lung for bacterial culture (p. 103). For bronchial and pulmonary arteriography, see p. 50. Perfuse lung with formalin (p. 47).

Cyst(s) with air, fluid, or both. Congenital cysts in lower lobes may have anomalous arterial supply ("intralobular bronchopulmonary sequestration"). Perifocal bronchopneumonia; hemorrhage. Cysts may represent lymphangiectasias (see above under "Related Terms").

In rare instances, cysts may co-exist in other organs, e.g. the kidneys.

Cyst(s), Renal

Related Terms: Acquired cystic renal disease; autosomal dominant (adult) polycystic renal disease (1); autosomal recessive (infantile and childhood form) polycystic renal disease (1); cystic renal lymphangiectasis; familial juvenile nephronophthisis; glomerulocystic disease; medullary cystic disease; multicystic dysplasia.

NOTE: Bilateral cystic disease of the kidneys may be acquired after long-term hemodialysis.

Possible Associated Conditions: Alagille's syndrome; Caroli's disease;* cerebral artery aneurysm* (with adult polycystic disease) (2); congenital hepatic fibrosis;* congenital pyloric stenosis; cysts of liver, pancreas, spleen, lungs,* and testes; Ehlers-Danlos syndrome;* hemihypertrophy.

Organs and Tissues

Procedures

Possible or Expected Findings

Kidneys

Liver

Other organs

For renal arteriography, venography, or urography, see p. 59. If infection of cysts is suspected, submit cyst contents or portions of the kidney for bacteriologic study (p. 102). For demonstration of cysts by injection of plastics, see p. 139. Formalin-gelatin mixtures are usually preferred. Prepare photographs and sample for histologic study.

See above under "Possible Associated Conditions." Other procedures depend on expected findings or grossly identified abnormalities as listed in right-hand column.

Infection or calcification of cysts; pyelonephritis;* perinephric abscess. Obstructive uropathy;* nephrolithiasis;* carcinoma (3) (see "Tumor of the kidneys"); hemorrhages, and related complications (4).

In recessive polycystic renal disease, diffuse biliary dysgenesis may be present but the bile ducts are normal in dominant cases. See above under "Possible Associated Conditions." Manifestations of portal or systemic hypertension* and kidney failure;* polycythemia.*

Rapola J, Kaariainen H. Polycystic kidney disease. Morphological diagnosis of recessive and dominant polycystic kidney disease in infancy and childhood. APMIS 1988;96:68-76. Chapman AB, Rubinstein D, Hughes R, Stears JC, Earnest MP, Johnson AM, et al. Intracranial aneurysm in autosomal dominant polycystic kidney disease. N Engl J Med 1992;327:916-920.

References

3. Banyai-Falger S, Susani M, Maier U. Renal cell carcinoma in acquired renal cystic disease 3 years after successful kidney transplantation. Two case reports and review of the literature. Eur Urol 1995;28:77-80.

Wilson PD, Falkenstein D. The pathology of human renal cystic disease. Curr Topics Pathol 1995;88:1-50.

Cystinosis

Synonyms and Related Terms: Cystine storage disease; de Toni-Debré-Fanconi syndrome;* infantile Fanconi syndrome.

Organs and Tissues Procedures Possible or Expected Findings

External examination Record body weight and length. Growth retardation.

Kidneys Freeze tissue samples or fix them in absolute Cystine crystals in tubular epithelial alcohol or Carnoy's fixative (p. 130) for cells (1) and foam cells in the preservation of cystine crystals. See also interstitium. "Swan's neck" deformity under "Glomerulonephritis." For preparation of nephrons (not specific). Atrophy for electron microscopy, see p. 132. with interstitial scarring and tubular

(See also under "Other organs.) degeneration.

Organs and Tissues

Procedures

Possible or Expected Findings

Urine

Other organs

Bone and bone marrow

Submit sample for chemical analysis. Submit samples of lymph nodes for histologic study (see above under "Kidneys"). For removal and specimen preparation of eyes, see p. 85. Excellent views of crystals can be provided in scanning electron microscopic preparations.

For removal, prosthetic repair, and specimen preparation of bones, see p. 95. For preparation of sections and smears of bone marrow, see p. 96. See also above under "Kidneys."

Glycosuria; generalized aminoaciduria. Cystine crystals occur throughout the reticuloendothelial system and in many other tissues, such as liver (2) or corneae and conjunctivae. Diagnostic doubly refractive brick- or needle-shaped cystine crystals in frozen sections or in smears from spleen, liver, lymph nodes, and bone marrow. Cystine crystals in bone marrow.

Hypophosphatemic rickets.

References

1. Thoene JG. Cystinosis. J Inherited Metabolic Dis 1995;18(4):380-386.

2. Klenn PJ, Rubin R. Hepatic fibrosis associated with hereditary cystinosis: a novel form of noncirrhotic portal hypertension. Modern Pathol 1994; 7:879-882.

Cytomegalovirus (See "Infection, cytomegalovirus.")

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