Organs and Tissues


Possible or Expected Findings


Remove esophagus together with stomach. Photograph esophagus and record diameter of lumen at various levels.

Prepare histologic sections (cut on edge) of narrow and dilated segments. Request Bodian stains and Verhoeff-van Gieson (p. 172).

Segmental dilatation and hypertrophy of esophagus. Accumulation of ingested food and esophagitis. Squamous cell carcinoma is a possible complication (1). Barrett's esophagus* with or without adenocarcinoma may be found (2). Loss of myenteric ganglion cells; partial replacement of myenteric nerves.

References Achondroplasia

1. Streitz JM Jr, Ellis FH Jr, Gibb SP, Heatley GM. Achalasia and squa- Synonyms: Chondrodystrophia fetalis; Parrot syndrome.

mous ceU carcinoma of the esophagus: analysis °f 241 patients. Ann NOTE: The appropriate resource is the International Skel-Thorac Surg 1995;59:1604-1609. . D l R

2. Ellis FH Jr, Gibb SP, Balogh K, Schwaber JR. Esophageal achalasia etal Dysplasia Registry and adenocarcinoma in Barrett's esophagus: a report of two cases and (Cedars-Sinai Medical Center, 444 S. San Vincente Blvd, a review of the literature. Dis Esophagus 1997;10:55-60. Ste. 1001, Los Angeles, CA 90048. Phone #310-855-7488).

Organs and Tissues


Possible or Expected Findings

External examination

Base of skull and spinal canal; brain and spinal cord; pituitary gland


Record body length, head circumference, length of extremities, and abnormal features. Prepare skeletal roentgenograms. Photograph head, thorax, hands, and all abnormalities. Radiographs should be reviewed by a pediatric radiologist.

For removal and specimen preparation of brain and spinal cord, see pp. 65 and 67, respectively. For removal of pituitary gland, see p. 71. Record appearance and photograph base of skull; record diameter of foramen magnum (1). Submit sections of spinal cord at sites of compression.

For removal, prosthetic repair, and specimen preparation, see p. 95.

Submit samples (especially of epiphyses) for histologic study. Snap-freeze tissue for molecular analysis.

Dwarfism;* micromelia with pudgy fingers; frontal bossing; depressed nasal bridge. Bowing of legs; kyphosis; short pelvis; broad iliac wings; horizontal acetabular roofs; narrowed vertebral interpedicular distance; shortened tubular bones of hands and feet; precocious ossification centers of epiphyses. Growth retardation of base of skull with compression of foramen magnum. Internal hydrocephalus.* Narrow spinal canal with compression of spinal cord (and clinical symptoms of paraplegia). Atrophy of pituitary gland.

Dorsolumbar kyphosis and lumbosacral lordosis; short iliac wings; short and thick tubular bones; excessive size of epiphysis in long bones; elongated costal cartilage. Decreased cartilage cell proliferation at costochondral junction and at epiphyses of long bones.


1. Knisely AS, Singer DB. A technique for necropsy evaluation of stenosis of the foramen magnum and rostral spinal canal in osteochondrodysplasia. Hum Pathol 1988;19:1372-1375.


1. Knisely AS, Singer DB. A technique for necropsy evaluation of stenosis of the foramen magnum and rostral spinal canal in osteochondrodysplasia. Hum Pathol 1988;19:1372-1375.


Synonyms and Related Terms: Familial acromegaly; hyper-pituitary gigantism.

Possible Associated Condition: Multiple endocrine neoplasia 1 (MEN 1)* (1). See also below under "Other organs."


NOTE: Acidosis cannot be diagnosed from postmortem blood pH values. Ketone values remain fairly constant in blood and vitreous and may thus support the diagnosis—for instance, of diabetic acidosis. See also under "Disorder, electrolyte(s)" and p. 115.

Organs and Tissues


Possible or Expected Findings

External examination, skin and subcutaneous tissue

Record body length and weight, length of extremities, and abnormal features.

Breast Blood

Other organs

Pituitary gland

Skeletal muscles Bones and joints

Prepare sections of skin and subcutaneous tissue.

Prepare skeletal roentgenograms, including skull.

Incise and prepare sections. Submit sample for calcium analysis and radioimmunoassay of plasma growth hormone. Record organ sizes and weights.

Sample all endocrine glands for histologic study. See also below under "Pituitary gland."

Other procedures depend on expected findings or grossly identified abnormalities as listed in right-hand column.

For in situ cerebral arteriography, see p. 80. For removal of pituitary gland, see p. 71. Weigh and photograph gland (include scale). Snap-freeze tumor tissue for histochemical study and hormone assay. For preparation for electron microscopic study, see p. 132.

For sampling and specimen preparation, see p. 80.

For removal, prosthetic repair, and specimen preparation, see p. 95.

Gigantism in younger persons; coarse facial features with prominent eyebrows and prognathism; maloccluded, wide-spaced teeth. Large, furrowed tongue with tooth marks. Parotid enlargement. Narrow ear canal.

Increased subcutaneous tissue; thickened skin; hypertrichosis; acanthosis nigricans. Osteoporosis;* kyphosis. See also below under "Bones and joints." Lactating breast tissue. Hypercalcemia in MEN 1 syndrome. Growth hormone excess. Splanchnomegaly, involving heart ("acromegalic heart disease"), liver, spleen, intestine, kidneys, and prostate. Endocrine organs may be enlarged (diffuse or nodular goiter; adrenal cortical hyperplasia; enlarged gonads; and parathyroid hyperplasia or adenoma). Pulmonary infections. Nephrolithiasis.* Manifestations of congestive heart failure,* diabetes mellitus,* hyperparathyroidism,* hypertension,* and pituitary insufficiency.* Tumors of breast, colon, thyroid gland, and other organs (1-4). Usually, pituitary adenoma with predominantly eosinophilic or with mixed eosinophilic-chromophobe cells. Enlargement or destruction of pituitary fossa. Tumor growth (see also "Tumor, pituitary") or hemorrhage may be the cause of death. Tumors may be ectopic (sphenoid sinus or parapharyngeal). Proximal myopathy.

Overgrowth of facial bones and enlarged sinuses (best seen in roentgenogram); thickening of long bones and of clavicles. Periosteal growth of metacarpal and metatarsal bones. Osteoporosis* (primarily of spine). Hypertrophy of costal cartilages. Acromegalic arthritis.


1. The BT, Kytola S, Farnebo F, Bergman L, Wong FK, Weber G, et al. Mutation analysis of the MEN 1 gene in multiple endocrine neoplasia type 1, familial acromegaly and familial isolated hyperparathyroidism. J Clin Endocrinol Metabol 1998;83:2621-2626.

2. Melmed S. Acromegaly. N Engl J Med 1990;322:966-971.

3. Cheung NW, Boyages SC. Increased incidence of neoplasia in females with acromegaly. Clin Endocrinol 1997;47:323-327.

4. Barzilay J, Heatley GJ, Cushing GW. Benign and malignant tumors in patients with acromegaly. Arch Intern Med 1991;151:1629-1632.


Synonym: Actinomyces infection.

NOTE: (1) Collect all tissues that appear to be infected. (2) Request anaerobic cultures for Actinomyces. (3) Request Gram stain (p. 172). (4) No special precautions are indicated. (5) Sero-logic studies are not reliable at present. (6) This is not a reportable disease.

Organs and Tissues


Possible or Expected Findings

External examination

Chest organs

Gastrointestinal tract

Other organs

Prepare roentgenograms (p. 117) and photographs of fistulas.

Submit samples of infected tissue for histologic study. For culturing fistules, see p. 104.

Submit samples of infected tissue for histologic study.

Submit samples of infected tissue for histologic study. For proper tracing of fistulas, in situ dissection is recommended. Procedures depend on expected findings or grossly identified abnormalities as listed in right-hand column.

Fistulas to skin of face, neck, and other sites. Periostitis or osteomyelitis of mandible. Extension of fistulas into orbits or paranasal sinuses. Mixed infections (microaerophilic streptococci, Bacteroides spp.). Suppurative fibrosing reaction with "sulfur granules" or gram-positive filaments of bacteria.

Chronic cavitary pneumonia; empyema; fistulas through chest wall, pericardium, or diaphragm or into thoracic vertebrae. Inflammatory masses. Fistulas through abdominal wall, to kidneys or pelvic organs (rare), or ileocecal and anorectal fistulas. Rare manifestations include cerebral, renal, or hepatic abscess, abscesses in other organs or tissues, endocarditis,* or periostitis and osteomyelitis* with fistulas to skin.

Addiction (See "Abuse, hallucinogen(s)," "Abuse, marihuana," "Dependence,..." and "Poisoning,..." See also "Alcoholism and alcohol intoxication.")

Adenoma (See "Neoplasia, multiple endocrine" and "Tumor...")

Adenomatosis, Multiple Endocrine (See "Neoplasia, multiple endocrine.")

Afibrinogenemia (See "Dysfibrinogenemia.")

Agammaglobulinemia (See "Syndrome, primary immunodeficiency.")

Agenesis, Renal

Synonym: Renal aplasia.

Organs and Tissues


Possible and Expected Findings

External examination


Abdominal cavity


Photograph infant. Record anomalies.

Weigh lungs; calculate ratio of lung weight to body weight. (For expected weights, see Part III.)

Record presence or absence of renal arteries and veins, as well as of ureters, urinary bladder, and internal genital organs. Ascertain patency of the lower urinary tract. Weigh and photograph fetal surface.

Evidence of oligohydramnios: flattened nose; prominent palpebral folds; flattened low set ears; flattened hands; recessed chin; joint contractures.

Pulmonary hypoplasia. Normal LW/BW ratio is greater than 0.015, less than 28 wk gestation and 0.012, older than 28 wk gestation.

Absence of kidneys and associated malformations (see middle column).

Amnion nodosum.

Agranulocytosis (See "Pancytopenia")

AIDS (See "Syndrome, acquired immunodeficiency.")

Alcohol, Ethyl (Ethanol) (See "Alcoholism and alcohol intoxication.")

Alcohol, Isopropyl (See "Poisoning, isopropyl alcohol.")

Alcohol, Methyl (See "Poisoning, methanol (methyl alcohol).")

Alcohol, Rubbing or Wood (See "Poisoning, isopropyl alcohol.")

Alcoholism and Alcohol Intoxication

Synonyms and Related Terms: Alcoholic cirrhosis; alcoholic liver disease;* ethanol intoxication; ethyl alcohol intoxication; fetal alcoholic syndrome;* Wernicke-Korsakoff syndrome.*

NOTE: Interpretation of alcohol concentrations can be problematic if body has been embalmed or is putrefied.

Organs and Tissues


Possible or Expected Findings

External examination

Blood from femoral, subclavian, or brachial veins

Hematoma Vitreous

Cerebrospinal fluid Urine






Pancreas Brain

Peripheral nerves and skeletal muscles Bones

Use heart blood only if peripheral blood is unavailable. In this instance, massage heart gently for good mixing. If the blood is not analyzed immediately, add sodium fluoride (10 mg/mL of blood). Fill container to just under the lid so that evaporation remains minimal. Shake thoroughly. Record time of sampling and refrigerate. Request determination of alcohol concentration and drug screen and carbon monoxide determination. If there are subdural or other hematomas, submit blood for alcohol determination. Submit (pp. 16 and 85) for alcohol determination, particularly if blood is not available. Process like blood. Request determination of potassium, sodium, and chloride concentrations. Submit with or instead of vitreous (p. 104). (Vitreous is probably preferable.) Submit for alcohol determination (p. 16). Process like blood. Record volume.

Record character and volume of contents.

Submit samples for histologic study.

Store for possible drug screen.

Record weight. Submit samples for histologic study.

Submit for microbiologic study (p. 103).

Record weight and submit samples for histo-logic study.

For removal, see p. 65. Submit for determination of alcohol concentration (p. 16). Submit samples for histologic study (p. 79).

For sampling and specimen preparation, see p. 79.

Malnutrition; signs of exposure, injuries, needle marks.

See below under "Can Postmortem Changes and Specimen Storage Affect Blood Alcohol (Ethanol) Concentrations?"

Hematoma may show alcohol concentration at time of injury (1). See below under "Interpretation of Laboratory Reports" and p. 113.

See below, "How Can One Estimate Blood Alcohol (Ethanol) Concentrations From Vitreous, Urine, or Tissue Alcohol Levels and From Alcohol in Stomach Contents? Gastritis. See also note above under "Urine."

Alcoholic cardiomyopathy.* Aspiration of vomitus. Lobar pneumonia. Tuberculosis.* Alcoholic liver disease.*

Acute or chronic pancreatitis.* See below under "Interpretation of Laboratory Reports." Cerebellar cortical degeneration;* Marchiafava-Bignami disease;* Wernicke-Korsakoff syndrome.* Alcoholic neuropathy or alcoholic myopathy (or both).

Osteonecrosis* ("aseptic necrosis of bone").

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