Info

see p. 96. Request iron stain.

macrophages.

Anemia, Megaloblastic

Related Terms: Pernicious anemia; vitamin B12 deficiency.

NOTE: The condition can be caused by many disorders associated with cobalamin or folic acid deficiency (e.g., malabsorp-tion-related); other causes include adverse drug effects, alcoholism, and rare metabolic disorders. The condition may occur in infancy or during pregnancy. Hemolytic anemia,* hypoparathyroidism,* adrenal cortical insufficiency* (Addison's disease), or scurvy may be present.

Organs and Tissues

Procedures

Possible or Expected Findings

External examination and oral cavity

Blood

Esophagus and neck organs with tongue Stomach

Intestinal tract

Liver and spleen Vagina

Thyroid gland Brain, spinal cord, and peripheral nerves

Eyes with optic nerves

Bone marrow

Record body weight, color of skin and sclerae, and presence or absence of conditions listed in right-hand colum.

Prepare smears.

Submit tissue samples of tongue.

Remove and place in fixative as early as possible in order to minimize autolysis (alternatively, formalin can be injected in situ; see below). Samples should include oxyntic corpus and fundus mucosa.

For in situ fixation and preparation for study by dissecting microscopy, see p. 54. For preservation of jejunal diverticula by air drying, see p. 55.

Record weights.

Submit tissue samples for histologic study. Record weight of thyroid gland. For removal and specimen preparation, see pp. 65, and 67, respectively. Request Luxol fast blue stain (p. 172).

For removal and specimen preparation, see p. 85. If there is a clinical diagnosis of anemia-related amblyopia, follow procedures described under "Amblyopia, nutritional." For preparation of sections and smears, see p. 96.

Jaundice. Manifestations of malnutrition.* Stomatitis with cheilosis and perianal ulcerations due to folic acid deficiency. Chronic exfoliative skin disorders. Vitiligo. Macrocytosis; poikilocytosis; macroovalocytes; hypersegmentation of leukocytes; abnormal platelets. Atrophic glossitis with ulcers. Pharyngoesophagitis (folic acid deficiency). Previous total or subtotal gastrectomy. Carcinoma of stomach.

Autoimmune gastritis (diffuse corporal atrophic gastritis) with intestinal metaplasia. Crohn's disease;* sprue;* other chronic inflammatory disorders; jejunal diverticula; intestinal malignancies; fish tapeworm infestation; previous intestinal resection or blind intestinal loop; enteric fistulas. Hepatosplenomegaly. Alcoholic liver disease.* Giant epithelial cells. Hyperthyroid goiter; thyroiditis. Demyelination of cerebral white matter (in advanced cases). Demyelination in posterior and lateral columns of spinal cord, most frequently in thoracic and cervical segments. Demyelination of peripheral nerves. Retinal hemorrhages; demyelination of optic nerves.

Hypercellular; megaloblastic. Myeloproliferative disorder.

Anemia, Pernicious (See "Anemia, megaloblastic.")

Anemia, Sickle Cell (See "Anemia, hemolytic" and "Disease, sickle cell.")

Anencephaly

Organs and Tissues Procedures Possible or Expected Findings

External examination Photograph all abnormalities. Absence of calvarial bones; protrusion of orbits; area cerebrovasculosa (disorganized hypervascular neuroglial tissue at the base of the skull).

Prepare full-body skeletal roentgenograms. Delay in development of ossification centers.

Organs and Tissues

Procedures

Possible or Expected Findings

Eyes

Thymus, adrenals, gonads, and thyroid

Base of skull

Lungs

For removal and specimen preparation, see p. 85.

Record weights. Submit tissue samples for histologic study.

Identify and record structures at base of skull. Prepare histologic sections.

Absence of ganglion cells in retina; absence or hypoplasia of optic nerves. Thymic and thyroid enlargement. Small adrenal glands with rudimentary fetal cortex after 20 wk gestation; small gonads. Shallow sella turcica; small pituitary gland; hypoplastic medulla oblongata. Aspiration of brain tissue.

Anesthesia (See "Death, anesthesia-associated.") Aneurysm, Aortic Sinus

NOTE: For general dissection techniques, see Part I, Chapter 3. Prepare sections of aorta and request Verhoeff-van Gieson stain (p. 173). Rupture of aneurysm usually causes a fistula to the right ventricle or right atrium.

Possible Associated Conditions: Cystic medial degeneration of aorta; infective endocarditis;* ventricular septal defect.*

Aneurysm, Ascending Aorta

Possible Associated Conditions: History of polymyalgia rheumatica;* see also below under "Possible or Expected Findings."

Organs and Tissues

Procedures

Possible or Expected Findings

Aorta

Muscular arteries

Collect 5-6 specimens for microscopic study. Request Verhoeff-van Gieson stain (p. 173). Collect specimens for microscopic study. Request Verhoeff-van Gieson stain.

Cystic medial degeneration; active arteritis (often giant cell type), or healed arteritis. Temporal arteritis; systemic giant cell arteritis.*

Aneurysm, Atherosclerotic Aortic

Organs and Tissues

Procedures

Possible or Expected Findings

Aorta Kidneys

If aneurysm was perforated, identify location of rupture in situ. Record location and volume of blood in peritoneum and retroperitoneum. Transverse or longitudinal sections of aneurysms are instructive.

Request Verhoeff-van Gieson stain (p. 173). Decalcification may be required (p. 97). Major arteries and kidneys may be left attached to aorta.

Saccular aneurysm, often inferior to origin of renal arteries. Mural thrombosis in aneurysm. Rupture into peritoneal cavity, retroperitoneum, or hollow viscus.

Arterial and arteriolar nephrosclerosis. Atheromatous emboli and microinfarcts of kidneys.

Aneurysm, Atrial Septum of Heart

Synonyms: Aneurysm of valve of fossa ovalis; fossa ovalis aneurysm.

NOTE: For general dissection techniques, see Part I, Chapter 3.

Possible Associated Conditions: Patent oval foramen (patent foramen ovale).

Aneurysm, Berry (See "Aneurysm, cerebral artery.")

Aneurysm, Cerebral Artery

Related Terms: Berry aneurysm; congenital cerebral artery aneurysm.

Organs and Tissues

Procedures

Possible or Expected Findings

Brain

Other organs

If mycotic aneurysms are expected and microbiologic studies are intended, follow procedures described below under "Aneurysm, mycotic aortic." Request Verhoeff-van Gieson, Gram, and Grocott's methenamine silver stains (p. 172). For cerebral arteriography, see p. 80. If arteriography cannot be carried out, rinse fresh blood gently from base of brain until aneurysm can be identified. Record site of rupture and estimated amount of extravascular blood. For paraffin embedding of aneurysms, careful positioning is required.

Expected findings depend on type of aneurysm.

Mycotic aneurysms are often multiple and deep in brain substance.

Berry aneurysms are the most frequent types and often are multiple. Most frequent sites are the bifurcations and trifurcations of the circle of Willis. Saccular atherosclerotic aneurysms are more common than dissecting aneurysms, which are very rare. With congenital cerebral artery aneurysm: coarctation of aorta;* manifestations of hypertension;* and polycystic renal disease. With mycotic aneurysm: infective endocarditis;* pulmonary suppurative processes; and pyemia.

Aneurysm, Dissecting Aortic (See "Dissection, aortic.")

Aneurysm, Membranous Septum of Heart

NOTE: For general dissection techniques, see Part I, Chapter 3. Most aneurysms of the membranous septum probably represent spontaneous closure of a membranous ventricular septal defect by the septal leaflet of the tricuspid valve.

Aneurysm, Mycotic Aortic

NOTE: (1) Collect all tissues that appear to be infected. (2) Request aerobic, anaerobic, and fungal cultures. (3) Request Gram and Grocott methenamine silver stains (p. 172). (4) No special precautions are indicated. (5) No serologic studies are available. (6) This is not a reportable disease.

Organs and Tissues

Procedures

Possible or Expected Findings

Chest and abdominal organs

Aorta

Other organs

Submit blood samples for bacterial culture (p. 102). En masse removal of adjacent organs is recommended (p. 3). Photograph all grossly identifiable lesions. Aspirate material from aneurysm or para-aortic abscess and submit for culture. Prepare sections and smears of wall of aneurysm and of aorta distant from aneurysm. Request Verhoeff-van Gieson and Gram stains (p. 172).

Septicemia and infective endocarditis.*

Streptococcus, staphylococcus, spirochetes, and salmonella can be found in mycotic aneurysm. Para-aortic abscess.

Septic emboli with infarction or abscess formation.

Aneurysm, Syphilitic Aortic

Organs and Tissues

Procedures

Possible or Expected Findings

Heart and aorta

En masse removal of organs is recommended (p. 3). For coronary arteriography, see p. 118.

Request Verhoeff-van Gieson stain from sections at different levels of aorta, adjacent great vessels, and coronary arteries (p. 173).

Aneurysm usually in ascending aorta. May erode adjacent bone (sternum). Syphilitic aortitis may cause intimal wrinkling, narrowing of coronary ostia, and shortening of aortic cusps.

Disruption of medial elastic fibrils.

Organs and Tissues

Procedures

Possible or Expected Findings

Other organs

See also under "Syphilis."

Aortic valvulitis and insufficiency;* syphilitic coronary arteritis; syphilitic myocarditis.

Aneurysm, Traumatic Aortic

Organs and Tissues

Procedures

Possible or Expected Findings

External examination Aorta

Penetrating or blunt trauma with wounds, abrasions, hematomas, and other traumatic lesions. Prepare chest and abdominal roentgenograms. Open aorta along line of blood flow, or bisect into anterior and posterior halves. Photograph tear(s). Measure or estimate amount of blood in mediastinum.

Request Verhoeff-van Gieson stain (p. 173).

Fractures of ribs. Hemorrhage into mediastinum.

Microscopy may show transmural rupture, false aneurysm, or localized dissection.

Angiitis (See "Arteritis, all types or type unspecified.") Angina Pectoris

NOTE: See under "Disease, ischemic heart" and Table 3-2 (p. 32) in Part I, Chapter 3. Angiokeratoma Corporis Diffusum (See "Disease, Fabry's.") Angiomatosis, Encephalotrigeminal (See "Disease, Sturge-Weber-Dimitri.")

Angiitis (See "Arteritis, all types or type unspecified.") Angina Pectoris

NOTE: See under "Disease, ischemic heart" and Table 3-2 (p. 32) in Part I, Chapter 3. Angiokeratoma Corporis Diffusum (See "Disease, Fabry's.") Angiomatosis, Encephalotrigeminal (See "Disease, Sturge-Weber-Dimitri.")

Angiopathy, Congophilic Cerebral

Synonyms and Related Terms: Beta amyloid angiopathy due to ß-amyloid peptide deposition (ß A4) (associated with Alzheimer's disease; hereditary cerebral hemorrhage with amyloid angiopathy of Dutch type; or sporadic beta amyloid angiopathy); hereditary cerebral amyloid angiopathy, due to deposition of other amyloidogenic proteins such as cystatin C (Icelandic type) and others (e.g., transthyretin, gelsolin) (1).

Organs and Tissues

Procedures

Possible or Expected Findings

Brain

Other organs

For removal and specimen preparation, see p. 65.

Request stains for amyloid, particularly Congo red (p. 172), and thioflavine S (examine with polarized and ultraviolet light, respectively). Request immunostain for P A4. Some tissue should be kept frozen for biochemical studies. Prepare material for electron microscopy (p. 132).

Multiple recent cerebral cortical infarctions or small cortical hemorrhages, or both, or massive hemispheric hemorrhages, both recent and old.

Amyloid deposition in leptomeninges and cortical blood vessels. Senile plaques are usually present. In some cases, angiopathy is part of Alzheimer's disease.*

Electron microscopic study permits definite confirmation of diagnosis. Organs and tissues may be minimally affected by amyloidosis.

Reference

1. Kalimo H, Kaste M, Haltia M. Vascular diseases. In: Greenfield's Neuropathology, vol. 1. Graham BI, Lantos PL, eds. Arnold, London, 1997, pp. 315-396.

Anomaly, Coronary Artery

Possible Associated Conditions: With double outlet right ventricle; persistent truncal artery; tetralogy of Fallot;* and transposition of the great arteries.*

NOTE: Coronary artery between aorta and pulmonary artery, often with flap-valve angulated coronary ostium. Coronary artery may communicate with cardiac chamber, coronary sinus, or other cardiac veins, or with mediastinal vessel through pericardial vessel. Saccular aneurysm of coronary artery with abnormal flow, infective endarteritis of arteriovenous fistula, and myocardial infarction may be present. If one or both coronary arteries originate from pulmonary trunk, myocardial infarction may be present.

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