Online survey of current autopsy practice.

AIMS: The Royal College of Pathologists (RCPath) has for several years published guidance on good autopsy practice. However, pressures such as time, cost and the introduction of the Human Tissue Act have generated suggestions that there is a discrepancy between the published guidelines and what can realistically be achieved in daily practice. The aims of this study were to determine the extent to which practising pathologists agree with this complaint, and what suggestions they might have for its resolution. METHODS: All histopathologists in the UK on the RCPath database (n = 1213) were sent an email invitation to participate in an online questionnaire. RESULTS: 406 pathologists completed the survey, providing numerical data and free-text responses. Results concerning pressures of time, resources and limitations on examination and sampling were in keeping with those expected from recent issues raised. The view that RCPath guidelines are higher than can be achieved in routine coronial autopsy practice was widely supported, but only 45% stated that the RCPath should publish separate guidelines to differentiate between hospital ("consent") autopsies and medico-legal cases. CONCLUSION: The circumstances under which coronial autopsies are conducted in many parts of the UK make it difficult or impossible to comply with current RCPath guidance. Pathologists disagree on whether this situation demands a reduction of RCPath standards, an improvement in autopsy practice in medico-legal cases to current RCPath standards, or the implementation of "double standards". Resolution of this dilemma requires clarification of exactly what a coronial autopsy is trying to achieve.

Can cause of death be predicted from the pre-necropsy information provided in coroners' cases?

AIM: To determine whether the cause of death can be accurately predicted from the pre-necropsy information available in coroners' cases, before carrying out a postmortem examination. METHODS: In this prospective study pathologists read the clinical summary provided by the Coroner's Office and formulated a predicted cause of death. An external examination was then conducted and any relevant information recorded, together with any changes to the original predicted cause of death. They then carried out a complete necropsy before recording a final cause of death, which was subsequently compared with their prediction. RESULTS: A total of 95 necropsies were included in the study. The cause of death was deemed to have been correctly predicted from the history in 62 cases (65.3%). In 33 cases (34.7%) an unexpected cause of death was found. Findings from the external examination were noteworthy in only 8 cases (8.4%), and did not alter the cause of death in any case. CONCLUSIONS: In certain circumstances an accurate cause of death may be given with confidence without the apparent need for necropsy. However, many common causes of death can present with similar or misleading scenarios. This study indicates that performing necropsies, despite seemingly predictable circumstances, is advisable if an accurate cause of death is to be recorded.

Kimura disease of the eyelid: a clinicopathologic study with electron microscopic observations.

A 70-year-old white man presented with a solitary eyelid nodule of 6 months' duration. Because lymphoma could not be excluded on the initial biopsy, the mass was completely excised. Histologic examination confirmed the diagnosis of Kimura disease, an uncommon chronic inflammatory condition. Peripheral eosinophilia was present. The patient did not have any other lesions of Kimura disease on follow-up examination. The clinical, radiologic, histologic, and electron microscopic findings of Kimura disease are discussed. To our knowledge, solitary involvement of the eyelid has not been reported previously. Kimura disease should be included in the differential diagnosis of an eyelid mass lesion.

Dermatomyositis as a paraneoplastic syndrome in carcinosarcoma of uterine origin.

Paraneoplastic syndromes are a collection of disorders affecting an organ or tissue caused by cancer but occurring at a site distant from the primary or metastases. Dermatomyositis can occur in association with malignancy as a paraneoplastic phenomenon. We present a case of a patient presenting simultaneously with an advanced carcinosarcoma of the uterus and dermatomyositis. The diagnoses, pathophysiology and treatment of these two conditions are discussed and current published studies reviewed.

Cervical schistosomiasis and neoplasia in HIV-infected patients.

We report two HIV-positive women with schistosomiasis of the uterine cervix, a disease that is being increasingly seen in developed countries. In both cases, there were no schistosoma ova in the cervical Papanicolaou smears. Both patients underwent LLETZ procedures that revealed an absence of a granulomatous response to the schistosoma ova, a finding that should alert the pathologist to the possibility of HIV infection. The absence of ova on cervical smears of HIV-infected women with schistosomiasis is probably related to the absence of granulomatous inflammation in these patients. A diligent search should be made for schistosoma ova in the cervical biopsy of patients from endemic areas. Treatment of schistosomiasis in HIV-infected patients should be prompt and complete to prevent recurrent high-risk HPV infection.

Angiotropic lymphoma occurring in a lacrimal sac oncocytoma.

This report describes a case of angiotropic variant of diffuse large B cell lymphoma within a benign oncocytoma of the lacrimal sac. The occurrence of this rare lymphoma within a benign neoplasm has not been documented previously. An 87 year old woman presented with a swelling over the area of the left lacrimal sac, which histological examination revealed to be an oncocytoma. Many small blood vessels within the tumour were filled with large cytologically atypical cells, which stained positively for leucocyte common antigen and a B cell antigen, CD20, confirming the presence of a large B cell non-Hodgkin's lymphoma of angiotropic type. Angiotropic lymphoma is a very rare and usually highly aggressive variant of non-Hodgkin's lymphoma, which classically involves the central nervous system and skin, but has been described within most organs. Its occurrence within a benign neoplasm is probably coincidental, although a close association between oncocytic epithelium and normal lymphoid cells is recognised in Warthin's tumour of salivary and lacrimal glands.

Malignant apocrine sweat gland carcinoma of the caruncle.

A 34-year-old male presented with a mass in the medial aspect of the orbit. Histological examination demonstrated a malignant apocrine sweat gland carcinoma, which we consider to be most likely derived from the caruncle. We describe the clinical, radiological and histological features, with management options and a review of the relevant literature regarding sweat gland carcinomas.

Adenoid cystic carcinoma of the superonasal conjunctival fornix.

The case of a 32-year-old female with a mass in the superonasal conjunctival fornix is described. Histological examination revealed an adenoid cystic carcinoma, which we consider to be most likely derived from an accessory lacrimal gland. The clinical presentation, histological features, management and follow-up are described. A literature review of orbital adenoid cystic carcinoma arising outside the main lacrimal gland is presented.