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PubMed1989

[Autopsy cases of terminal pulmonary infections].

In order to clarify the present state of terminal pulmonary infections, all autopsy cases from 1976 to 1985 reported in the annual records of autopsy cases in Kyushu University Hospital were reviewed. Of the total of 2,238 autopsy cases, pulmonary infections were present in 1,042 (46.6%) and in 595 (26.6%) pulmonary infections were fatal. Among the primary diseases associated with pulmonary infections, hematologic diseases such as leukemia and malignant lymphoma, lung cancer, esophageal cancer and cerebrovascular disease were most frequent. The pathogens of fatal pulmonary infections occurring in autopsy cases were bacteria (26.6%), Aspergillus (3.2%), Candida (1.8%), cytomegalovirus (1.7%), Pneumocystis carinii (1.1%), Mycobacterium (0.9%), Cryptococcus (0.6%) and phycomycetes (0.1%). The incidence of non-bacterial, especially fungal, pulmonary infections has increased during the recent five-year period. Among the pulmonary infections associated with lung cancer in autopsy cases, mycobacteriosis occurred more frequently than fungal infection. The incidence of fatal mycobacteriosis was more frequent in cases receiving steroids than in those not receiving steroids. Antemortem diagnosis of pulmonary infections was made in only 4.6% and 26.3% of cases of non-bacterial infection and mycobacteriosis, respectively. There was no autopsy case diagnosed before death as aspergillosis, which most frequently occurred among the fungal pulmonary infections in autopsy cases.

Bacterial Infections↗
PubMed2005

Asteroid hyalosis in an autopsy population: The University of California at Los Angeles (UCLA) experience.

OBJECTIVES: To study the prevalence and associations of asteroid hyalosis (AH) in a series of autopsy eyes. METHODS: Retrospective review of the University of California at Los Angeles (UCLA) autopsy eye database from 1965 to 2000 yielded 10,801 patients. The patients' medical histories were reviewed for evidence of diabetes mellitus, hypertension, hyperlipidemia, alcohol abuse, hypercalcemia, hypothyroidism, and chronic renal failure. Autopsy records were searched for evidence of optic atrophy, macular degeneration, posterior vitreous detachment, atherosclerosis, and chronic renal failure. Asteroid hyalosis was diagnosed by examination of the autopsy eyes. Univariate and multivariate statistical methods were used to analyze our data. RESULTS: The prevalence of AH was 1.96% in this autopsy population. By chi(2) analysis, AH was significantly correlated with age (P<.001), male sex (P = .006), age-related macular degeneration (P = .02), hypertension (P = .03), atherosclerosis (P<.001), and posterior vitreous attachment (P<.001). After adjusting for age in a multivariate logistic regression analysis, statistical significance was found only for posterior vitreous attachment (P = .002) and male sex (P = .046). No statistically significant association was found with diabetes mellitus or alcohol abuse by univariate or multivariate analysis. Analysis of the odds ratio showed a strong age effect that increased from 5.0 (95% confidence interval, 2.2-11.3) in age group 41 to 50 years, compared with 25.4 (95% Wald confidence interval, 8.2-77.9) in the age group of patients older than 90 years. CONCLUSIONS: A unique epidemiological autopsy cohort study of AH and its systemic associations yielded a higher prevalence of AH than previous studies. Asteroid hyalosis was strongly correlated with age and inversely correlated with posterior vitreous detachment. Unlike some previous reports, we found no statistically significant correlation between AH and diabetes mellitus.

Academic Medical Centers↗
PubMed1995

Thoracoscopy vs conventional autopsy of the thorax. A promising perspective.

OBJECTIVE: To analyze the sensitivity and specificity of thoracoscopic autopsy compared with that of conventional postmortem examination. DESIGN: Consecutive sampling, case-series study. SETTING: A general community referral center and the local Institute of Forensic Medicine. PARTICIPANTS: A consecutive sample of 20 fresh cadavers (less than 24 hours old), victims of motor vehicle crashes, gunshot wounds, in-hospital deaths. INTERVENTIONS: Introduction of the thoracoscope through the fourth or fifth intercostal space, anterior or midaxillary line. The pleural cavity and mediastinum were examined. Formal postmortem examination was then performed, and the findings of both procedures were recorded, compared, and analyzed. MAIN OUTCOME MEASURES: Prior to the beginning of the study, it was hypothesized that thoracoscopic autopsy would reach an overall sensitivity and specificity of at least 85% and enable accurate inspection of the thoracic cavity and mediastinum in search of trauma-related abnormalities in trauma victims or cause of death in in-hospital patients. RESULTS: There was an 85% correlation of both procedures in all cases. The sensitivity of thoracoscopic autopsy was 87% and overall specificity reached 72%. CONCLUSIONS: Thoracoscopic autopsy is accurate and easy to perform. It is highly sensitive, especially in deaths due to trauma and following thoracic surgery. Thoracoscopic autopsy is an important tool that allows the diagnosis of major chest abnormalities as well as ruling out postoperative catastrophe, information that is invaluable for the surgeon, as well as all the medical staff and families. Thoracoscopic postmortem examination should be offered to mourning families as a cosmetic and reliable option when informed consent for conventional autopsy is lacking.

Autopsy↗
PubMed1982

Intracranial metastases in small cell carcinoma of the lung: correlation of clinical and autopsy findings.

Two hundred-twelve consecutive patients with small cell carcinoma of the lung were included in an evaluation of clinical and diagnostic neurologic findings of intracranial metastases. A correlation of premortem findings to postmortem examination of the brain was obtained in 87 of the patients. Clinical intracranial metastases were diagnosed in 21.2% on the basis of symptoms and signs. At autopsy 44 of the 87 patients (50%) had metastases. Lesions located to the posterior cranial fossa were demonstrated in 53% of the positive autopsies. A correlation of 96% existed between significant premortem clinical findings and positive autopsy, while 33% had clinically "silent" metastases at autopsy. A neuro-oncologic examination was performed in 49 patients at the time of presentation of neurologic symptoms. Twenty-eight patients were considered to have intracranial metastases. Gait disturbances were the presenting signs in more than 50% of the patients. Brain metastases were demonstrated at autopsy in 14 of 15 patients considered to have intracranial metastases by the neuro-oncologist, and clinically "silent" metastases were observed in one out of 10 patients. Radionuclide brain scan was negative in seven of 13 patients in spite of "positive" neuro-oncological examination had a subsequent positive autopsy. Cerebrospinal fluid examination was of no value in the diagnosis of brain metastases. It is concluded that a careful clinical examination by a neuro-oncologist is of great value in early detection of brain metastases, especially in diagnosing metastases to the posterior cranial fossa.

Autopsy↗
PubMedDate not supplied

An exploratory study of the pattern of consent for autopsy in a regional hospital setting.

A prospective study of the pattern of responses to requests for autopsy in a general surgical unit was performed. Information on the characteristics of the deceased, of the requestee and of the requester was documented in the case of 66 patients who died while in hospital. Permission to perform autopsy was not requested in 39 out of 66 cases and this was the most frequent contributory factor to the low rate of autopsy. Once a decision to grant or refuse autopsy is made by relatives of the deceased, the decision is unlikely to be reversed. Permission to perform autopsy was more likely to be sought when the deceased was male than when deceased was female. The relatives of patients who had recently undergone surgery were more likely to refuse permission for autopsy than were those of patients who had not had recent surgery.

Age Distribution↗
PubMed2001

Should we confirm our clinical diagnostic certainty by autopsies?

OBJECTIVE: To evaluate the frequency of diagnostic errors assessed by autopsies. DESIGN AND SETTING: Retrospective review of medical and pathological records in an 11-bed closed medical intensive care unit (ICU) at a 860-bed general hospital. PATIENTS AND INTERVENTIONS: Patients who died in the ICU between January 1998 and December 1999. Medical diagnoses were rated into three levels of clinical diagnostic certainty: complete certainty (group L1), minor diagnostic uncertainty (group L2), and major diagnostic uncertainty (group L3). The patients were divided into three error groups: group A, the autopsy confirmed the clinical diagnosis; group B, the autopsy demonstrated a new relevant diagnosis which would probably not have influenced the therapy and outcome; group C, the autopsy demonstrated a new relevant diagnosis which would probably have changed the therapy and outcome. RESULTS: The overall mortality was 20.3% (270/1331 patients). Autopsies were performed in 126 patients (46.9% of deaths), more often in younger patients (66.6+/-13.9 years vs 72.7+/-12.0 years, p<0.001), in patients with shorter ICU stay (4.7+/-5.6 days vs 6.7+/-8.7 days, p=0.054), and in patients in group L3 without chronic diseases (15/126 vs 1/144, p<0.001). Fatal but potentially treatable errors [group C, 12 patients (9.5%)] were found in 8.7%, 10.0%, and 10.5% of patients in groups L1, L2, and L3, respectively (NS between groups). An ICU length of stay shorter than 24 h was not related to the frequency of group C errors. CONCLUSIONS: Autopsies are performed more often in younger patients without chronic disease and in patients with a low clinical diagnostic certainty. No level of clinical diagnostic certainty could predict the pathological findings.

Adult↗
PubMed2007

[Necessity of increasing autopsy frequency following the introduction of DRGs].

With the introduction of DRGs (diagnosis related groups) in 2004, a new charging system was initiated in Germany. Changes primarily involve lump sum based charging of inpatient cases regardless of the duration or complexity of diagnostic procedures and therapy, and the equalization of costs for similar services. Calculation of DRGs also includes the costs of autopsy. This has three major consequences for autopsy practice: Quality assurance: continuous monitoring of professional quality under lump sum payment can only be permanently guaranteed and independently and reliably attained by autopsy. This is the only way to overcome the danger of abolishing essential diagnostic procedures because of economic pressure and thus risking incorrect diagnoses. Economy: additional diagnoses revealed by autopsy will, in many cases, raise calculated charges. This could have a significant financial impact. Legal certainty: autopsies increase the accuracy and objectivity of diagnoses. Thus, they protect the attending physician from incorrect charging which may be unintended but could be legally relevant, especially when the cause of death is unclear. For these reasons, autopsy should become more important in clinical routine.

Autopsy↗
PubMed2000

Correlation between autopsy findings for chronic obstructive airways disease and in-life disability in South African gold miners.

OBJECTIVES: In South Africa chronic obstructive airway disease (COAD), which could be due to working in a dusty atmosphere in scheduled mines or works, is a compensatable disease. Miners are compensated for in-life respiratory disability and for findings at autopsy of COAD, which includes emphysema, bronchitis assessed by mucus gland hyperplasia in the main bronchus, and bronchiolitis assessed by goblet cell metaplasia. The question arises as to whether the autopsy findings correlate with in-life impairment. The objectives of the study were: (1) to determine whether autopsy COAD outcomes relate to lung function and to respiratory symptoms and signs; and (2) to quantify the individual contributions of emphysema, bronchiolitis and bronchitis to lung function impairment. METHODS: On 724 gold miners, pathological findings of COAD--emphysema, bronchitis and bronchiolitis-- were related to lung function measurements and respiratory symptoms and signs observed within 5 years prior to death. RESULTS: Emphysema diagnosed at autopsy was the main determinant of airflow impairment. The emphysema score categories 0-5, 5-35, 35-65 and > 65 were associated with decreased forced expiratory volume in 1 s, expressed as percentage predicted (FEV1%) as follows: 78.8%, 66.2%, 52.0% and 46.0%, respectively. The score was also associated with increasing frequency of dyspnoea. After adjustment for emphysema, the bronchitis and bronchiolitis were not related to significant lung function loss, and in subjects without emphysema, the presence of moderate or marked bronchitis was associated with a mild impairment only. Bronchitis at autopsy was associated with increased frequency of rhonchi, sputum and cough, whereas bronchiolitis was associated with increased sputum only. Silicosis found at autopsy was associated with some obstructive and restrictive lung function impairment. Tobacco smoking was associated with all the COAD outcomes.

Aged↗
PubMed2001

Multiple colorectal cancers in the elderly: a retrospective study of both surgical and autopsy cases.

BACKGROUND: Multiple primary cancers are not rare events in the large intestine, and account for approximately 5-7% of patients with colorectal cancer (CRC). There are few reports demonstrating clinicopathologic features of multiple CRCs in the elderly. METHODS: We clinicopathologically investigated 947 surgical patients and 362 autopsy samples from patients aged 65 years or more with CRC, including 81 surgical and 34 autopsy cases of multiple CRCs. We compared the data in the very old group (age > or = 85 years) with those of the younger age groups, i.e., a young-old group (65-74 years) and a middle-old group (75-84 years). RESULTS: The proportion of multiple CRCs was 8.6% (81/947) in the surgical patients and 9.4% (34/362) in the autopsy cases, with no significant difference among the three age groups. Similar site distributions and sex ratios, indicating proximal shift and female predominance with advancing age, were found in multiple and single CRCs, except for autopsy cases with multiple CRCs. Multiple CRCs in nonadjacent segments of the large intestine accounted for 11% (9/81) in surgical cases and 35% (12/34) in autopsy cases. In autopsy cases, the incidence of extracolorectal malignancies in patients with a single CRC was 22% (17/76) in the young-old group, 27% (39/147) in the middle-old group, and 35% (37/105) in the very old group, whereas the incidences in patients with multiple CRCs were 25% (1/4), 11% (2/18), and 50% (6/12), respectively. Regarding the organs with extracolorectal malignancies, the stomach (29%) was most frequent, followed by lung (14%), hematopoietic system (12%), and pancreatobiliary system (10%). CONCLUSIONS: These results indicate that the incidence of multiple CRCs in elderly patients with CRC is approximately 8%-10%, with no age-related difference, while extracolorectal malignancies increase with advancing age.

Adenocarcinoma↗
PubMed2006

A quick-solidifying, coloured silicone mixture for injecting into brains for autopsy: technical report.

The injection of cadaver brains is invaluable for anatomic study, but cadavers that have been properly handled are not easy to obtain. A large number of cadavers pass through forensic departments around the world, and these cadavers could provide hundreds of research specimens, though they remain in the forensic unit for only a short time. The injection of a silicone mixture that quickly solidifies during autopsy would provide greater numbers of fresh specimens for study. The authors describe a technique for injecting a self-curing silicone mixture that can be used on autopsy specimens in a forensic unit. This technique does not interfere with routine autopsy findings. We describe the preparation of the mixture and autopsy specimens, the injection process, and the method for removing injected brains from cadavers. The solidifying process took a 1-h duration in this injection method and was in accord with autopsy procedure. The arterial bed was satisfactorily filled, and even small perforating branches and pial anastomoses were well demonstrated. Injecting autopsy specimens with the quick-solidifying silicone mixture allows anatomical studies of specimens even from cadavers admitted to forensic departments for only a short time. This method can provide neurosurgery laboratories with sufficient numbers of specimens appropriate for various studies.

Autopsy↗
PubMed1991

Autopsy in general surgery practice.

This study evaluates the impact of the autopsy on a general surgical training program from 1984 through 1988. We have retrospectively examined the charts of all patients who died during this period. Included in this analysis are the records of patients from the general, cardiac, pediatric, and transplant surgery departments during this 5-year period. In all, 628 patients were evaluated. The overall autopsy rate was 73%. The clinical impressions prior to death are correlated with the anatomic diagnoses found during autopsy. Significant diagnostic discrepancies (errors unrecognized and directly related to or associated with the cause of death) were determined. On a yearly basis, diagnostic discrepancies range between 23% to 39%. Gross and histologic examination of surgical patients reveals significant information concerning the cause of death. These data confirm the educational benefit of autopsy despite escalating utilization of sophisticated, noninvasive diagnostic modalities. It is our opinion that the mortality conference, with formal autopsy presentation, is a vital forum for the discussion of patient care and quality assurance issues. Autopsy remains the most specific indicator of errors in diagnosis, management, judgment, and technique in surgical practice today.

Autopsy↗
PubMed1990

An unintentional irony: the autopsy in modern medicine and society.

Autopsy rates continue to decline despite abundant evidence of the autopsy's value. Such an extraordinary contradiction requires that we look beyond issues of education to consider our basic moral and political commitments; to consider, in other words, the kind of society in which we live, and the kind of people we are. In a heterogeneous culture, we should not be surprised to find that even our most basic obligations may be in conflict. This essay draws on social and ethical perspectives to examine a peculiar phenomenon: the reluctance of physicians to have autopsies performed on themselves or their family members. Such behavior reflects an unintentional irony, a conflict between our societal commitments to treat dead persons properly and our professional commitments to remain self-critical. The resources needed to resolve medicine's unintentional irony are to be found in our traditional language of medicine as a moral praxis, an uncertain but honorable craft devoted to the care of those who suffer. Autopsies remain the best way to learn whether or not clinical judgments are made correctly. Therefore, the autopsy is not an option; it is a professional obligation. We simply cannot hope to maintain our professional integrity as long as we proclaim the value of autopsies for our patients, but deny for ourselves and our families the same privilege.

Autopsy↗
PubMed2004

Value of fetal autopsy after medical termination of pregnancy.

We carried out a retrospective study of 352 medical terminations of pregnancy (MTP) carried out in a large French administrative region over two consecutive years. We analysed the indications for MTP and then compared the prenatal ultrasound diagnosis with fetal autopsy findings in order to demonstrate the value of pathological examination of the fetus in prenatal diagnosis and genetic counselling as well as the need to check by autopsy the quality of ultrasound screening. Preliminary analysis of the indication for these MTP showed that in 69.9% ultrasound screening had been carried out, revealing mainly brain abnormalities (22.2%) and heart defects generally associated with chromosomal abnormalities (32.1%). Prenatal findings were in agreement with autopsy results, showing no false-positive prenatal diagnoses. However, in 7.9% of cases in which brain abnormalities were detected, confirmation was not possible at autopsy because of tissue autolysis, showing the need for optimal conditions of expulsion. In 35.8% of cases, confirmation of the diagnosis by autopsy was not useful for management but still added to medical knowledge and demonstrated to the mother the reality of the defects. In 50.9%, the autopsy findings were decisive for genetic counselling.

Aborted Fetus↗
PubMed2006

Is there progress in the autopsy diagnosis of sudden unexpected death in adults?

Sudden death is now currently described as natural unexpected death occurring within 1h of new symptoms. Most studies on the subject focused on cardiac causes of death because most of the cases are related to cardiovascular disease, especially coronary artery disease. The incidence of sudden death varies largely as a function of coronary heart disease prevalence and is underestimated. Although cardiac causes are the leading cause of sudden death, the exact incidence of the other causes is not well established because in some countries, many sudden deaths are not autopsied. Many risk factors of sudden cardiac death are identified: age, gender, heredity factors such as malignant mutations, left ventricular hypertrophy and left ventricle function impairment. The role of the police surgeon in the investigation of sudden death is very important. This investigation requires the interrogation of witnesses and of the family members of the deceased. The interrogation of physicians of the rescue team who attempted resuscitation is also useful. Recent symptoms before death and past medical history must be searched. Other sudden deaths in the family must be noted. The distinction between sudden death at rest and during effort is very important because some lethal arrhythmia are triggered by catecholamines during stressful activity. The type of drugs taken by the deceased may indicate a particular disease linked with sudden death. Sudden death in the young always requires systematic forensic autopsy performed by at least one forensic pathologist. According to recent autopsy studies, coronary artery disease is still the major cause of death in people aged more than 35 years. Cardiomyopathies are more frequently encountered in people aged less than 35 years. The most frequent cardiomyopathy revealed by sudden death is now arrhythmogenic right ventricular cardiomyopathy also known simply as right ventricular cardiomyopathy (RVC). The postmortem diagnosis of cardiomyopathies is very important because the family of the deceased will need counseling and the first-degree relatives may undergo a possible screening to prevent other sudden deaths. In each case of sudden death, one important duty of the forensic pathologist is to inform the family of all autopsy results within 1 month after the autopsy. Most of the recent progress in autopsy diagnosis of sudden unexpected death in the adults comes from molecular biology, especially in case of sudden death without significant morphological anomalies. Searching mutations linked with functional cardiac pathology such as long-QT syndrome, Brugada syndrome or idiopathic ventricular fibrillation is now the best way in order to explain such sudden death. Moreover, new syndromes have been described by cardiologists, such as short-QT syndrome and revealed in some cases by a sudden death. Molecular biology is now needed when limits of morphological diagnosis have been reached.

Autopsy↗
PubMed2006

Sensitivity of autopsy and radiological examination in detecting bone fractures in an animal model: implications for the assessment of fatal child physical abuse.

Skeletal injuries are often strong indicators of child abuse and their detection is therefore crucial. The aim of this study was to compare the sensitivity of three diagnostic approaches, namely autopsy, traditional (conventional) radiology, and computed tomography on "battered" piglets, in order to verify the sensitivity of each method, with respect to the true number of bone fractures assessed once the piglet was skeletonised (osteological control). Four newborn cadaver piglets who had died from natural causes were severely beaten post-mortem in every district of the body. Traditional radiography, computed tomography (CT) and autopsy were performed. The piglet was then macerated until skeletonised and the number of all fractures present recorded (osteological control). On the cranium, traditional radiology revealed only 35% circa of actual fractures, autopsy detected only 31% (P<0.01 for both comparisons versus osteological control), whereas CT imaging detected all fractures actually present. For ribs, radiology detected only 47% of all fractures present, and autopsy 65% circa (P>0.05 for both comparisons versus osteological control), while CT scans detected 34% (P<0.01). In suspected cases of fatal child abuse, we suggest that the bones of specific districts be directly analysed either at autopsy or by collecting specific diagnostic sites, such as parts of the rib cage, and subjecting them to maceration. The removed areas could be replaced with artificial material for cosmetic purposes. The authors stress the importance of combined radiological, CT scan, autopsy and osteological survey in the detection of perimortem bone fractures.

Animals↗
PubMed1998

Autopsy in a neonatal intensive care unit: utilization patterns and associations of clinicopathologic discordances.

OBJECTIVES: (1) To develop methods to describe autopsy utilization patterns in a neonatal intensive care unit. (2) To identify classes of patients likely to have clinicopathologic concordance or discordance. METHODS: Five hundred forty-five consecutive neonatal intensive care unit deaths (338 autopsied, rate 62%) in a regional tertiary/quaternary care neonatal intensive care unit for referred infants (65,000 annual births) were classified in six clinical diagnostic groups (anomalies, cardiac anomalies, hypoxic ischemic encephalopathy, prematurity and its complications, infections, and other) and rated in three levels of certainty of clinical diagnosis as "gold standard" certainty, almost complete certainty, and less certain than the latter. Clinicopathologic discordances were rated in three classes using clinical, pathologic, and multidisciplinary mortality conference records. The proportions of autopsied cases, cases with major discordances, and cases with no discordances were compared and analyzed in relation to diagnostic group and level of certainty. RESULTS: Performance of autopsy was associated with clinical diagnostic uncertainty (p = 0.008). Major discordances with implications for outcome (Class I) were found in 3%, and without implications for outcome (Class II) in 15% of cases; 42% of cases had no discordances. Major discordance rate varied inversely with the degree of diagnostic certainty (p = 0.000) and varied among clinical groups. CONCLUSIONS: (1) Autopsy was used most for cases with potential for high yields. (2) Clinicopathologic discordances were more frequent and important in certain clinical diagnostic groups (prematurity, other) and with high levels of diagnostic uncertainty. When the diagnostic "gold standard" is available during life, autopsy will provide little information.

Autopsy↗
PubMed2003

The value of autopsy in pediatric cardiology and cardiovascular surgery.

Autopsy has been considered extremely helpful in determining the accuracy of the premorbid diagnosis. With recent advances in diagnostic imaging, the value of the autopsy has been called into question. The aim of this study was to assess the value of the pediatric autopsy in the current era of advanced diagnostic technology and sophisticated surgical intervention for congenital heart disease (CHD) and also to determine the autopsy's potential impact on clinical management. We compared the data from the postmortem examination of 29 children with CHD with the data obtained before death and evaluated for the accuracy of the diagnosis of the cardiac anatomy as well as the cause of death. The diagnosis of the anatomy was confirmed in 13 cases (45%), additional cardiovascular abnormalities with potential clinical impact were found in 11 cases (38%), and additional abnormalities without clinical impact were found in 5 cases (17%). The cause of death was confirmed in 15 cases (52%), determined by autopsy in 12 cases (41%), and uncertain in 2 cases (7%). We conclude that the pediatric autopsy continues to provide clinically relevant information with a potential impact on patient management and to reveal unexpected causes of death in a significant proportion of patients with CHD.

Adolescent↗
PubMedDate not supplied

Atypical adenomatous hyperplasia of the lung in autopsy cases.

BACKGROUND: Atypical adenomatous hyperplasia (AAH) is a possible precursor lesion of adenocarcinoma of the lung, but very few reports of AAH have focused on the autopsy lung. METHODS: We intended to clarify the characteristics of AAH in the general population by using 207 autopsy cases, ranging in age from 0 to 90 years old. RESULTS: A total of 179 eligible cases (86.5%) and 1265 tissue slides (7.0 per case) was examined independently by two pathologists. One hundred seventy-nine autopsy cases consisted of 125 males and 54 females, whose median ages were 38 (range 0-90) and 31 (range 0-81) years old, respectively. AAH was microscopically found in five of 179 autopsy cases (2.8%). The male/female ratio was 5/0 and age distribution was 52-63 years of age (median 57). One of five cases with AAH harbored esophageal carcinoma, but the others had no present or previous malignant neoplasm. One of five lesions was high grade and the others were low grade. All five cases showed positive immunoreactivity for proSP-C, a type II pneumocytes marker, but not for p53, Ki-67 or CEA. CONCLUSIONS: The incidence of AAH was very low in the general autopsy cases, as compared with the previously reported surgically resected lung and senile autopsy cases, and AAH seems to occur after middle age in general.

Adenocarcinoma↗