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PubMed2005

An insurer's perspective on error and loss in pathology.

OBJECTIVES: To identify errors in surgical pathology practice that lead to malpractice claims, and to define the frequency and severity of pathology malpractice claims and discuss the implications. DESIGN: Three hundred seventy-eight pathology malpractice claims reported to The Doctors Company of Napa, Calif, between 1998 and 2003, were reviewed. Nuisance claims and autopsy claims were excluded; the 335 remaining claims were analyzed. RESULTS: Pathology claim frequency is low. Pathology claim severity is high, especially for claims involving a misdiagnosis of melanoma or a false-negative Papanicolaou test. Fifty-seven percent of claims involved the following 5 categories: breast specimens, melanoma, Papanicolaou smears, gynecologic specimens, and operational error. Sixty-three percent of claims involved failure to diagnose cancer, resulting in delay in diagnosis or inappropriate treatment. CONCLUSION: A false-negative diagnosis of melanoma is the single most common reason for filing a malpractice claim against a pathologist. Nearly one third of misdiagnoses involve melanoma misdiagnosed as Spitz nevus, "dysplastic" nevus, spindle cell squamous carcinoma, atypical fibroxanthoma, and dermatofibroma.

Diagnostic Errors↗
PubMed2005

Frozen section diagnosis in pediatric surgical pathology: a decade's experience in a children's hospital.

CONTEXT: Intraoperative consultations, including frozen sections (FSs), are essential for patient care and are a key quality component in anatomic pathology. Little data exists about the use, frequency, and type of discrepancies and deferral rates of FS diagnoses in pediatric and adolescent surgical pathology. OBJECTIVE: The purpose of this study was to analyze indications, discrepancies, and deferrals for all FSs performed at a children's hospital during a 10-year period. DESIGN: All FSs for 1995-2004 were reviewed for indications, discrepancies, deferred diagnoses, and turnaround time. Discrepancies were categorized into major and minor subtypes according to potential impact on patient care. RESULTS: A total of 35,611 surgical pathology cases were accessioned, with 2839 intraoperative consultations, which included 2783 FSs and 56 nonmicroscopic consultations. Most frequent indications included questions related to neoplasms (tumor detection, specimen adequacy, triage, classification, and margins) and suspected Hirschsprung disease. In these consultations, 115 discrepancies (4%) were identified, of which 7 (0.2%) were major, with potentially significant clinical impact, and 108 (3.9%) were minor. The major discrepancies included tumor, ganglion cell, or organism detection. The minor discrepancies involved sampling error, reclassification of benign or malignant neoplasms without clinical consequences, tumor typing or grading, and ganglion cell identification without clinical impact. Deferrals in 718 FSs (25% deferral rate) included tumor classification from generic to specific, identification of organisms, and evaluation of lymph node biopsies for lymphoma. Turnaround time exceeded 20 minutes in 403 cases (14%). CONCLUSIONS: The FS rate of 7.8% overall and 5% of surgical pathology cases is similar in children's and general hospitals. The major discrepancy (discordance) rate is lower, which may reflect the different indications for FS in children and adolescents. Evaluation of colonic biopsies for ganglion cells is a diagnostic pitfall. The deferral rate of 25% reflects the definition of a deferred diagnosis. Traditional definitions of deferred and discordant FS diagnoses should be refined to reflect the increasing use of adjunct techniques, especially in tumor classification. These findings emphasize that, in children and adolescents, most FSs are performed for tumor classification, triage, detection, and specimen adequacy, and for possible Hirschsprung disease. In children and adolescents, FSs are used infrequently to identify normal or unknown tissue, to analyze a lesion in a radiographically directed specimen, or to detect lymph node metastases. The differences in pediatric and adolescent FS indications and use underscore the importance of focused education in pediatric surgical pathology.

Frozen Sections↗
PubMed2005

Patient safety in anatomic pathology: measuring discrepancy frequencies and causes.

CONTEXT: Anatomic pathology discrepancy frequencies have not been rigorously studied. OBJECTIVE: To determine the frequency of anatomic pathology discrepancies and the causes of these discrepancies. DESIGN: Participants in the College of American Pathologists Q-Probes program self-reported the number of anatomic pathology discrepancies in their laboratories by prospectively performing secondary review (post-sign-out) of 100 surgical pathology or cytology specimens. Reasons for the secondary review included conferences, external review, internal quality assurance policy, and physician request. PARTICIPANTS: Seventy-four laboratories self-reported data. MAIN OUTCOME MEASURES: Frequency of anatomic pathology discrepancy; type of discrepancy (ie, change in margin status, change in diagnosis, change in patient information, or typographic error); effect of discrepancy on patient outcome (ie, no harm, near miss, or harm); and clarity of report. RESULTS: The mean and median laboratory discrepancy frequencies were 6.7% and 5.1%, respectively. Forty-eight percent of all discrepancies were due to a change within the same category of interpretation (eg, 1 tumor type was changed to another tumor type). Twenty-one percent of all discrepancies were due to a change across categories of interpretation (eg, a benign diagnosis was changed to a malignant diagnosis). Although the majority of discrepancies had no effect on patient care, 5.3% had a moderate or marked effect on patient care.Conclusions.-This study establishes a mean multi-institutional discrepancy frequency (related to secondary review) of 6.7%.

Humans↗
PubMed2006

Key issues in reporting common cancer specimens: problems in pathologic staging of colon cancer.

CONTEXT: Standardized pathologic assessment is a quality measure for cancer care. OBJECTIVE: Pathologic staging parameters and the clinically important stage-independent pathologic factors that pathologists find most problematic to evaluate in colorectal cancer resection specimens are reviewed. The objective of this review is to provide practical guidance for the practicing surgical pathologist. DATA SOURCES: Published literature related to the TNM staging system for colorectal cancer of the American Joint Committee on Cancer and the International Union Against Cancer and to stage-independent tissue-based prognostic factor evaluation was included in the review. STUDY SELECTION, DATA EXTRACTION, AND SYNTHESIS: Published guidelines from authoritative sources and published peer-reviewed data related to colorectal cancer staging and pathologic prognostic factor assessment were included for consideration. The general and site-specific rules of application of the American Joint Committee on Cancer and International Union Against Cancer TNM staging system for the colorectum and the protocol for evaluation of colorectal cancer resection specimens of the Cancer Committee of the College of American Pathologists served as the basis for discussion and amplified with practical advice on specific application. CONCLUSIONS: Standardization of pathologic evaluation of colorectal cancer resection specimens is essential for optimal patient care and is aided by the use of data-driven guidelines that are easily understood and consistently applied.

Colorectal Neoplasms↗
PubMed2006

Surgical pathology--second reviews, institutional reviews, audits, and correlations: what's out there? Error or diagnostic variation?

CONTEXT: A variety of methodologies have been used to report error rates in surgical pathology within the peer-reviewed medical literature. The media has selectively and superficially reported these error rates creating a climate of disinformation between physicians and the public. OBJECTIVES: To review the medical literature on diagnostic error in surgical pathology and summarize and compare these data with selected reports in the print and broadcast media. DESIGN: A search of the medical literature from the National Library of Medicine database using the heading "Error and Pathology Diagnosis." RESULTS: Three thousand nine hundred ninety-two citations were found, of which 83 directly measured in some manner errors in surgical and cytopathology. Major error rates ranged from 1.5% to 5.7% globally for institutional consults. Error rates were less, 0.26% to 1.2% for global in-house prospective review and 4.0% for in-house and retrospective blinded review. Error rates also varied by anatomic site: skin, institutional consult, 1.4%; prostate, institutional consult, 0.5%; and thyroid, institutional consult, 7.0%. Error rates reported in citations used by the Wall Street Journal were as follows: prostate, Gleason score changed by 1 point, 44% and resultant change in treatment for prostate cancer, 10%; for breast, altered lumpectomy or mastectomy plan, 8%; and diagnosis changed for thyroid lesions, 18%. Errors in second opinion on breast lesions (single pathologist author for the study) fall within the range of global reviews. Errors for second opinions on prostate cancer were principally 81% upgrades in Gleason score for prostate core needle biopsies. However, this resulted in an upgrade of patient risk category in only 10.8% of patients. Data for the article on change in diagnosis of thyroid lesions were incomplete. There appeared to be 3 significant diagnostic errors (4.5%). CONCLUSIONS: Pathology is not immune to the power of the media to create concern about accuracy of diagnosis in surgical pathology and cytopathology. Detailed analysis of the medical literature cited by the media determines that painting the big picture and hitting the highlights can be profoundly misleading.

Databases, Bibliographic↗
PubMed1999

Mandatory second opinion surgical pathology at a large referral hospital.

BACKGROUND: When patients are referred to one's own institution for therapy based on a histopathologic diagnosis rendered at another institution, many hospitals require a second opinion of the surgical pathology material. This quality assurance practice has been threatened in the era of managed care and cost containment. METHODS: The authors reviewed the impact of mandatory second opinion surgical pathology at The Johns Hopkins Hospital. Cases were collected prospectively over a 21-month period from April 1995 to December 1996. For the purposes of this study, a changed diagnosis was defined as a discordant diagnosis resulting in a major modification in therapy or prognosis. The majority of cases involved a change between benign and malignant or a major change in tumor classification. Changes involving a modification of tumor grade or stage were not included. RESULTS: Of 6171 cases reviewed, second opinion surgical pathology resulted in 86 changed diagnoses (1.4%). Compared with the entire group, 2 organ systems were significantly more likely to undergo a change in diagnosis: serosal surfaces (9. 5%) (P < 0.0001) and the female reproductive tract (5.1%) (P < 0. 0001). Organ systems that were not more likely to undergo a change in diagnosis than the group as a whole included the skin (2.9%); central nervous system (2.8%); breast (1.4%); genitourinary system (1.2%); gastrointestinal tract (1.2%); hematologic system (1.1%); ear, nose, and throat (1.0%); bone/soft tissue (0.9%); lung (0.6%); endocrine (0%); mediastinum (0%); and cardiovascular system (0%). CONCLUSIONS: Second opinion surgical pathology can result in major therapeutic and prognostic modifications for patients sent to large referral hospitals. Although the overall percentage of affected cases is not large, the consistent rate of discrepant diagnosis uncovered by second opinion surgical pathology may have an enormous human and financial impact. Accordingly, the authors recommend that review of the original histologic material should be undertaken prior to the institution of a major therapeutic endeavor.

Adolescent↗
PubMed2000

Pathfinder: multiresolution region-based searching of pathology images using IRM.

The fast growth of digitized pathology slides has created great challenges in research on image database retrieval. The prevalent retrieval technique involves human-supplied text annotations to describe slide contents. These pathology images typically have very high resolution, making it difficult to search based on image content. In this paper, we present Pathfinder, an efficient multiresolution region-based searching system for high-resolution pathology image libraries. The system uses wavelets and the IRM (Integrated Region Matching) distance. Experiments with a database of 70,000 pathology image fragments have demonstrated high retrieval accuracy and high speed. The algorithm can be combined with our previously developed wavelet-based progressive pathology image transmission and browsing algorithm and is expandable for medical image databases.

Abstracting and Indexing↗
PubMed2001

Comparison of histopathologists' workloads in two pathology departments in Croatia.

AIM: To calculate workloads of Departments of Pathology and staff histopathologists at two Croatian University Hospitals by means of the Suvarna and Kay's Kim Unit (KU) activity index. METHOD: The total number of specimens and KU activity/year were calculated to compare staff pathologists' workload in two Pathology Departments, one at Split and the other at Zagreb University Hospital. The individual specimen types were assigned a difficulty score on a scale of 1-5 units (KUs), depending on the time needed for specimen dissection and macroscopic description, number of sections and stains required, and time spent on microscopy of an "average case". KU activity was calculated for all pathologists individually in terms of histology (1-5 KUs), autopsy (10 KUs), supervision of residents, and outside consultations (2 KUs). RESULTS: According to calculated Kim Unit activity index, pathologists' workload in two investigated pathology departments was not equally spread. In the Split Department of Pathology the distribution of workload was more uniform than in the Zagreb Department of Pathology. The average workload of both institutions was 4,562 KUs. CONCLUSION: KU activity index is a very useful method for assessing average pathologists' workload. It may be also used in hospital administration for predicting changes in service and number of working pathologists.

Biopsy, Needle↗
PubMed1993

[Introduction and establishment of pathology in Korea (1910-1960)].

The concept of modern pathology had not been present in Korea until it was introduced through the Japanese pathologists who came to Korea to work as staff pathologists at [Korean] Hospital in 1913. Two prominent Japanese pathologists at that time were Dr. Inamoto and Dr. Tokumitzu who taught pathology at Hospital affiliated Medical Institute. Department of Pathology was established at Keijo Medical College in 1916 and at Keijo Imperial University Faculty of Medicine in 1926. In the private medical school, Severance Union Medical School, the pathology was taught by Japanese and American Physicians until Dr. Il Sun Yun established Department of Pathology in 1929. Papers on histopathological description of disease started to appear in the medical literature, Chosen Medical Journal that was first issued just after Japanese occupation of Korea in 1910. Many diseases of Koreans had been scientifically documented in medical literature since 1911 by the leading role of faculty pathologists of Keijo Medical College and Keijo Imperial University Faculty of Medicine until 1940. ...

Education, Medical↗
PubMed2001

[Melanoma of the skin: excision policy and pathology report writing in the 'Integraal Kankercentrum Zuid' region is in accordance with the guideline in slightly more than half of the patients].

OBJECTIVE: To determine the extent to which the guidelines for cutaneous melanoma had been implemented in the diagnostic and treatment approach of general hospitals. DESIGN: Retrospective, descriptive. METHOD: Patients were selected via the cancer registration system of the 'Integraal Kankercentrum Zuid' (Integral Cancer Centre South, the Netherlands). They were submitted through the pathology laboratory by 1 of the 16 general hospitals in the region. Data was collected from the pathology (PA) reports of the 573 patients for whom a cutaneous melanoma was diagnosed in 1988, 1993 and 1997. The treatment policy and the PA reports were compared with the recommendations in the guidelines concerned and the revised versions of these published in 1985, 1990 and 1997. The patients studied were 212 men (37%) and 361 women (63%) with an average age of 51 years (range 13-96). RESULTS: A diagnostic excision was performed in 485/573 patients (85%). Invasiveness was assessed in 99% of the preparations; in 14% a melanoma was encountered in situ. Invasive melanomas were less often seen in the head and neck region than on the trunk or limb. Thickness of the tumour was not determined in 8% of all 493 invasive tumours and in 19% the pathology report did not state whether the diagnostic biopsy was performed radically. In accordance with the guidelines, diagnostic excision biopsy was first performed in 59% of patients with a subsequent re-excision if necessary; 77% of the PA reports satisfied the fundamental recommendations from the guidelines. For 55% of the patients the diagnostic and therapeutic procedures as well as the pathology report were completed in accordance with the guideline recommendations. Modest improvement occurred over time. CONCLUSION: The excision and re-excision policies as well as the pathology report writing concurred with the recommendations in the consensus for cutaneous melanoma in slightly more than half of the patients who were diagnosed within the IKZ region in the years 1988, 1993 and 1997.

Adolescent↗
PubMed2001

Fibroadenoma of the breast: analysis of associated pathological entities--a different risk marker in different age groups for concurrent breast cancer.

BACKGROUND: Fibroadenoma, one of the most common benign breast lesions, has a characteristic age-specific incidence and is associated with other pathological entities in 50% of cases. The clinical or imaging diagnosis of fibroadenoma may be erroneous, and in some cases is found to be invasive cancer. The clustering of such entities, their correlation with age, and the risk of synchronous breast malignancy are uncertain. OBJECTIVE: To explore the possibility of any significant clustering of fibroadenoma-associated benign breast diseases and to assess the possible risk of concomitant breast cancer. METHODS: We analyzed the pathological results of 147 women undergoing excisional biopsies for fibroadenoma diagnosed pre-operatively either by clinical examination and imaging (n = 17) or by radiology alone (n = 30). The inter-relationships among all entities associated with fibroadenoma were studied by hierarchical cluster analysis. The correlation of the various pathologies with the risk of invasive breast cancer in relation to the patient's age was also evaluated. RESULTS: Fibroadenoma-associated pathologies were found in 48% of the cases: sclerosing adenosis (23%), duct ectasia (17.7%), apocrine metaplasia (15.6%), florid fibrocystic disease (12.9%), duct papillomatosis (11.6%), infiltrating duct carcinoma (5.4%), duct carcinoma in situ (3.4%), and 1 case of lobular carcinoma in situ (0.6%). An orderly internal hierarchy and three significant clusters emerged: a) epithelial apocrine metaplasia, duct ectasia and sclerosing adenosis (similarity coefficients 16.0, 11.0 and 8.0 respectively); b) papillomatosis, florid fibrocystic disease and calcifications (similarity coefficients of 6.0, 4.0 and 2.0 respectively); and c) infiltrating duct carcinoma and duct carcinoma in situ (similarity coefficients of 1.8 and 1.6 respectively). Seven of the eight patients with breast cancer were older than 40 years. CONCLUSIONS: In about half of the cases fibroadenoma was associated with other pathological entities clustered in an orderly hierarchy. The rarity of synchronous breast cancer in the younger age group and its more common association with fibroadenoma in the older age groups dictate a different approach to each. The finding of fibroadenoma in women older than 40 indicates the need for surgical excision.

Adolescent↗
PubMedDate not supplied

[Certain biological regularities and basic mechanisms of pathological processes].

The following general biological regularities and basic mechanisms of pathological processes development are considered: endogenesis of pathological processes, biological loss of inhibition, disregulation pathology, pathological systems and pathological determinants. The problem of development of general theory of medicine was also discussed.

Animals↗
PubMed2001

Quantitative RT-PCR assay for mRNA of VEGF and histone H4 in the determination of proliferative and angiogenic activity in vulvar pathology.

Proliferative and angiogenic activity of tissue specimens taken from women with various vulvar pathologies were evaluated by determining the number of mRNA VEGF molecules and H4 histone mRNA molecules, by means of the QRT-PCR (TaqMan) technique. Following a cluster analysis the results, where normalised. Euclidean distances were used, all the cases were classified into three groups of pathologies. Group I included low degree vulvar pathologies, group II included high degree vulvar pathologies and group III included vulvar pathologies with high proliferative and angiogenic activity. Significant differences were found in the proliferative and angiogenic activity between groups I and III, and between groups II and III, while no statistically significant differences were found between groups I and II.

Carcinoma in Situ↗
PubMed2001

[Pathology and clinical medicine in the 21st Century].

The major task of pathology is to bridge the gap between basic science and clinical medicine. Consequently, pathology has to keep pace particularly with the progress in molecular biology and genetics and has to transfer the progress of basic research to studies of disease. Pathology has to test and continuously incorporate new methods into its scientific and diagnostic repertoire to improve diagnostic sensitivity and accuracy. The recognition of genetic alterations, particularly associated with tumors and chronic degenerative diseases, and its consequences in correlation with morphology allows the evaluation of changes in the genetic set-up and related cellular functions. This greatly improves the basis for understanding the biological background and clinical behavior of disease, thus adding a dynamic component to the snap-shot picture provided by the histologic slide. Application of genomics and proteomics will have significant impact on diagnostic pathology in the 21st century regarding definition and classification of pathologic processes, assessment of prognosis and guidance of treatment. The modern pathologist has to accept this challenge in order to maintain his position in the center of clinical medicine. However, despite all present and future advances, experience and skills in the morphologic evaluation of disease processes will still remain the "gold standard" in our field and the basis for proper application of these new technologies. When we accept the promising new techniques and tools already at the present early stage of development we may not only improve the clinical relevance of our work but gain invaluable information on the nature of diseases and the basic principles responsible for the complex morphologic pictures we enjoy in our daily work.

Clinical Medicine↗
PubMed2002

[The pathology department].

The evolution of the Laboratory of Pathology at Erasmus Hospital is directly related to the morphological diagnosis integration in the medico-surgical organization of the Hospital. Such integration is based on the creation of links between the Laboratory of Pathology and the clinical departments and necessitates permanent adaptations to new complementary technology. Immunohistochemical methods were gradually included in the surgical morphological diagnosis. Currently, new markers from molecular biology are needed to obtain accurate pathological diagnosis. We observe an increasing hyperspecialization of the morphological classification with complete integration of such biological markers leading to the necessity of carrying out collegial diagnosis. The development of the telepathology technology permits international collegial diagnosis. According to its central position the Laboratory of Pathology plays an important part in the development of the clinical and fundamental research. The research subjects of the Laboratory of Pathology concern diagnostic and prognostic evaluation in colic cancers, sarcomas, brain tumors and HPV related tumors endometriosis.

Belgium↗
PubMed2003

Hysterectomy in women with cervical stenosis. Surgical indications and pathology.

OBJECTIVE: To evaluate indications for surgery and final pathology results in patients who underwent hysterectomy with a concurrent diagnosis of cervical stenosis. STUDY DESIGN: Retrospective chart review of 25 women who underwent hysterectomy after diagnosis of cervical stenosis. RESULTS: The average age was 59 years (range, 38-80). Indications for surgery included postmenopausal bleeding in 10 patients, previous dysplasia with inadequate Papanicolaou test follow-up in 4, recurrent high grade squamous intraepithelial lesion in 1, chronic pelvic pain in 5, acute pain in 2, dysfunctional uterine bleeding in 2 and thickened endometrial stripe in 1 patient on tamoxifen. An attempt to obtain an endometrial sample was unsuccessful in 14 patients. Twenty patients had undergone prior gynecologic surgery. The results of final cervical pathologic examination revealed severe cervical dysplasia or carcinoma in situ in 3. Final uterine pathology revealed 1 patient with uterine adenocarcinoma and 19 patients with benign pathology, including endometritis, fibroids, adenomyosis and endometrial hyperplasia. CONCLUSION: The majority of patients with cervical stenosis resulting in inadequate cancer screening and/or symptoms resulting from stenosis will have significant benign pathology (64%), cervical dysplasia (12%) or uterine cancer (4%). For these patients, hysterectomy is a reasonable option.

Adenocarcinoma↗
PubMed1992

Teaching pathology without lectures through computer-based exercises, small-group discussions and reading.

The Department of Pathology at Robert Wood Johnson Medical School teaches a 205-hour, one semester course to 150 second-year students in the fall semester of the second year. The course begins with General Pathology (4 weeks) and continues with Systemic Pathology (12 weeks). In 1986, lectures were eliminated as a means of conveying the course content. Students were expected to read the textbook and to participate in obligatory small group discussions. Extensive computer based self-learning materials were provided in both MS/DOS and Macintosh formats. In 1991, these computer resources included the full text of Robbins Pathologic Basis of Disease, extensive question banks and a guide through the Slice of Life Videodisc. Over the past 6 years this modified curriculum has been enthusiastically received by the students and faculty. Student performance on internal and external examinations has been excellent. Approximately 4% of the graduating students select pathology for their post-graduate training.

Computer-Assisted Instruction↗
PubMed2004

The historical outline of Vilnius pathological anatomy in the first half of the 19th century.

The first post mortem examination was performed in Vilnius by a priest Stefan Bisio in 1770. At the end of the 18th century, Jakub Briotet, a surgeon and anatomist, founded a modest anatomical (surgery) study. In 1804, Jan Piotr Frank and his son Józef arrived to Vilnius and became professors of the University. Jan Piotr Frank took charge of the University Teaching Hospital and Józef of the Chair of Pathology. When, in 1805, Józef Frank took charge, after his father, of the University Hospital, he founded the first anatomopathological examination room there. The samples were obtained mainly from post mortem studies--autopsies. Most of the samples kept in spirit in the Frank's room were eaten by the starving French soldiers during the retreat of Napoleon's army. Getting dead bodies for the Universities was easy thanks to Tsar's decrees from the years 1793-1809 which ordered to open dead bodies and collect monsters. Moreover, a permission to transfer dead bodies from military hospitals to the University was issued in 1810. These decrees did not stop the cases of students digging out dead bodies from the graves, which still happened in 1810 and 1817. Józef Frank acknowledged great role of post mortem in medicine teaching. He wrote: an author describing a disease with lethal outcome, who does not mention pathological changes found through autopsy is backward. Beside Frank's study, there was still a study founded by Briotet at the Vilnius University, at the Chair of Anatomy. In 1808, Tsar Alexander I designed ruins of Spaska Orthodox Church for an anatomic theater. After seven year redecoration works, it was opened. Beside the theater, dissection room and Veterinary Institute, the building included zoological, veterinary and anatomical museum. The growing anatomical museum had, in 1841, 2895 preparations including 1239 anatomopathological preparations. After closing down Vilnius University and opening Medical and Surgery Academy, pathological anatomy classes were introduced for the 5th year students in 1834. The first lecturer of pathological anatomy, as an individual subject, was Ludwik Siewruk. He started the classes in 1840 when he took charge of the Chair of Anatomy at the Moscow University. Jan Leonow continued the classes till the closing down of Medical and Surgery Academy by the tsar in 1842. The classes performed by Siewruk and Leonow were limited to lectures. Practical knowledge, autopsies were a part of pathology classes and specific therapy (3rd and 4th years of studies). After the Academy had been closed down, all the exhibits of the Vilnius anatomical museum, including anatomopathological preparations were moved to the anatomical museum of Kiev University. Few of them remained in the Vilnius Medical Society.

Anatomy↗