NYC-WTC_000174805

NYC 9/11 Public Portal Document

2 AFIP Letter / Vol. 159, No. 5 / October 2001

Atlas of Tumor Pathology, Third Series, Fascicle 31 Director’s Message Tumors of the Liver and Intrahepatic Bile Ducts Kamal G. Ishak, MD, PhD, Zachary D. Goodman, MD, PhD Armed Forces Institute of Pathology, Washington, DC, AFI P’s Response and J. Thomas Stocker, MD to September 11 Uniformed Services University of the Health Sciences, Bethesda, MD Armed Forces Institute of Pathology, Washington, DC • 2001

T his issue of the Letter is focused on the efforts of the AFIP to respond to the tragedy of September 11,2001 at the Pentagon, and secondarily to identification efforts at the Somerset, Pa site. The Institute’s timely response to these ISBN: 1-881041-69-7 In the 12 years since publication of the second series fascicle on this subject, there have been many advances in epidemiologic, histoge- incidents underscores the importance of an intact infrastructure to netic, pathogenetic, and clinicopathologic aspects of tumors and support such activities, especially when they become extended. tumor-likc lesions of the liver and intrahepatic bile ducts. This third The medicolegal death investigation of the Pentagon incident has series fascicle is divided into 14 chapters: extended over 2 months and has involved around-the-clock • Embryology, histology, and anatomy laboratory testing. All avenues of forensic investigation were • Benign hepatocellular tumors explored and deployed with zero defects. I am very proud of the • Benign cholangiocellular tumors effort and the succes.s of this multidisciplinary and multifactorial • Benign mesenchymal tumors and pseudotuniors investigation. In such federal investigations, the Office of the • Miscellaneous benign tumors and pseudotumors Armed Forces Medical Examiner is the spear point for the AFIP’s • Hepatoblastoma 911 response. The OAFME is the headquarters of the global • Putative precancerous lesions Armed Forces Medical Examiner System (AFMES) and the only • Hepatocellular carcinoma federal medical examiner system. It i.s routinely used by other • Fibrolamellar hepatocellular carcinoma federal agencie.s, including State, Justice, Treasury, and Transpor­ • Intrahepatic cholangiocarcinoma and other malignant biliary tumors tation, as well as by Veterans Affairs and DoD. • Miscellaneous malignant tumors The Pentagon investigation highlighted the importance of a • Malignant rnesenchymal tumors multidisciplinary effort. Forensic anthropology was a significant • Primary hepatic lymphomas and suspected lymphomas component; made up of physical anthropologists from the AFIP, • .Metastatic tumors the Smithsonian Institution, and the US Army Central Identifica­ • and an appendix on the TNM classification of malignant tumors tion Laboratory-Hawaii. A comprehensive dental team was of the liver. formed with expanded capabilities in digital imaging and com­ Several tumors and tumor-like lesions are extensively discussed, parative analysis. The medical radiographic section included full­ commensurate with increased knowledge about them, such as time, fully trained radiologists assisting the dentists, anthropolo­ perihiliary gland hamartoma (bile duct adenoma), hepatobiliary gists, and pathologists in the identification and characterization of cystadenoma, biliary papillomatosis, lymphangioma, angiomyolipoma, all specimens received. Where appropriate, both toxicology and miscellaneoLi.s heterotopias, hepatoblastoma, hepatocellular carcinoma, DNA specimens were obtained in each case. This was the first intrahepatic cholangiocarcinoma, epithelioid hemangioendothelioma, time that military nursing staff was incorporated to assist the and primary hepatic lymphomas (including a section on diagnosis of forensic pathologist in the postmortem physical examination and suspected lymphoma). recording of findings. Thi.s medical team was paired with forensic Tumor entities not covered in the previous fascicle include ciliated anthropologists, dieners, photographers, and evidence technicians. foregut cyst, peribi liary gland cysts, hereditary hemorrhagic telang­ The entire operation remained under the watchful eye of the FBI, iectasia, myelolipoma, focal fatty change, Langerhans’ cell histiocyto­ which had two teams on-site—a fingerprint team and a trace sis, solitary fibrous tumor, miscellaneous benign mesenchymal tumors evidence team. All activities were coordinated between the FBI, (such as plexiform neurofibromatosis), hepatic pregnancy, putative AFIP/AFMEO, Dover AFB Base, Service Personnel Offices, precancerous lesions, malignant rhabdoid tumor, and two hitherto Dover Port Mortuary, and DoD assets. undescribed tumors: ossifying stromal-epithelial tumor and kapo,siform The succes.s of thi.s investigation and similar past experiences angiosarcoma. underscores the importance of a collaborative, cooperative The 511 gross photographs and photomicroeraphs (most in color) are of outstanding quality. Only a few electron micrographs are enterprise where consensus, commitment, and communication are prized. included, in keeping with the authors’ belief that they are of limited diagnostic value. The chapters are extensively referenced. Imaging studies of most of the tumors are briefly covered but only rarely Glenn N. Wagner illustrated. This 356-page fascicle should be an essential reference for CAPT, MC, USN residents, oncologists, hepatologists, gastroenterologists and patholo­ The Director gists in practice.

CITY_21MC1OO_O1256482O

NYC-WTC_000174806