The Case of Will Smithers: To Exhume or not Exhume, that is the Question A surprising amount of information can be gleaned about an individual just from one’s tissues. In this case, you have been assigned to shadow histopathologist Dr. Jonas Riehm as he attempts to identify the cause of death of 42-year-old Will Smithers. Mr. Smithers’s body was discovered sitting in his car near an alley several miles from his home. There was no obvious cause of death, necessitating an autopsy to determine if the death was from natural causes or foul play. However, due to a clerical error, the decedent’s body was released and interred before a proper autopsy could be performed, and an official cause of death was not established. Fortunately, several tissue samples were taken before the interment and remain available for examination. Mr. Smithers’s family does not wish to have his body exhumed, so local law enforcement professionals have asked Dr. Riehm to examine the tissue samples in the hopes of determining his cause of death and whether or not an exhumation is needed. The following sections have been taken from the official report that Dr. Riehm sent to the local coroner’s office. You are to report to Dr. Riehm’s office with your anatomy and physiology textbook. He expects students to answer questions related to the work that he does in his histopathology laboratory. Dr. Riehm enjoys teaching, and has a collection of microscope slides that he uses to introduce students to the fascinating universe of histology. He starts with the following definition: histology is the study of the normal structure of tissues. Although Dr. Riehm is an expert in the study of the diseases and abnormalities of tissues, histopathology, he is a firm believer that you must be able to recognize normal tissue before you can understand diseased tissue. He has set up four microscope stations for students to get familiar with how the microscopes function and to view slides of normal tissues. Each station has a microscope with a slide of one of the four primary tissue types. (a) Define tissue and organ, and then describe how each fits into the levels of body organization. (b) Describe what you would expect to observe on the epithelial tissue slide. What are the general functions of this tissue? (c) Describe what you would expect to see on the connective tissue slide. What are the general functions of this tissue? (d) Describe what you would expect to see on the muscle tissue slide. What are the general functions of this tissue? (e) Describe what you would expect to observe on the nervous tissue slide. What are the general functions of this tissue? Satisfied that you are properly introduced to the concepts of normal tissue, Dr. Riehm begins to fill you in on the details of Mr. Smithers’s case, whose tissue samples have coincidentally arrived just in time for your shadowing visit. The first set of slides included an epithelium sample taken from Mr. Smithers’s forehead. The slide w.

1. The Case of Will Smithers: To Exhume or not Exhume, that is
the Question
A surprising amount of information can be gleaned about an
individual just from one’s tissues. In this case, you have been
assigned to shadow histopathologist Dr. Jonas Riehm as he
attempts to identify the cause of death of 42-year-old Will
Smithers. Mr. Smithers’s body was discovered sitting in his car
near an alley several miles from his home. There was no
obvious cause of death, necessitating an autopsy to determine if
the death was from natural causes or foul play. However, due to
a clerical error, the decedent’s body was released and interred
before a proper autopsy could be performed, and an official
cause of death was not established.
Fortunately, several tissue samples were taken before the
interment and remain available for examination. Mr. Smithers’s
family does not wish to have his body exhumed, so local law
enforcement professionals have asked Dr. Riehm to examine the
tissue samples in the hopes of determining his cause of death
and whether or not an exhumation is needed. The following
sections have been taken from the official report that Dr. Riehm
sent to the local coroner’s office. You are to report to Dr.
Riehm’s office with your anatomy and physiology textbook. He
expects students to answer questions related to the work that he
does in his histopathology laboratory.
Dr. Riehm enjoys teaching, and has a collection of microscope
slides that he uses to introduce students to the fascinating
universe of histology. He starts with the following definition:
histology is the study of the normal structure of tissues.
Although Dr. Riehm is an expert in the study of the diseases and
abnormalities of tissues, histopathology, he is a firm believer

2. that you must be able to recognize normal tissue before you can
understand diseased tissue. He has set up four microscope
stations for students to get familiar with how the microscopes
function and to view slides of normal tissues.
Each station has a microscope with a slide of one of the four
primary tissue types. (a) Define tissue and organ, and then
describe how each fits into the levels of body organization. (b)
Describe what you would expect to observe on the epithelial
tissue slide. What are the general functions of this tissue? (c)
Describe what you would expect to see on the connective tissue
slide. What are the general functions of this tissue? (d) Describe
what you would expect to see on the muscle tissue slide. What
are the general functions of this tissue? (e) Describe what you
would expect to observe on the nervous tissue slide. What are
the general functions of this tissue?
Satisfied that you are properly introduced to the concepts of
normal tissue, Dr. Riehm begins to fill you in on the details of
Mr. Smithers’s case, whose tissue samples have coincidentally
arrived just in time for your shadowing visit. The first set of
slides included an epithelium sample taken from Mr. Smithers’s
forehead. The slide was taken from some oddly colored patches
of skin that revealed some abnormal cells, specifically,
squamous cell carcinoma. These cancerous cells were in the
early stages of the disease and had not spread, or metastasized,
to cause disease in other tissues. Dr. Riehm documented that
while there was pathology noted in the epithelial slides
provided, the squamous cell carcinoma, this was not the cause
of Mr. Smithers’s death. Dr. Riehm continued to ask questions
about epithelial tissues.
Dr. Riehm has asked you to look at the epithelial tissue slide

3. from the skin of Mr. Smithers’s forehead, and describe how the
normal epithelium appeared. (a) Describe the difference
between simple and stratified epithelium. Which type would you
expect to see in Mr. Smithers’s tissue slide? (b) What are the
different shapes that epithelial cells can assume in different
epithelial tissues? Which cell shape would you expect to see in
Mr. Smithers’s tissue slide; what type of specific epithelium is
found in the skin? How would you describe the other two cell
shapes? (c) Define what the basement membrane is and discuss
the functions of its two components. (d)Which cellular junctions
would you expect to find holding these cells to one another? (e)
Describe where the apical, basal, and lateral surfaces of an
epithelial cell are located.
Dr. Riehm began to review the next set of tissue samples, which
included slides prepared from liver tissue and blood smears. He
began with the slides taken from the liver and documented the
following: the microscopic evaluation of the liver tissue is
abnormal. Large deposits of adipose tissue can be seen
interspersed throughout the normal structure of the liver tissue
that is suggestive of hepatic lipidosis, or fatty liver. The most
likely cause of hepatic lipidosis is excessive alcohol
consumption, but this would need to be corroborated by further
investigation outside the scope of this inquiry. For the record,
he documented his findings of hepatic lipidosis. He then
explained to you that these findings only indicate that the
patient had tissue evidence of an unhealthy behavior, likely
alcoholism, which could be a contributing factor in his cause of
death but unlikely the cause itself. His family and friends would
need to fill in the details about Mr. Smithers’s personal life.
This wasn’t enough individually to warrant an exhumation of
the body, nor was it enough to establish the cause of death as
liver failure. He explained that this is a common histological
finding in several long-standing illnesses, but in particular
hepatitis, obstructive jaundice, and acute and chronic

4. alcoholism with liver disease. This was still not enough to
establish a cause of death but it was more information that
would support an exhumation order by the state authorities. A
review of Mr. Smithers’s medical history or a report from his
personal physician would be helpful in determining the
relevance of this finding.
Dr. Riehm moved on to Mr. Smithers’s peripheral blood smear
slides. The erythrocytes appeared abnormally large, which
provided more evidence that Mr. Smithers had done some
significant damage to his body and tissues with alcohol
consumption. Dr. Riehm documented his findings from the
blood smear as abnormal, having found these large round
erythrocytes called macrocytes. This condition called
megaloblastic anemia leads to fewer normal cells, which limits
the amount of oxygen and metabolic waste products that can be
transported. This is a common finding in the peripheral blood
smears of alcoholic patients with anemia. Many people
suffering from alcohol dependence also have nutritional
deficiencies, including poor intake of vitamin B12 and folate,
both of which are critical for the normal development of
erythrocytes in the bone marrow.
Dr. Riehm asked you to quickly finish your work on the
connective tissue slides and take a look at the new set of cardiac
muscle samples. Has he finally found something that could have
caused Mr. Smithers’s death?
Dr. Riehm has been keeping you busy cataloging the slides that
he has finished with while he prepares to review the slides of
Mr. Smithers’s cardiac muscle tissue. Dr. Riehm described
regions of necrosis, or dead tissue, as he explains, where
cardiac muscle cells have died after being separated from the
blood supply. This finding indicated that Mr. Smithers had a
myocardial infarction or heart attack. Before you are able to
even speculate “Was this the cause of Mr. Smithers’s death,”

5. Dr. Riehm poses this question—are heart attacks always fatal,
or in other words, can we determine from this slide that this
event preceded and therefore caused Mr. Smithers’s death?
People survive heart attacks, don’t they? Dr. Riehm would need
to look at the slides more closely later in the day before he
completed this portion of his report. He was not ready to sign
off on myocardial infarction as the cause of death just yet.
Dr. Riehm reviewed the remaining slides in the set. He selected
a blood vessel slide and discovered hypertrophy, or an
enlargement of the smooth muscle, and damage to the
endothelium lining the vessel walls. Both were signs of vascular
disease, as was the finding of atherosclerosis, or plaque, which
had probably clogged Mr. Smithers’s arteries and veins. All of
these were pathological findings that supported a diagnosis of
vascular disease. Vascular disease increases the likelihood of
myocardial infarction. Mix the cardiovascular findings with
fatty liver disease, anemia, and enough alcohol, and that could
explain this man’s death. But it would still be speculation. All
of these certainly could lead to a myocardial infarction, no
doubt. There was evidence that a cardiac event had happened at
some point in Mr. Smithers’s life. Like his fatty liver, these
findings indicated that Mr. Smithers was unhealthy.
A review of Mr. Smithers’s medical history or a report from his
personal physician would be helpful in determining the
relevance of these finding. A pathologist would probably need
to see the actual heart itself to make a cause of death by
myocardial infarction determination. Dr. Riehm reminded you
to get those slides filed away so we could move on to the last
set of samples from Mr. Smithers’s brain tissue.
Dr. Riehm suggested that you make flashcards of the following
information: (a) briefly describe the structural characteristics
and functions of skeletal muscle; (b) briefly describe the

6. structural characteristics and functions of cardiac muscle; (c)
briefly describe the structural characteristics and functions of
smooth muscle; and (d) discuss the similarities and differences
between the three different muscle tissue types.
Finally, being thorough, Dr. Riehm wanted to review his
assessment of the cardiac tissue slides. Finding evidence of
fibrous tissue interspersed among cardiac muscle cells indicated
that the heart had tried to heal itself. Mr. Smithers would have
had to have been alive long enough for scar tissue to form in his
heart. The evidence from the cardiac tissue was consistent with
an old myocardial infarction that Mr. Smithers survived. There
was no evidence in the tissue samples to suggest that he had had
an acute myocardial infarction. Dr. Riehm could only document
what he observed in a small amount of cardiac tissue. Mr.
Smithers could have had an acute and fatal myocardial
infarction in a region of the heart from which no tissue samples
were collected. For what he observed from the available tissue
slide, however, a cardiac event as the cause of his death was
unlikely. His report would undoubtedly leave more unanswered
questions about the cause of Mr. Smithers’s death. A full gross
examination of Mr. Smithers’s heart would be needed, which
would obviously require that his body be exhumed.
Dr. Riehm has found evidence of fibrosis in the cardiac muscle
tissue slides, scattered throughout the dead cardiac muscle cells.
This suggested that Mr. Smithers had survived that particular
cardiac event. Which of the following statements is true with
regard to how cardiac muscle tissue is repaired?
Cardiac muscle cells are only capable of regeneration if the
degree of damage is minimal. Extensive damage results in
healing by fibrosis.

7. Cardiac muscle cells are incapable of tissue regeneration
because they are no longer capable of dividing by mitosis.
Damaged cardiac tissue is replaced with scar tissue.
Cardiac muscle cells differentiate into fibroblasts and
regenerate functional cardiac tissue through the process of
fibrosis.
Fibroblasts secrete cardiac tissue ECM and once surrounded
differentiate into mature cardiac muscle cells. This leads to
regeneration of fully functional cardiac tissue.
WRAPPING UP THE CASE
Based on his findings, Dr. Riehm is fairly confident that the
cause of Mr. Smithers’s death could not be determined based on
an examination of tissue slides alone. Given the liver and
vascular disease, he certainly wasn’t healthy, and a heart attack
is a common outcome associated with both conditions.
However, one question remains unanswered: the damage to the
brain. This could have been the result of an accident or
deliberate blunt force trauma. Mr. Smithers’s body would need
a full autopsy to answer these questions. Tissue slides could
provide details not seen with the naked eye but a close look at
the body is required—this could be a criminal case. Mr.
Smithers’s remains would need to help answer these questions.
Due to the unknown cause of head trauma, Dr. Riehm
recommends that Mr. Smithers’s body be exhumed so that it can
be examined more closely. The details of the pathology will be
available in the continuation of Mr. Smithers’s case (see
Chapter 12).

8. Assignment Expectations
Length:
750 - 1250 words
Structure:
Include a title page and reference page in APA style. These do
not count towards the minimal word amount for this assignment.
Be sure to include an introduction and conclusion paragraph for
the assignment.
References
: Use the appropriate APA style in-text citations and references
for all resources utilized to answer the questions. Include at
least three (3) scholarly sources to support your claims.