In 1885, pathologist George Elliott was looking through his microscope at the histological preparation of a tumor pictured here. He noted that "the structure is largely composed of epithelial tissue which in places appears in the form of distinct lobules or "cell nests." In spots the cells show a tendency to group and form concentric globes, which indicates that the cells have been rapidly forming." Based on his findings, Elliott diagnosed the tumor as "epithelioma of a squamous cell variety."
By the time the Armed Forces Institute of Pathology's Dennis Heffner examined the slide in 2000, much had changed: improved histological preparation, better microscope optics, DNA testing, and a more sophisticated understanding of cancer. Heffner observed "some remaining hematoxlin chromasia, reveals an abnormal cellular proliferation. There is a suggestion of an interconnected broad trabecular pattern and whorling of elongated cells." Heffner noted that Elliott had emphasized the lobular cell nest pattern of growth, and while he also saw that pattern, he did not find it striking. He commented on the significant pronounced mitotic rate, which Elliott had vaguely referred to "a great diversity in the shape of cell elements."
His diagnosis: squamous cell carcinoma. Elliott's "epithelioma of a squamous cell variety," used in nineteenth and early twentieth centuries, changed as the meaning of epithelioma was imprecise and insufficiently distinct from carcinoma. Despite these innovations, the bread and butter of surgical pathology remains a pathologist looking through the microscope. Heffner could not improve on Elliott's 1885 diagnosis.
The patient, of course, had been dead for more than a century. He was Ulysses S. Grant, the 18th president of the United States.