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Gotsmy W, Neumayer B, Kraus T, Zellinger B, Neureiter D, Monticelli F, Meyer H, Hofer P. Fatal course of undetected Ewing-like sarcoma in a 9-year-old boy with uncharacteristic clinical presentation. Forensic Sci Med Pathol 2022; 18:231-239. [PMID: 34780010 PMCID: PMC9587088 DOI: 10.1007/s12024-021-00437-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 12/14/2022]
Abstract
A 9-year-old boy collapsed shortly after complaining of shortness of breath. Despite immediate resuscitation measures, the boy died. A few weeks earlier, he had received antibiotic treatment for respiratory infection. However, the post-mortem examination revealed an advanced tumor mass of the mediastinum with infiltration of vital structures, which was identified as a small blue round neoplasm with aspects of an extramedullary Ewing-like sarcoma by supplementary histological and immunohistochemical examinations.This dramatic clinical course of events shows that the possible presence of serious diseases should always be considered behind harmless symptoms, even in children.
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Affiliation(s)
- Walther Gotsmy
- Department of Forensic Medicine, Paris-Lodron University of Salzburg, Salzburg, Austria
| | - Bettina Neumayer
- Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Theo Kraus
- Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Barbara Zellinger
- Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Daniel Neureiter
- Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Fabio Monticelli
- Department of Forensic Medicine, Paris-Lodron University of Salzburg, Salzburg, Austria
| | - Harald Meyer
- Department of Forensic Medicine, Paris-Lodron University of Salzburg, Salzburg, Austria
| | - Peter Hofer
- Department of Forensic Medicine, Paris-Lodron University of Salzburg, Salzburg, Austria.
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2
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Alotaibi AS, Mahroos RA, Al Yateem SS, Menezes RG. Central Nervous System Causes of Sudden Unexpected Death: A Comprehensive Review. Cureus 2022; 14:e20944. [PMID: 35004089 PMCID: PMC8730823 DOI: 10.7759/cureus.20944] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 01/03/2023] Open
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3
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Ogunbona OB, Heninger M, Bradley K, Geller R. Sudden death in an adolescent due to undiagnosed classic Hodgkin lymphoma. J Forensic Sci 2021; 67:387-390. [PMID: 34499743 DOI: 10.1111/1556-4029.14879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/14/2021] [Accepted: 08/17/2021] [Indexed: 11/29/2022]
Abstract
Few cases of natural sudden death presenting as an undiagnosed lymphoma have been reported in the literature, especially in adolescents. Herein we provide a report of sudden death caused by undiagnosed classic Hodgkin lymphoma (cHL). We describe an 18-year-old female who collapsed after several weeks of weight loss, decreased appetite, and dyspnea. At autopsy, a bulky mass arising in the mediastinum and neck compressed the esophagus and trachea, surrounded the great vessels, obliterated the pericardial sac, and infiltrated the myocardium. The lungs were collapsed and large pleural effusions were present. The tumor burden, which weighed at least 2710 g in aggregate, was entirely above the diaphragm. Microscopic examination of the masses showed features typical for nodular sclerosis cHL including large bands of sclerosis, numerous Hodgkin/Reed-Sternberg (HRS) cells, and an eosinophil-rich mixed inflammatory cell infiltrate. Immunohistochemical stains showed the HRS cells to be uniformly positive for CD30 and CD15 and negative for CD3, CD20, CD45, and PAX5. This case exemplifies a rare sudden natural death due to previously undiagnosed cHL in a young patient.
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Affiliation(s)
- Oluwaseun B Ogunbona
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael Heninger
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Fulton County Medical Examiner, Atlanta, Georgia, USA
| | - Kyle Bradley
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rachel Geller
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,DeKalb County Medical Examiner, Decatur, Georgia, USA
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4
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Morota K, Shimizu M, Sugitate R, Ide M, Yamato G, Tomizawa D, Muramatsu K, Matsui A. Sudden unexpected death caused by infantile acute lymphoblastic leukaemia. Oxf Med Case Reports 2021; 2021:omab073. [PMID: 34408894 PMCID: PMC8366071 DOI: 10.1093/omcr/omab073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 11/14/2022] Open
Abstract
A 7-week-old girl with a normal birth history suddenly developed respiratory distress while feeding. Cardiopulmonary resuscitation was initiated at home after she had a cardiac arrest and was continued in the emergency room but all efforts at resuscitation proved unsuccessful and she died 2 h after presentation. Investigations performed in the emergency room revealed that she had a significantly high white blood cell count and severe anaemia. The cause of death was identified as KMT2A-rearranged infantile acute lymphoblastic leukaemia based on cytogenetic tests. She had no abnormalities at the 4-week check-up; however, she developed a skin nodule on her abdomen thereafter, and the family did not consult a doctor for fear of contracting COVID-19. Early detection and diagnosis could have changed the prognosis of the patient. The present case highlights the negative impact of the reduction of outpatient consultations during the COVID-19 pandemic.
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Affiliation(s)
- Kei Morota
- Department of Paediatrics, Japanese Red Cross Maebashi Hospital, Gunma 371-0811, Japan
| | - Mariko Shimizu
- Department of Paediatrics, Japanese Red Cross Maebashi Hospital, Gunma 371-0811, Japan
| | - Ryo Sugitate
- Department of Paediatrics, Japanese Red Cross Maebashi Hospital, Gunma 371-0811, Japan
| | - Munenori Ide
- Department of Pathology, Japanese Red Cross Maebashi Hospital, Gunma 371-0811, Japan
| | - Genki Yamato
- Department of Paediatrics, Gunma University, Gunma 371-8511, Japan
| | - Daisuke Tomizawa
- Division of Leukaemia and Lymphoma, Children's Cancer Centre, National Centre for Child Health and Development, Tokyo 157-0074, Japan
| | - Kazuhiro Muramatsu
- Department of Paediatrics, Jichi Medical University, Tochigi 329-0498, Japan
| | - Atsushi Matsui
- Department of Paediatrics, Japanese Red Cross Maebashi Hospital, Gunma 371-0811, Japan
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5
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van Heerden J, Abraham N, Schoeman J, Reynders D, Singh E, Kruger M. Reporting Incidences of Neuroblastoma in Various Resource Settings. JCO Glob Oncol 2021; 7:947-964. [PMID: 34138644 PMCID: PMC8457875 DOI: 10.1200/go.21.00054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The incidences of neuroblastoma (NB) differ significantly between various resource settings because of varying quality of cancer registries and underdiagnoses. This study aimed to evaluate current regional variations as reported by international cancer registries and the theoretical and reported differences in international NB incidences and to evaluate South Africa (SA) as a case for variable reporting.
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Affiliation(s)
- Jaques van Heerden
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Paediatric Haematology and Oncology, Department of Paediatrics Antwerp University Hospital, Antwerp, Belgium
| | - Natasha Abraham
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
| | - Judy Schoeman
- Paediatric Haematology and Oncology, Department of Paediatrics University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa.,South African Children's Tumour Registry, Pretoria, South Africa
| | - David Reynders
- Paediatric Haematology and Oncology, Department of Paediatrics University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa.,South African Children's Tumour Registry, Pretoria, South Africa
| | - Elvira Singh
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Mariana Kruger
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Sudden and unexpected death in childhood due to an undiagnosed hepatoblastoma: Case report and review of literature. J Forensic Leg Med 2020; 77:102086. [PMID: 33242744 DOI: 10.1016/j.jflm.2020.102086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 11/14/2020] [Indexed: 11/20/2022]
Abstract
The sudden and unexpected death of an infant or child due to cancer is a particularly rare event. Most of the cases concern primary growths located in vital organs such as the heart or the brain. Only in an extremely small number of cases does it occur in infants or children affected by liver cancer. Herein we report the sudden and unexpected death of a 3-and-a-half-year-old infant, who due to an undiagnosed tumor of the liver, namely hepatoblastoma, suffered a major intra-abdominal (hemoperitoneum) bleed, leading to a fatal hemorrhagic trauma. In cases like these, it is of utmost importance to carry out both an autopsy as well as complete histological tests in order to determine if the hepatic tumor is the real cause of death or if it was a mere chance finding. In the case of sudden and unexplained deaths in infancy and childhood, the forensic pathologist should always consider that other complications, for example, those correlated with hepatoblastoma could, in fact, cause sudden death given that this particular tumor is often scarcely symptomatic and can remain undiscovered for a long period of time.
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Iacobuzio-Donahue CA, Michael C, Baez P, Kappagantula R, Hooper JE, Hollman TJ. Cancer biology as revealed by the research autopsy. Nat Rev Cancer 2019; 19:686-697. [PMID: 31519982 PMCID: PMC7453489 DOI: 10.1038/s41568-019-0199-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2019] [Indexed: 12/19/2022]
Abstract
A research autopsy is a post-mortem medical procedure performed on a deceased individual with the primary goal of collecting tissue to support basic and translational research. This approach has increasingly been used to investigate the pathophysiological mechanisms of cancer evolution, metastasis and treatment resistance. In this Review, we discuss the rationale for the use of research autopsies in cancer research and provide an evidence-based discussion of the quality of post-mortem tissues compared with other types of biospecimens. We also discuss the advantages of using post-mortem tissues over other types of biospecimens, including the large amounts of tissue that can be obtained and the extent of multiregion sampling that is achievable, which is not otherwise possible in living patients. We highlight how the research autopsy has supported the identification of the clonal origins and modes of spread among metastases, the extent that selective pressures imposed by treatments cause bottlenecks leading to parallel and convergent tumour evolution, and the creation of rare tissue banks and patient-derived model systems. Finally, we comment on the future of the research autopsy as an integral component of precision medicine strategies.
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Affiliation(s)
- Christine A Iacobuzio-Donahue
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- David M. Rubenstein Center for Pancreatic Cancer Research, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Chelsea Michael
- Department of Health Informatics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Priscilla Baez
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rajya Kappagantula
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jody E Hooper
- Department of Pathology, The Johns Hopkins University, Baltimore, MD, USA
| | - Travis J Hollman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Parker Institute for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Carreon CK, Sanders SP, Perez-Atayde AR, del Nido PJ, Walsh EP, Geva T, Alexander ME. Interdigitating Myocardial Tongues in Pediatric Cardiac Fibromas. JACC Clin Electrophysiol 2019; 5:563-575. [DOI: 10.1016/j.jacep.2019.01.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/16/2019] [Accepted: 01/31/2019] [Indexed: 10/27/2022]
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9
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Menezes RG, Ahmed S, Pasha SB, Hussain SA, Fatima H, Kharoshah MA, Madadin M. Gastrointestinal causes of sudden unexpected death: A review. MEDICINE, SCIENCE, AND THE LAW 2018; 58:5-15. [PMID: 29141499 DOI: 10.1177/0025802417737001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Gastrointestinal conditions are a less common cause of sudden unexpected death when compared to other conditions such as cardiovascular conditions, but they are equally important. Various congenital and acquired gastrointestinal conditions that have resulted in sudden unexpected death are discussed. The possible lethal mechanisms behind each condition, along with any associated risk factors or secondary diseases, have been described. Through this article, we aim to highlight the need for physicians to prevent death in such conditions by ensuring that subclinical cases are diagnosed correctly before it is too late and by providing timely and efficacious treatment to the patient concerned. In addition, this review would certainly benefit the forensic pathologist while dealing with cases of sudden unexpected death due to gastrointestinal causes. This article is a review of the major gastrointestinal causes of sudden unexpected death. In addition, related fatal cases encountered occasionally in forensic autopsy practice are also included. There are several unusual and rare causes of life-threatening gastrointestinal bleeding that may lead to sudden unexpected death to cover all the entities in detail. Nevertheless, this article is a general guide to the topic of gastrointestinal causes of sudden unexpected death.
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Affiliation(s)
- Ritesh G Menezes
- 1 Forensic Medicine Division, Department of Pathology, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia (KSA)
| | - Saba Ahmed
- 2 Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Syed Bilal Pasha
- 2 Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Syed Ather Hussain
- 2 Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Huda Fatima
- 2 Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Mohammed Madadin
- 1 Forensic Medicine Division, Department of Pathology, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia (KSA)
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