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Krebs-Drouot L, Karpathiou G, Scolan V, Bidat-Callet C, Boyer B, Péoc'h M. Death due to unsuspected acute myeloid leukaemia: an unusual forensic diagnosis. Forensic Sci Med Pathol 2023; 19:60-66. [PMID: 35984604 DOI: 10.1007/s12024-022-00516-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 11/30/2022]
Abstract
Acute myeloid leukaemia (AML) is a rare haematologic cancer with a rapid increase in blast cells, which need to be rapidly diagnosed and treated. The aim of this report is to analyse the rare phenomenon of AML diagnosed at autopsy after sudden death. We report three cases of AML and perform a literature review using the mesh terms "sudden death" and "leukaemia". We report the cases of three young women diagnosed with AML only after autopsy. We found seven articles which reported sudden death due to AML diagnosed at autopsy. Diagnosis of AML during autopsy is rare but can raise forensic issues. A complete autopsy with pathology analysis is needed.
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Affiliation(s)
- Lila Krebs-Drouot
- Forensic Medicine Department, Grenoble Alpes University Hospital, La Tronche, Grenoble, France.
| | - Georgia Karpathiou
- Pathology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Virginie Scolan
- Forensic Medicine Department, Grenoble Alpes University Hospital, La Tronche, Grenoble, France
| | - Carolyne Bidat-Callet
- Forensic Medicine Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Baptiste Boyer
- Forensic Medicine Department, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Michel Péoc'h
- Pathology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
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2
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Ho C, Lo YY, Crawford JR. Intracerebral haemorrhage as an initial manifestation of T-cell acute lymphoblastic leukaemia in a paediatric patient. BMJ Case Rep 2022; 15:e252594. [PMID: 36167433 PMCID: PMC9516204 DOI: 10.1136/bcr-2022-252594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Clarice Ho
- University of Nevada Reno School of Medicine, Reno, Nevada, USA
| | - Yan Yuen Lo
- Neurosciences, University of California, La Jolla, California, USA
| | - John Ross Crawford
- Pediatrics, CHOC Children's Hospital, Orange, California, USA
- Department of Pediatrics, University of California, Irvine, California, USA
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3
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Fatal intracranial hemorrhage as the presenting sign of acute promyelocytic leukemia: A case report. Radiol Case Rep 2022; 17:2123-2128. [PMID: 35464791 PMCID: PMC9024374 DOI: 10.1016/j.radcr.2022.02.086] [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: 02/03/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/21/2022] Open
Abstract
Intracranial hemorrhage (ICH) can be a devastating medical event with numerous potential etiologies. In young people under age 40, ruptured vascular malformation is the most common cause of ICH. Without critical review of imaging and laboratory findings and clinical suspicion beyond vascular malformation, alternative etiologies of hemorrhage may be overlooked in the younger age group. Here we present a case of a 22-year-old male presenting with large ICH originally thought secondary to ruptured vascular malformation. After careful review of all imaging and laboratory findings, the patient was found to have hemorrhage secondary to acute promyelocytic leukemia (APL). Though ICH proved fatal in this case, early treatment of acute leukemia with appropriate chemotherapeutic agents and correction of coagulopathy could be life saving for patients with less severe intracranial injury.
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Lou Y, Suo S, Tong H, Qian W, Mai W, Meng H, Yu W, Wei J, Jin J. Hypofibrinogenemia as a clue in the presumptive diagnosis of acute promyelocytic leukemia. Leuk Res 2016; 50:11-16. [DOI: 10.1016/j.leukres.2016.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 08/20/2016] [Accepted: 09/04/2016] [Indexed: 11/27/2022]
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5
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Sudden Death Due to Cerebral Leukemic Hemorrhage in a 32-Year-Old Woman Who Had a Short-Term Benzene Exposure History. Am J Forensic Med Pathol 2016; 37:60-3. [DOI: 10.1097/paf.0000000000000226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Death resulting from a mesenteric hemorrhage due to acute myeloid leukemia: An autopsy case. Leg Med (Tokyo) 2014; 16:373-5. [DOI: 10.1016/j.legalmed.2014.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 04/10/2014] [Accepted: 07/07/2014] [Indexed: 11/17/2022]
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7
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Saint-Martin P, O'Byrne P, Gaulier JM, Martin-Dupont S, Peyclit A, Paraf F. Undiagnosed, untreated acute promyelocytic leukemia presenting as a suspicious sudden death. J Forensic Sci 2012; 57:829-31. [PMID: 22292852 DOI: 10.1111/j.1556-4029.2012.02053.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Acute promyelocytic leukemia (APL) is a subtype of acute myelogenous leukemia frequently associated with clotting abnormalities and severe hemorrhagic diathesis. The disease is associated with a high incidence of early fatal hemorrhage. We report the sudden death of a 40-year-old male without significant medical history in which foul play had been initially suspected. A thorough postmortem investigation performed on the decedent lead to the diagnosis of APL. Cause of death was a cerebellar hematoma. Underlying APL should be considered in the differential diagnosis when unexplained bleeding is encountered in a decedent. This case emphasizes the value of routinely collecting bone marrow during an autopsy to enable accurate testing and diagnosis.
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Affiliation(s)
- Pauline Saint-Martin
- Service de Médecine Légale, Université François Rabelais, Centre Hospitalier Régional Universitaire de Tours, 37044 Tours, France.
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Cartiser N, Bévalot F, Fanton L, Gaillard Y, Guitton J. State-of-the-art of bone marrow analysis in forensic toxicology: a review. Int J Legal Med 2011; 125:181-98. [PMID: 21061013 DOI: 10.1007/s00414-010-0525-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 10/20/2010] [Indexed: 10/18/2022]
Abstract
Although blood is the reference medium in the field of forensic toxicology, alternative matrices are required in case of limited, unavailable or unusable blood samples. The present review investigated the suitability of bone marrow (BM) as an alternative matrix to characterize xenobiotic consumption and its influence on the occurrence of death. Basic data on BM physiology are reported in order to highlight the specificities of this matrix and their analytical and toxicokinetic consequences. A review of case reports, animal and human studies involving BM sample analysis focuses on the various parameters of interpretation of toxicological results: analytic limits, sampling location, pharmacokinetics, blood/BM concentration correlation, stability and postmortem redistribution. Tables summarizing the analytical conditions and quantification of 45 compounds from BM samples provide a useful tool for toxicologists. A specific section devoted to ethanol shows that, despite successful quantification, interpretation is highly dependent on postmortem interval. In conclusion, BM is an interesting alternative matrix, and further experimental data and validated assays are required to confirm its great potential relevance in forensic toxicology.
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Affiliation(s)
- Nathalie Cartiser
- Université de Lyon, Université Claude Bernard Lyon 1, ISPB-Faculté de pharmacie, Laboratoire de Toxicologie, 8 avenue Rockefeller, 69373 Lyon cedex 08, France
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Abstract
In the investigation of sudden death in adults, channelopathies, such as long QT syndrome, have risen to the fore in the minds of forensic pathologists in recent years. Examples of these disorders are touched upon in this review as an absence of abnormal findings at postmortem examination is characteristic and the importance of considering the diagnosis lies in the heritable nature of these conditions. Typically, a diagnosis of a possible channelopathy is evoked as an explanation for a 'negative autopsy' in a case of apparent sudden natural death. However, the one potential adverse effect of this approach is that subtle causes of sudden death may be overlooked. The intention of this article is to review and discuss potential causes of sudden adult death (mostly natural) that should be considered before resorting to a diagnosis of possible channelopathy. Nonetheless, it becomes apparent that many of the potential causes of sudden death can have a genetic basis. Thus, it becomes an important consideration that there may be a genetic basis to sudden death that extends beyond the negative autopsy.
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Roll P, Beham A, Beham-Schmid C. Post-mortem histopathological investigations of the bone marrow in forensic medicine: an important issue for both the forensic and clinical pathologist. Forensic Sci Int 2009; 186:e17-20. [PMID: 19231118 DOI: 10.1016/j.forsciint.2008.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Revised: 12/01/2008] [Accepted: 12/02/2008] [Indexed: 11/28/2022]
Abstract
In the forensic literature only a few scientific reports are dealing with series of histopathological bone marrow (BM) investigations, mainly concerning changes after drug abuse and alcoholic consumption. In a period of 13 years (1995-2008) we routinely investigated 225 BM specimens from anterior iliac crests taken at forensic autopsies if the cause of death was unclear or vague, septicaemia was suspected or known, in cases of presumed haemorrhagic diathesis or bleeding tendencies, spleens were found to be enlarged or intoxications were suspected or proofed. In 78 cases (34.66%) abnormal histopathologic changes were found. Forty of those revealed neoplastic, mainly haematological diseases, which were unknown during lifetime. Referring to our findings, extraction of post-mortem BM specimens for histopathological investigations should become an essential issue for both the forensic and clinical pathologist.
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Affiliation(s)
- P Roll
- Institute of Forensic Medicine, Medical University of Graz, Universitätsplatz 4/II, A-8010 Graz, Austria.
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Guddat SS, Tsokos M, Schalinski S, Byard RW. Vertebral column kyphoscoliosis and unexpected death. Int J Legal Med 2007; 122:169-71. [PMID: 17701418 DOI: 10.1007/s00414-007-0188-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2007] [Accepted: 07/18/2007] [Indexed: 10/23/2022]
Abstract
A case of spontaneous gastric perforation is reported in a 75-year-old woman due to massive hemorrhaging from a benign gastric ulcer. Blood was prevented from leaving the stomach due to posterior displacement and rotation of the stomach associated with marked underlying vertebral column kyphoscoliosis. Significant deformity of the spine had caused malpositioning of the stomach as a result of the abnormal shape of the peritoneal and chest cavities. This in turn had led to mechanical obstruction and prevented egress of blood arising from a bleeding arteriole in the base of a chronic gastric ulcer. Rapid distension had resulted from the inability to spontaneously decompress the stomach, which in turn had led to rupture.
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Affiliation(s)
- Saskia S Guddat
- Institute of Legal Medicine and Forensic Sciences, Charité-Universitätsmedizin Berlin, Turmstr. 21 (Haus L), 10559 Berlin, Germany
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Tsokos M, Schalinski S, Paulsen F, Sperhake JP, Püschel K, Sobottka I. Pathology of fatal traumatic and nontraumatic clostridial gas gangrene: a histopathological, immunohistochemical, and ultrastructural study of six autopsy cases. Int J Legal Med 2007; 122:35-41. [PMID: 17370083 DOI: 10.1007/s00414-007-0163-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Accepted: 02/20/2007] [Indexed: 10/23/2022]
Abstract
We prospectively investigated six fatal cases of clostridial gas gangrene using autopsy, histology, immunohistochemistry, microbiology, and scanning electron microscopy. The causative pathogen was Clostridium perfringens in four cases, C. sordellii in one case, and a mixed infection with both C. perfringens and C. sordellii in one case. According to the previous medical history and autopsy findings, clostridial infection was related to trauma in three cases. Characterized by extensive tissue necrosis and total absence of an accompanying leukocyte infiltration and tissue inflammatory response, the histopathological picture of clostridial gas gangrene is distinctly different from other bacterial infections. In medicolegal casework, the proof of the source of infection and the portal of entry of the responsible pathogen is not always an easy task, especially in the absence of trauma.
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Affiliation(s)
- Michael Tsokos
- Institute of Legal Medicine and Forensic Sciences, Charité-Universitätsmedizin Berlin, Turmstr. 21 (Haus L), 10559, Berlin, Germany.
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Türk EE, Lockemann U, Tsokos M. Fatal bleeding from major femoral vessels: three case reports. Int J Legal Med 2007; 121:220-2. [PMID: 17273876 DOI: 10.1007/s00414-007-0152-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2006] [Accepted: 12/05/2006] [Indexed: 11/24/2022]
Abstract
We present three unusual cases of fatal bleeding from eroded femoral blood vessels. Erosion was due to tumor metastases in one and abscess formation in two cases. Bleeding occurred from the femoral vein in two cases and from the femoral artery in one case. Extensive bloodstains at the death scene were suspicious of homicide, which was ruled out by medico-legal autopsy in all cases.
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Affiliation(s)
- Elisabeth E Türk
- Institute of Legal Medicine, University of Hamburg, Hamburg, Germany.
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