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Atallah O, Badary A, Almealawy YF, Sanker V, Andrew Awuah W, Abdul-Rahman T, Alrubaye SN, Chaurasia B. Non-colloid-cyst primary brain tumors: A systematic review of unexpected fatality. J Clin Neurosci 2024; 119:129-140. [PMID: 38029695 DOI: 10.1016/j.jocn.2023.11.022] [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] [Received: 10/10/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE Primary brain tumors have the potential to present a substantial health hazard, ultimately resulting in unforeseen fatalities. Despite the enhanced comprehension of many diseases, the precise prediction of disease progression continues to pose a significant challenge. The objective of this study is to investigate cases of unexpected mortality resulting from primary brain tumors and analyze the variables that contribute to such occurrences. METHODS This systematic review explores research on individuals diagnosed with primary brain tumors who experienced unexpected deaths. It uses PRISMA standards and searches PubMed, Google Scholar, and Scopus. Variables considered include age, gender, symptoms, tumor type, WHO grade, postmortem findings, time of death - time taken from first medical presentation or hospital admission to death, comorbidity, and risk factors. RESULTS This study examined 46 studies to analyze patient-level data from 76 individuals with unexpected deaths attributed to intracranial lesions, deliberately excluding colloid cysts. The cohort's age distribution showed an average age of 37 years, with no significant gender preference. Headache was the most common initial symptom. Astrocytomas, meningiomas, and glioblastoma were the most common lesions, while the frontal lobe, temporal lobe, and cerebellum were common locations. Meningiomas and astrocytomas showed faster deaths within the first hour of hospital admission. CONCLUSION The etiology of unforeseen fatalities resulting from cerebral tumors elucidates an intricate and varied phenomenon. Although unexpected deaths account for a very tiny proportion of total fatalities, it is probable that their actual occurrence is underestimated as a result of underreporting and misdiagnosis.
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Affiliation(s)
- Oday Atallah
- Departemnt of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Amr Badary
- Departemnt of Neurosurgery, Klinikum Dessau, Dessau-Roßlau, Germany
| | | | - Vivek Sanker
- Department of Neurosurgery, Trivandrum Medical College, Kerala, India
| | | | | | | | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj ,Nepal.
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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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Maiellaro A, Perna A, Giugliano P, Esposito M, Vacchiano G. Sudden Death from Primary Cerebral Melanoma: Clinical Signs and Pathological Observations. Healthcare (Basel) 2021; 9:healthcare9030341. [PMID: 33802952 PMCID: PMC8002833 DOI: 10.3390/healthcare9030341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 12/20/2022] Open
Abstract
Primary cerebral tumors rarely provoke sudden death. The incidence is often underestimated with reported frequencies in the range of 0.02 to 2.1% in medicolegal autopsy series. Furthermore, primary cerebral melanoma is an uncommon neoplasm. It represents approximately 1% of all melanoma cases and 0.07% of all brain tumors. This neoplasm is very aggressive, and its annual incidence is about 1 in 10 million people. In the present study, a 20-year-old male was admitted to hospital with vomiting, headache, paresthesia and aggressive behavior. A computed tomography (CT) scan of the head was performed showing a hyperdense nodule in the right parietal lobe with inflammation of the Silvian fissure. A complete autopsy was performed 48 h after death. A blackish material was displayed on the skull base, and posterior fossa. Microscopic examination diagnosed primary brain melanoma. A systematic review of the literature was also performed where no previous analogous cases were found. The forensic pathologist rarely encounters primary cerebral melanoma, and for these reasons, it seemed appropriate to describe this case as presenting aspecific clinical symptoms and leading to sudden unexpected death. Histopathological observations are reported and discussed to explain this surprising sudden death caused by a primary cerebral melanoma.
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Affiliation(s)
- Alfonso Maiellaro
- Legal Medicine Department, A. Cardarelli Hospital, 80131 Naples, Italy;
| | - Antonio Perna
- Pathology Unit, Mauro Scarlato Hospital, 84018 Scafati, Italy;
| | - Pasquale Giugliano
- AORN Sant’Anna e San Sebastiano di Caserta, 81100 San Sebastiano, Italy;
| | - Massimiliano Esposito
- Legal Medicine, Department of Medical, Surgical and Advanced Technologies, “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy
- Correspondence: (M.E.); (G.V.); Tel.: +39-3409348781 (M.E.); +39-3475386107 (G.V.)
| | - Giuseppe Vacchiano
- Department of Law, University of Sannio, 82100 Benevento, Italy
- Correspondence: (M.E.); (G.V.); Tel.: +39-3409348781 (M.E.); +39-3475386107 (G.V.)
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Conway KS, Jentzen J, Pratt D, Camelo-Piragua S. Sudden Death Due to Calcifying Pseudoneoplasm of the Neuraxis: A Case Report and a Review of Sudden Death Due to Undiagnosed Central Nervous System Mass Lesions. Am J Forensic Med Pathol 2020; 41:70-74. [PMID: 31850919 DOI: 10.1097/paf.0000000000000520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We present a case of a 22-year-old man who died unexpectedly after a seizure due to a previously undiagnosed calcifying pseudoneoplasm of the neuraxis (CAPNON). Calcifying pseudoneoplasm of the neuraxis is a rare entity, and this is, to our knowledge, the first described case of sudden death due to CAPNON. Sudden death due to undiagnosed central nervous system mass lesions is rare, and most cases are attributable to hemorrhage, hydrocephalus, or increased intracranial pressure due to mass effect. Seizure is a rare cause of sudden death due to central nervous system mass lesions. This case highlights that mass lesions may cause sudden death due to seizure, even without other pathologic evidence of a cause of death, such as hemorrhage or edema. Furthermore, benign, reactive, and low-grade mass lesions may cause sudden death due to seizure. Seizure should remain in the autopsy differential as a cause of death, even where there is no pathologically evident mechanism by which a mass lesion caused death.
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Affiliation(s)
- Kyle S Conway
- From the Department of Pathology, University of Michigan
| | | | - Drew Pratt
- From the Department of Pathology, University of Michigan
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5
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Abstract
Primary central nervous system tumors are an extremely rare cause of sudden, unexpected death in children as most patients develop symptoms because of increased intracranial pressure and seek medical attention. Rarely, a forensic pathologist may encounter a primary intracranial neoplasm in a pediatric decedent that was not suspected before death. Herein, we present a case of a supratentorial neuroepithelial tumor found at autopsy in a 3-year-old African American boy without any reported significant medical history. The tumor had significant mass effect and caused cerebral edema, which ultimately resulted in transtentorial herniation and death. The gross, histopathological, immunohistochemical, and ultrastructural findings were most consistent with an anaplastic ependymoma.
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6
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Ross J, Olar A, Fuller C. A Pediatric Case of Diffuse Glioma Diagnosed at Autopsy. Acad Forensic Pathol 2017; 7:657-666. [PMID: 31240015 DOI: 10.23907/2017.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 11/07/2017] [Indexed: 01/18/2023]
Abstract
Sudden death from an undiagnosed primary intracranial neoplasm is extremely uncommon and even rarer in the pediatric population. Gliomatosis cerebri (GC) represents a growth pattern demonstrable by a variety of gliomas, predominating in adults. Herein we present a rare occurrence of diagnosis of a pediatric glioma with a GC pattern of infiltration at autopsy and compare the immunohistochemical results and molecular characteristics in this tumor to the small amount of published knowledge available about pediatric diffuse gliomas with widespread brain invasion.
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Affiliation(s)
- Jennifer Ross
- Harris County Institute of Forensic Sciences - Pathology
| | - Adriana Olar
- Medical University of South Carolina & Hollings Cancer Center - Pathology and Neurosurgery
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7
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Lee B, Chan M, Goh R. An Unusual Cause of Headache and Sudden Death of a Young Sailor—Postmortem Computed Tomography and Histological Findings of a Fatal Retroperitoneal Malignant Mixed Germ Cell Tumor. J Forensic Sci 2017; 63:1568-1572. [DOI: 10.1111/1556-4029.13703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/02/2017] [Accepted: 11/02/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Belinda Lee
- Forensic Medicine Division Health Sciences Authority 11 Outram Rd Singapore 169078 Singapore
| | - Michelle Chan
- Department of Anatomical Pathology Singapore General Hospital Outram Road Singapore 169856 Singapore
| | - Ronald Goh
- Department of Anatomical Pathology Singapore General Hospital Outram Road Singapore 169856 Singapore
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8
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Lagman C, Rai K, Chung LK, Nagasawa DT, Beckett JS, Tucker AM, Yang I. Fatal Colloid Cysts: A Systematic Review. World Neurosurg 2017; 107:409-415. [PMID: 28801184 DOI: 10.1016/j.wneu.2017.07.183] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 07/26/2017] [Accepted: 07/29/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To accurately describe patient characteristics and the clinical presentation of fatal colloid cysts. METHODS A systematic literature search of 3 popular databases was performed. Inclusion criteria were individuals with sudden-onset death and colloid cysts identified on imaging and/or autopsy. The cause of death must have been ascribed to the colloid cyst to be eligible for data extraction. Deaths precipitated by lumbar puncture were excluded. Clinical data were extracted and descriptive statistics were ascertained. Subgroup analyses were performed to compare adults with pediatric patients. RESULTS A total of 107 patients were included in the quantitative synthesis. The mean age was 28.5 years (standard deviation 13.3, range 6-79 years). Male and female patients were affected equally. Headache was the most frequent symptom (n = 86, 80%). There were 6 patients (5 adults and 1 child) who reported positional headaches. The mean duration of signs and symptoms was shorter in adults versus pediatric patients (2.1 days vs. 6.5 days, P = 0.02), and more adults presented with signs and symptoms for less than 24 hours than did pediatric patients (38% vs. 6%, P = 0.01). Colloid cyst mean diameter was 2.0 cm (standard deviation 1.1, range 0.5-7.9 cm) and 96% measured 1 cm or larger. CONCLUSIONS Our data suggests that the prodrome preceding sudden death in the setting of a colloid cyst may be shorter in adults. Also, most fatal colloid cysts measured 1 cm or larger.
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Affiliation(s)
- Carlito Lagman
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA
| | - Kanwaldeep Rai
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA
| | - Lawrance K Chung
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA
| | - Daniel T Nagasawa
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA
| | - Joel S Beckett
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA
| | - Alexander M Tucker
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA
| | - Isaac Yang
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, USA; Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, USA; Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, USA; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, USA; Department of Neurosurgery, Harbor-UCLA Medical Center, Torrance, California, USA; Los Angeles Biomedical Research Institute (LA BioMed), Harbor-UCLA Medical Center, Torrance, California, USA.
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The unexpected finding of a benign mature teratoma in a forensic pathology autopsy: a rare cause for sudden, unexpected death. Am J Forensic Med Pathol 2014; 34:302-5. [PMID: 24189635 DOI: 10.1097/paf.0b013e3182a18983] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Intracranial teratomas are rare tumors that are usually discovered in infancy due to progressive symptoms. We describe a case of a 38-year-old man who was found dead 9 hours after the last sign of life. The deceased's medical history could not explain the sudden, unexpected death. A forensic autopsy revealed an asymptomatic, mature teratoma in the left frontal and temporal lobes. We concluded that the cause of death must have been a generalized epileptiform seizure originating in the tumor site(s) leading to aspiration of the stomach contents and unfavorable positioning, resulting in asphyxia.
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10
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Mandonnet E, de Witt Hamer P, Pallud J, Bauchet L, Whittle I, Duffau H. Silent diffuse low-grade glioma: Toward screening and preventive treatment? Cancer 2014; 120:1758-62. [DOI: 10.1002/cncr.28610] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 11/16/2013] [Accepted: 12/12/2013] [Indexed: 01/20/2023]
Affiliation(s)
- Emmanuel Mandonnet
- Department of Neurosurgery; Lariboisiere Hospital; Paris France
- University of Paris 7; Paris France
- Imaging and Modeling Laboratory for Neurobiology and Oncology; Medical Research Unit 8165; Orsay France
| | - Philip de Witt Hamer
- Department of Neurosurgery; VU University Medical Center; Amsterdam the Netherlands
| | - Johan Pallud
- Department of Neurosurgery; Saint-Anne Hospital; Paris France
- University of Paris 5; Paris France
| | - Luc Bauchet
- Department of Neurosurgery; Gui de Chauliac Hospital; Montpellier Medical University Center; Montpellier France
| | - Ian Whittle
- Department of Clinical Neurosciences; University of Edinburgh; Edinburgh United Kingdom
| | - Hugues Duffau
- Department of Neurosurgery; Gui de Chauliac Hospital; Montpellier Medical University Center; Montpellier France
- Institute of Health and Medical Research Unit 1051, Institute of Neuroscience of Montpellier; Montpellier France
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11
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Riezzo I, Zamparese R, Neri M, De Stefano F, Parente R, Pomara C, Turillazzi E, Ventura F, Fineschi V. Sudden, unexpected death due to glioblastoma: report of three fatal cases and review of the literature. Diagn Pathol 2013; 8:73. [PMID: 23638625 PMCID: PMC3652782 DOI: 10.1186/1746-1596-8-73] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 04/21/2013] [Indexed: 11/10/2022] Open
Abstract
Abstract Sudden death from an undiagnosed primary intracranial neoplasm is an exceptionally rare event, with reported frequencies in the range of 0.02% to 2.1% in medico-legal autopsy series and only 12% of all cases of sudden, unexpected death due to primary intracranial tumors are due to glioblastomas. We present three cases of sudden, unexpected death due to glioblastoma, with different brain localization and expression. A complete methodological forensic approach by means of autopsy, histological and immunohistochemical examinations let us to conclude for an acute central dysregulation caused by glioblastoma and relative complication with rapid increase of intracranial pressure as cause of death. Although modern diagnostic imaging techniques have revolutionized the diagnosis of brain tumors, the autopsy and the careful gross examination and section of the fixed brain (with coronal section) is still the final word in determining exact location, topography, mass effects and histology and secondary damage of brain tumor and contributed the elucidation of the cause of death. Immunohistochemistry and proteomic analysis are mandatory in such cases. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1218574899466985
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Affiliation(s)
- Irene Riezzo
- Department of Forensic Pathology, University of Foggia, Ospedale C, D'Avanzo, viale degli Aviatori, 1, Foggia 71100, Italy
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12
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Lott Limbach AA, Prayson RA. Utility of autopsy in uncovering unexpected neuropathology. Ann Diagn Pathol 2012; 16:350-3. [PMID: 22520718 DOI: 10.1016/j.anndiagpath.2012.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 02/23/2012] [Accepted: 02/23/2012] [Indexed: 11/18/2022]
Abstract
Autopsy rates have declined in the last several decades for a variety of reasons. The purpose of this study is to compare autopsy neuropathologic findings from 2 periods to assess the prevalence of unexpected neuropathologic findings and unexpected neuropathologic diagnoses determined to be the major cause of death. Retrospective review of autopsies with examination of the central nervous system was performed in 2007 to 2008 (n = 289) and 1984 to 1985 (n = 328). Unexpected neuropathologic diagnoses were found at autopsy in 42.4% of cases from 1984 to 1985 vs 38.8% of cases from 2007 to 2008. The neuropathology was felt to contribute to the cause of death in 22% of cases from 1984 to 1985 vs 19.7% of cases from 2007 to 2008. Unexpected neuropathologic findings were the cause of death in 5.2% of cases from 1984 to 1985 vs 3.1% of cases from 2007 to 2008. These findings underscore the continued use of brain and spinal cord examination at autopsy despite advances in "modern" medicine.
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13
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Sudden unexpected death from oligodendroglioma: a case report and review of the literature. Am J Forensic Med Pathol 2012; 32:336-40. [PMID: 20375839 DOI: 10.1097/paf.0b013e3181d3dc86] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Sudden and unexpected deaths due to asymptomatic 5 primary brain tumors are extremely rare, with an incidence that ranges from 0.16 to 3.2%. Usually, such tumors are glioblastomas or, less commonly, astrocytomas. Asymptomatic oligodendrogliomas causing sudden death are hardly ever reported among medico-legal investigated cases.We report a rare case of sudden and unexpected death from a previously asymptomatic and undiagnosed, well-differentiated, grade II oligodendrogloioma (WHO classification). According to the autopsy and the microscopic findings brain edema as a result of obstruction of the cerebrospinal fluid flow due to hemorrhagic leakage of the oligodendroglioma is incriminated as the most probable physiopathological mechanism for the sudden death. Diagnosis is mainly based on the special microscopic features of the tumor cells (typical "fried-egg" appearance), interrupted by a dense network of branching capillaries. We discuss further the pathophysiological mechanisms of death and present a short review of literature.
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14
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Raghunathan A, Takei H, Powell SZ. Rare Tumors of the Sellar Region. Acad Forensic Pathol 2012. [DOI: 10.23907/2012.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Context The sellar/ parasellar region is the location for a vast array of neoplastic and nonneoplastic intracranial space-occupying lesions. While several common lesions arising in this location have been well-described in the literature, there are rare and challenging tumors that may also arise in this region. Objective We focus this review on five rare tumors reported to arise in the sellar region, including spindle cell oncocytoma of the adenohypophysis, pituicytoma, intravascular papillary endothelial hyperplasia, epithelioid hemangioendothelioma and xanthogranuloma. We review their clinical presentation, histologic features, differential diagnosis and outcomes for these tumors. Data sources All medical literature pertaining to these entities that was searchable on PubMed was comprehensively reviewed. Conclusions Spindle cell oncocytoma and pituicytoma have recently been included in the 2007 edition of the World Health Organization classification of tumours of the CNS, while intravascular papillary endothelial hyperplasia, epithelioid hemangioendothelioma and xanthogranuloma have only rarely been described in this region. Knowledge of these may help prevent possible diagnostic pitfalls during postmortem evaluation.
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Affiliation(s)
- Aditya Raghunathan
- The Methodist Hospital & University of Texas M.D. Anderson Cancer Center program in Houston, TX
- The Methodist Hospital in Houston, TX, and Weill Cornell Medical College of Cornell University (HT, SZP)
| | - Hidehiro Takei
- The Methodist Hospital in Houston, TX, and Weill Cornell Medical College of Cornell University (HT, SZP)
| | - Suzanne Z. Powell
- The Methodist Hospital in Houston, TX, and Weill Cornell Medical College of Cornell University (HT, SZP)
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15
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Shields LB, Balko MG, Hunsaker III JC. Sudden and Unexpected Death from Pituitary Tumor Apoplexy. J Forensic Sci 2011; 57:262-6. [DOI: 10.1111/j.1556-4029.2011.01906.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
We present a case of sudden death of a 7-year-old boy who at autopsy was found to have an undiagnosed glioblastoma. The boy was asymptomatic until 2 hours before death complaining of a headache and was later found unresponsive in bed. A medicolegal autopsy was notable for a large hemorrhagic mass of the right frontal lobe, which on analysis was diagnostic of a glioblastoma. We feel that this is a unique case for 2 main reasons; high-grade gliomas of the cerebral cortex are rare in the pediatric population, and it is unusual for a large neoplasm to remain asymptomatic until 2 hours prior to death.
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Li DR, Ishikawa T, Zhao D, Michiue T, Quan L, Zhu BL, Maeda H. Unexpected sudden death due to intracranial chordoma: An autopsy case. Forensic Sci Int 2010; 200:e15-8. [DOI: 10.1016/j.forsciint.2010.03.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 02/25/2010] [Accepted: 03/24/2010] [Indexed: 11/25/2022]
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Abstract
Fatal brain tumors are often diagnosed well before death. Rarely, they present as sudden and unexpected death. Most of these undiagnosed brain tumors are gliomas. Death in custody is uncommon and can be caused by natural diseases. These are mainly associated with the cardiovascular system and rarely by cancers such as primary intracranial tumors.We present a case of a 55-year-old man who died while in police custody. At the autopsy there was a previously undiagnosed large soft intraventricular tumor. Cerebrospinal fluid flow was obstructed causing a raised intracranial pressure which resulted in displacement of the pons, and death. Microscopy and immunohistochemistry confirmed a central neurocytoma.
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Brain germinoma in a young adult man with suspicion of fatal neglect. Am J Forensic Med Pathol 2009; 30:180-2. [PMID: 19465813 DOI: 10.1097/paf.0b013e3181875ac5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a forensic autopsy case of brain germinoma in a 26-year-old man who was severely wasted and initially suspected of fatal neglect. He had a history of nocturnal wandering and was confined by his parents. Neuropathological examination showed germinoma in the hypothalamus and neurohypophysis. The cause of death was certified as hypothalamo-hypophyseal insufficiency due to germinoma. Because hypothalamic lesions may dysregulate feeding behavior and sleeping rhythms, germinoma was considered the causative lesion of the anorexic wasting and nocturnal wandering. Confinement was a preventive measure of the patient's wandering. The findings in this case indicated that hypothalamic tumors should be recognized as a cause of wasting in autopsies suspected of fatal neglect.
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Elgamal EA, Richards PG. Sudden death in children due to intracranial mass lesion. Childs Nerv Syst 2006; 22:305-9. [PMID: 16180045 DOI: 10.1007/s00381-005-1215-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2003] [Revised: 10/18/2004] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE Intracranial causes of sudden and unexpected death in children are uncommon and are usually due to trauma, epilepsy or to catastrophic haemorrhage associated with neoplasms or vascular malformations. We sought to review the presenting symptoms and signs of intracranial mass lesions that led to sudden death to guide clinicians in early identification of these potentially treatable conditions. METHODS All cases of sudden unexpected death attributed to intracranial mass lesion that occurred from 1996 to 2002 at the Oxford Radcliffe Hospitals, NHS Trust, were reviewed. RESULTS During the study period, six children, aged between 10 weeks and 12 years, died suddenly with intracranial mass lesions other than haematomas. All of them were unsuspected of having a neurological disease prior to death. All patients were found to have an intracranial mass lesion. There were colloid cyst (n=2), glioblastoma multiform (n=1), primitive neuro-ectodermal tumour (n=1), pyogenic abscess (n=1) and histologically unverified tumour (n=1). Presenting features included headache and vomiting in four cases, vomiting longer than 1 week in three and lethargy in four cases. Three patients were misdiagnosed with viral illness. CONCLUSION The case series highlights a life-threatening but misleading presentation of intracranial mass lesions. The diagnosis of viral illness should be made cautiously when headache and vomiting occur in the absence of focal complaints. A history of vomiting exceeding a few days duration warrants further investigation. Persistent lethargy should be considered a neurological rather than a non-specific clinical sign.
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Affiliation(s)
- Essam A Elgamal
- Neurosurgery Division 37, College of Medicine & King Khalid University Hospital, PO Box 7805, Riyadh, Saudi Arabia.
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21
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Shiferaw K, Pizzolato GP, Perret G, Harpe RL. Sudden, unexpected death due to undiagnosed frontal glioblastoma in a schizophrenic patient. Forensic Sci Int 2005; 158:200-3. [PMID: 16191472 DOI: 10.1016/j.forsciint.2005.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2003] [Accepted: 08/05/2005] [Indexed: 10/25/2022]
Abstract
The incidence of sudden death due to undiagnosed primary intracranial tumor is low in forensic autopsy. We report a case of a 48-year-old white male, known to be a schizophrenic patient for several years, and in whom a medico-legal autopsy disclosed a large, previously undiagnosed, bilateral frontal glioblastoma infiltrating the genu of corpus callosum. We emphasize the importance of performing complete autopsy, including a thorough neuropathological examination, in all cases of sudden unexpected death, especially in those cases in which no extracerebral cause of death had been established and whose clinical history was primarily of a psychiatric nature.
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Affiliation(s)
- K Shiferaw
- Unité de Médecine Forensique, Institut Universitaire de Médecine Légale de Genève, 9 Av. de Champel, 1211 Geneva, Switzerland.
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22
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Matschke J, Tsokos M. Sudden unexpected death due to undiagnosed glioblastoma: report of three cases and review of the literature. Int J Legal Med 2005; 119:280-4. [PMID: 15864615 DOI: 10.1007/s00414-005-0551-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2004] [Accepted: 04/07/2005] [Indexed: 11/26/2022]
Abstract
Although glioblastomas are among the most common primary cerebral neoplasms, sudden death due to these tumors is an uncommon event. Due to the usual rapid increase in intracranial pressure, patients develop symptoms rather early, leading to medical attention in time. A search for cases of sudden unexpected death due to undiagnosed glioblastoma from a total of 14,482 cases from the archives of the Institute of Legal Medicine in Hamburg in the period of 1991-2003 revealed only one such case. Out of a total of 5,432 cases from the Institute of Neuropathology, Hamburg, during the same period, two further cases were found. A comprehensive literature review on cases of sudden death due to primary cerebral neoplasms published so far revealed a total of 83 cases with only ten cases of glioblastoma (12%), whereas 55 of these cases were due to histological benign tumors (66%).
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Affiliation(s)
- Jakob Matschke
- Institute of Neuropathology, University Medical Centre, Martinistrasse 52, 20246 Hamburg, Germany.
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Parham DM, Savell VH, Kokes CP, Erickson SA, Peretti FJ, Gibson JB, Sturner WQ. Incidence of autopsy findings in unexpected deaths of children and adolescents. Pediatr Dev Pathol 2003; 6:142-55. [PMID: 12481231 DOI: 10.1007/s10024-002-0016-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2002] [Accepted: 03/30/2002] [Indexed: 10/27/2022]
Abstract
Studies in various settings reveal that a significant percentage of autopsies demonstrate findings that were not previously clinically diagnosed. In the pediatric and adolescent age group, forensic examinations comprise a large percentage of total autopsies performed. We hypothesized that a similar number of previously undiagnosed findings would be present in this population and thus reviewed a series of autopsy reports from the Medical Examiners Office in the Arkansas Crime Laboratory. During 1997 through 1999, we performed 439 complete forensic autopsies on children and adolescents (age range 1 day to 19 years; median 18 months). Previously undiagnosed lesions were found in 173 (39%). Of these subjects, 68 (39%) had clinically significant pathology, 60 (35%) had insignificant pathology, and 45 (26%) had pathology of undetermined significance. Thirty-six subjects had lesions expected from a previously diagnosed condition. Of the total number of lesions found, 168 were inflammatory, 58 were congenital anomalies (48 unexpected), and 88 comprised miscellaneous other conditions. Infants <6 months of age were significantly more likely to have a previously undiagnosed lesson than children > 6 months (P <0.0001). Previously undiagnosed findings, mostly inflammatory, occur relatively frequently in pediatric and adolescent forensic autopsies and are more likely to occur in infants.
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Affiliation(s)
- David M Parham
- Department of Pediatric Pathology, Slot 820, Arkansas Children's Hospital, 800 Marshall Street, Little Rock, AR 72202, USA.
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Velásquez-Pérez L, Jiménez-Marcial ME. Clinical-histopathologic concordance of tumors of the nervous system at the Manuel Velasco Suárez National Institute of Neurology and Neurosurgery in Mexico City. Arch Pathol Lab Med 2003; 127:187-92. [PMID: 12562232 DOI: 10.5858/2003-127-187-chcoto] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT When making a diagnosis, the main purpose of clinicians should not be to achieve certainty, but to decrease diagnostic uncertainty in order to make optimal therapeutic decisions. Diagnostic concordance is an essential characteristic if a measurement is to be considered scientific. In the case of tumors of the nervous system (TNS), one of the most accurate diagnostic tests is magnetic resonance imaging. However, histopathologic analyses are essential, because they refine the diagnosis, benefit the patient, and improve our understanding of the disease. By determining the clinical-histopathologic correlation of TNS in one of the main neurologic centers in Mexico, we sought to project reliable morbidity and/or mortality statistics. OBJECTIVE To assess clinical and histopathologic diagnostic agreement in cases involving TNS admitted to the Manuel Velasco Suárez National Institute of Neurology and Neurosurgery between 1990 and 1999. DESIGN Cross-sectional diagnostic concordance study, including all clinical hospital records of patients with histopathologically diagnosed TNS, classified according to World Health Organization criteria. RESULTS Among 2041 TNS cases, the 3 most frequent types were those affecting the neuroepithelial tissue (32.9%), tumors of the sellar region (29.2%), and tumors of the meninges (25.6%). We found that, overall, clinical-histopathologic concordance for these 3 categories was substantial and statistically significant. CONCLUSIONS Tumors of the nervous system constitute a heterogeneous group of neoplasms. In the present study, clinical diagnoses substantially agreed with pathologic diagnoses. The a priori clinical diagnosis allowed prompt treatment even before diagnostic confirmation by histopathologic analysis, which is the best way to confirm, clarify, and correct a diagnosis.
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Affiliation(s)
- Leora Velásquez-Pérez
- Department of Neuroepidemiology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico.
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Abstract
Epidermoid cysts of the brain are rare tumor-like lesions, most often of maldevelopmental origin. They are benign in nature, causing symptoms depending on their localization. Surgical resection leads to excellent results. A case is reported of a 68-year-old-man who died suddenly and unexpectedly. Postmortem examination revealed signs of central dysregulation and a bifrontal epidermoid cyst. To the authors' knowledge, death resulting from epidermoid cyst of the brain has not been reported so far.
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Affiliation(s)
- Jakob Matschke
- Department of Neuropathology, University of Hamburg, Germany.
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