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Sudden Death by Occult Metastatic Carcinoma |
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| Authors: | Stephanie A. Dean M.D. Benjamin Mathis M.D. Leslie A. Litzky M.D. Ian C. Hood M.B.Ch.B. J.D. |
| Affiliation: | 1. Maryland Office of the Chief Medical Examiner, 900 West Baltimore Street, Baltimore, MD, 21223 Additional information and reprint requests Stephanie A. Dean, M.D. Maryland Office of the Chief Medical Examiner 900 West Baltimore Street Baltimore, MD 21223 E-mail: stephanie.dean1122@gmail.com;2. Miami-Dade County Medical Examiner Department, 1851 NW 10th Ave, Miami, FL, 33136;3. Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA;4. Burlington County Medical Examiner's Office, 4 Academy Dr, Westampton, NJ, 08060 |
| Abstract: | A 33-year-old female collapsed and died suddenly after presenting with acute dyspnea and increasing cough over the preceding several months. Autopsy revealed poorly differentiated linitis plastica adenocarcinoma of the stomach. Microscopic examination of the lungs showed features consistent with pulmonary tumor thrombotic microangiopathy (PTTM). PTTM is a well-described complication in patients with adenocarcinoma. The typical presentation involves acute pulmonary hypertension, right-sided heart failure, and sudden death, often before the adenocarcinoma is discovered. The pathophysiology of PTTM remains elusive; it has been suggested that carcinoma cells may produce substances that influence pulmonary vasculature. Our patient had classic clinical and histologic features of PTTM in addition to prominent extravascular compression by intralymphatic tumor cells. These features undoubtedly caused her precipitous decline and lethal pulmonary hypertension, induced by underlying adenocarcinoma. This case demonstrates that sudden death can occur from pulmonary hypertension induced by metastatic carcinoma with remarkably little prior symptomatology. |
| Keywords: | forensic science forensic pathology hypertension pulmonary death sudden adenocarcinoma autopsy pulmonary tumor thrombotic microangiopathy |