Undiagnosed Hematopoietic Neoplasms Discovered at Autopsy
Undiagnosed Hematopoietic Neoplasms Discovered at Autopsy
Objectives In the United States, autopsy rates have diminished to less than 5% during the last half of the 20th century and the beginning of the 21st century for a multitude of reasons. Many believe this results in unrecognized malignancies that could have explained a patient's death.
Methods We describe six deaths in which hematopoietic neoplasms were identified at autopsy but were not diagnosed clinically.
Results The six undiagnosed hematopoietic malignancy cases discovered at autopsy include four men and two women ranging from 50 to 78 years of age. One patient was African American and five patients were white, all with multiple comorbidities. The tumors included diffuse large B-cell lymphoma, activated B-cell type, intravascular large B-cell lymphoma, ALK-negative anaplastic large cell lymphoma arising in a setting of human immunodeficiency virus, and a myeloid sarcoma.
Conclusions These cases illustrate the importance of the traditional postmortem examination in not only confirming clinical diagnoses but also identifying previously unknown diagnoses. Hematologic malignancies may present with nonspecific clinical manifestations, and this series of cases also emphasizes the necessity for widening the differential diagnosis in patients with unexplained lactic acidosis and hepatic failure to include hematopoietic malignancies since prompt treatment may be lifesaving.
Since the 1970s, the average nonmedicolegal autopsy rate has declined to less than 5% in the United States. The prevalence and trust in radiographic imaging have been acknowledged as one cause of this decline. Virtual autopsy or the "virtopsy" has been opined to replace the traditional autopsy, which remains the gold standard for cause of death determination. Virtual autopsy has advantages in identifying trajectory of bullets and air emboli; however, the traditional autopsy is more advantageous for malignant and cardiovascular diseases. Typical clinical manifestations of hematopoietic neoplasms include lymphadenopathy and/or other "B symptoms" such as fever, weight loss, or night sweats. However, hematologic malignancies may present with subtle clinical manifestations such as lactic acidosis (LA) and hepatic failure. We present the clinical, pathology, and autopsy findings of six cases of clinically undiagnosed hematopoietic malignancies discovered at autopsy.
Abstract and Introduction
Abstract
Objectives In the United States, autopsy rates have diminished to less than 5% during the last half of the 20th century and the beginning of the 21st century for a multitude of reasons. Many believe this results in unrecognized malignancies that could have explained a patient's death.
Methods We describe six deaths in which hematopoietic neoplasms were identified at autopsy but were not diagnosed clinically.
Results The six undiagnosed hematopoietic malignancy cases discovered at autopsy include four men and two women ranging from 50 to 78 years of age. One patient was African American and five patients were white, all with multiple comorbidities. The tumors included diffuse large B-cell lymphoma, activated B-cell type, intravascular large B-cell lymphoma, ALK-negative anaplastic large cell lymphoma arising in a setting of human immunodeficiency virus, and a myeloid sarcoma.
Conclusions These cases illustrate the importance of the traditional postmortem examination in not only confirming clinical diagnoses but also identifying previously unknown diagnoses. Hematologic malignancies may present with nonspecific clinical manifestations, and this series of cases also emphasizes the necessity for widening the differential diagnosis in patients with unexplained lactic acidosis and hepatic failure to include hematopoietic malignancies since prompt treatment may be lifesaving.
Introduction
Since the 1970s, the average nonmedicolegal autopsy rate has declined to less than 5% in the United States. The prevalence and trust in radiographic imaging have been acknowledged as one cause of this decline. Virtual autopsy or the "virtopsy" has been opined to replace the traditional autopsy, which remains the gold standard for cause of death determination. Virtual autopsy has advantages in identifying trajectory of bullets and air emboli; however, the traditional autopsy is more advantageous for malignant and cardiovascular diseases. Typical clinical manifestations of hematopoietic neoplasms include lymphadenopathy and/or other "B symptoms" such as fever, weight loss, or night sweats. However, hematologic malignancies may present with subtle clinical manifestations such as lactic acidosis (LA) and hepatic failure. We present the clinical, pathology, and autopsy findings of six cases of clinically undiagnosed hematopoietic malignancies discovered at autopsy.
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