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

Abstract

A 26-year-old Caucasian sailor, with no past medical history aside from headache for the last 1 week, was found dead in his cabin. The body was stored in a refrigerator on board and disembarked for autopsy 3 days later. Autopsy showed a large, nodular, necrotic and hemorrhagic retroperitoneal mass, and smaller hemorrhagic nodules in the brain, lungs, liver, and left kidney, with the brain being markedly edematous. Both testes were descended and normal. Histologically, the retroperitoneal mass showed a malignant mixed germ cell tumor comprising choriocarcinoma, embryonal carcinoma, and teratoma components. Retroperitoneal extragonadal germ cell tumors are uncommon, and this case of a young male who presented with headache and sudden death due to metastases is extremely rare.

Teratoma quístico maduro de localización suprahepática. Presentación de caso y revisión de la literatura

“…Extragonadal germ cell tumors are rare and represent from 1.6 to 5% of all germ cell tumors, the most common site of extragonadal presentation is the mediastinum (50-70%), retroperitoneum (30-40%), other rare locations pineal gland, sacrococcygeal region, prostate, and bladder; however, the supra-hepatic location is not so common and is not documented in the literature [1][2][3] .…”

“…Teratoma quístico maduro de localización suprahepática. Presentación de caso y revisión de la literatura Ediel O. Dávila-Ruiz 1* , Roberto A. García-Manzano 1 , Alan Barker-Antonio 1 , Rolando R. Garcia-Matus 1,2 , and Fabian Tafoya-Ramirez 3…”

Central Nervous System Causes of Sudden Unexpected Death: A Comprehensive Review

“…Brain metastasis is reported in 20% to 25% of all cancer patients and autopsy findings report intracranial metastasis to be the cause of death in up to 25% of cases [66]. Lee et al described a case of a 22-year-old man who shortly prior to death experienced episodic headaches and later was found lying unconscious by his friends [67]. Postmortem CT scan showed a prevertebral retroperitoneal mass, a lesion in the right frontal lobe compressing the right lateral ventricle, and distinct masses in the lung, liver, and kidney [67].…”

“…Internal examination revealed a retroperitoneal mass that was diagnosed histologically as a malignant mixed germ cell tumor with metastatic nodules to the brain, lung, liver, and left kidney [67]. The cause of death was reported to be increased intracranial pressure due to brain metastasis occurring as a result of metastatic retroperitoneal malignant tumor [67].…”