Neoplastic disease in a medicolegal autopsy material

Abstract

Only a small fraction of sudden unexpected deaths are caused by neoplastic disease and thus subject ot medicolegal autopsy. The medicolegal autopsy forms an opportunity to study not only medically diagnosed and treated neoplasms, but also the natural evolution of untreated disease. In a series of 7,020 consecutive medicolegal autopsies in northern Sweden, we found 171 cases with malignant and/or intracranial neoplasms. In 41 cases, sudden death was caused by previously unknown tumors. The most common mechanisms of death in this group were disseminated cancer, intracranial tumors, pulmonary thromboembolism, hemoptysis, and aspiration of blood, and the most common locations were the bronchi and the lung. In some of these cases, the mechanism was sometimes dramatic, raising a question of violent death or intoxication. In 30 cases, sudden unexpected death was caused by previously known tumors, and also in this group disseminated cancer was the most common cause of death, and the most common locations were the bronchi and the lung. In 22 cases, tumors were found suicidal cases; in 14 of these, the tumor was considered to be a major causative factor to the suicide, while in eight cases the tumor was considered to be an incidental finding. The expected number of cancers in the 1,060 suicides investigated in this series was 27, according to the official cancer prevalence data. Thus, a possible over-representation of suicides among persons with cancer seems doubtful and needs further exploration.

Programmed cell death in cardiac myocytes: strategies to maximize post-ischemic salvage

“…While their use in short-term animal models reveals benefits, the long-term implications of systemic apoptotic inhibition are still unresolved. It is widely known from autopsy studies that in situ neoplasia and atypia may exist in otherwise healthy individuals [194,195]. The potential effects of even transient, systemic inhibition of apoptosis in such individuals are concerning.…”

High preoperative prevalence of deep venous thrombosis in patients with colorectal cancer

“…Venous thromboembolism (VTE) is associated with malignant disease and is a predictor of reduced survival1, 2. Pulmonary embolism (PE) is the second most common cause of death in patients with cancer3–6. Patients admitted for cancer surgery have at least twice the risk of postoperative deep venous thrombosis (DVT) and more than three times the risk of fatal PE than those undergoing similar procedures for benign disease1.…”

Thromboprophylaxis in the Cancer Patient

“…Data from a number of large autopsy studies [2, 3, 4]have revealed pulmonary emboli as the primary cause of death in 8–35% of cancer patients and a contributing cause in a further 43% [3]. A study of 21,530 Swedish autopsies [5]over a 24-year period showed the highest prevalence of pulmonary embolism (PE) in patients with ovarian cancer, cancer of the extrahepatic bile duct system and cancer of the stomach (34.6, 31.7 and 15.2%, respectively).…”