Sudden, unexpected death due to glioblastoma: report of three fatal cases and review of the literature

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 slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1218574899466985

The Role of Forensic Autopsies in Diagnosis of Cancer

“…Akyıldız et al found primary cause of death with malignant tumors with a lower rate (0.25%) in a study conducted in Istanbul Turkey (18). However the age and sex distribution of this study was similar with literature of cancer (8)(9)(10).…”

“…Malignancies could also be found incidentally in medico-legal autopsies (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). In the present study such kind of malignancies was found 2.1 % in 3722 medicolegal autopsy cases in which histopathological examination was performed.…”

“…In the present study such kind of malignancies was found 2.1 % in 3722 medicolegal autopsy cases in which histopathological examination was performed. The ratio of malignancies as a cause of death in medico-legal autopsies was reported to be between 0.02 % and 8.6 % in different surveys carried out in different countries including Turkey (9,10,(15)(16)(17)(18)(19). In one study includes hospital autopsies, this ratio is higher (20%) (17).…”

“…In a similar study involving hospital autopsies in New Orleans the rate was found to be 20 % (17). The ratio of malignancies as a cause of death in medico-legal autopsies was reported to be between 0.02 % and 8.6 % in different surveys carried out in different countries including Turkey (9,10,(15)(16)(17)(18)(19).…”

Current perspectives concerning the multimodal therapy in Glioblastoma

“…The clinical picture of GBM depends on several aspects: the location of the tumor and adjacent structures involved in tumor expansion, the rhythm of tumor progression, the marked invasive behavior, a hallmark for GBM, bleeding -either within the tumor (glioblastomas are strongly vascularized tumors, with an impressive potential of neoangiogenesis), or bleeding in other vascular structures secondarily involved in the extending -infiltrative lesion, the existence of multifocal lesions, patient age and comorbidities. There have been reported cases with atypical clinical features such as ulnar neuropathy, syncopal events [93], or even sudden unexpected death [88]. The progress of medical imaging tools, today owning a remarkable degree of accuracy in describing different types of lesions, decreased the importance of a thorough clinical approach in order to establish the topography of the tumor.…”