title: Multiple bee stings, peritumoral mast cell degranulation and anaphylaxis--is there a relationship?
abstract: A case of a 58-year-old with fatal anaphylaxis due to multiple bee stings is reported. Supportive evidence for anaphylaxis included post-mortem serum tests, which demonstrated a markedly elevated tryptase level and increased sensitivity to bees on radioallergosorbent test (RAST). At autopsy a previously undiagnosed esophageal adenocarcinoma involving the gastroesophageal (GE) junction was also identified. Histology of the tumor demonstrated significant numbers of mast cells, many of which were degranulating. Increased numbers of mast cells, as in mastocytosis, are known to predispose to an allergic sensitivity to Hymenoptera. The finding of a significant peritumoral mast cell population with degranulating forms in this case, therefore, raises the possibility that death due to anaphylaxis was contributed to by mast cell proliferation in an occult esophageal carcinoma.
authors.affiliation: Forensic Science South Australia, 21 Divett Place, Adelaide, SA 5000, Australia. Jonathon.Herbst@wellstar.org
authors.forename: Jonathon
authors.initials: J
authors.lastname: Herbst
authors.forename: Karen
authors.initials: K
authors.lastname: Heath
authors.forename: Robert
authors.initials: R
authors.lastname: Heddle
authors.forename: John D
authors.initials: JD
authors.lastname: Gilbert
authors.forename: Roger W
authors.initials: RW
authors.lastname: Byard
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology; D000707:Anaphylaxis / Q000209:etiology*; D000818:Animals; D001516:Bees; D001733:Bites and Stings / Q000150:complications*; D015550:Cell Degranulation; D004938:Esophageal Neoplasms / Q000473:pathology; D049429:Forensic Pathology; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008407:Mast Cells / Q000201:enzymology / Q000473:pathology*; D008415:Mastocytosis / Q000209:etiology; D008853:Microscopy; D008875:Middle Aged; D053802:Tryptases / Q000378:metabolism
chemical_list: D007073:Immunoglobulin E; D053802:Tryptases
keywords: Anaphylaxis; Autopsy; Bee sting; Esophageal adenocarcinoma; Mast cells