title: A case series of clinically undiagnosed hematopoietic neoplasms discovered at autopsy.
abstract: OBJECTIVE
  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.
authors.affiliation: From the Department of Pathology, Baylor University Medical Center, Dallas, TX. varsha.podduturi@gmail.com.
authors.forename: Varsha
authors.initials: V
authors.lastname: Podduturi
authors.affiliation: From the Department of Pathology, Baylor University Medical Center, Dallas, TX.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Guileyardo
authors.affiliation: From the Department of Pathology, Baylor University Medical Center, Dallas, TX.
authors.forename: Luis R
authors.initials: LR
authors.lastname: Soto
authors.affiliation: From the Department of Pathology, Baylor University Medical Center, Dallas, TX.
authors.forename: John R
authors.initials: JR
authors.lastname: Krause
mesh_terms: D000368:Aged; D001344:Autopsy; D005260:Female; D019337:Hematologic Neoplasms / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: Anaplastic large cell lymphoma; Autopsy pathology; Diffuse large B-cell lymphoma; Hematopathology; Hematopoietic neoplasms; Intravascular large B-cell lymphoma; Lymphoma; Myeloid sarcoma; Type B lactic acidosis; Virtual autopsy