Sudden Death by Occult Metastatic Carcinoma.
A 33-year-old female collapsed and died suddenly after presenting with acute dyspnea and increasing cough over the preceding several months. Autopsy revealed poorly differentiated linitis plastica adenocarcinoma of the stomach. Microscopic examination of the lungs showed features consistent with pulmonary tumor thrombotic microangiopathy (PTTM). PTTM is a well-described complication in patients with adenocarcinoma. The typical presentation involves acute pulmonary hypertension, right-sided heart failure, and sudden death, often before the adenocarcinoma is discovered. The pathophysiology of PTTM remains elusive; it has been suggested that carcinoma cells may produce substances that influence pulmonary vasculature. Our patient had classic clinical and histologic features of PTTM in addition to prominent extravascular compression by intralymphatic tumor cells. These features undoubtedly caused her precipitous decline and lethal pulmonary hypertension, induced by underlying adenocarcinoma. This case demonstrates that sudden death can occur from pulmonary hypertension induced by metastatic carcinoma with remarkably little prior symptomatology.
Maryland Office of the Chief Medical Examiner, 900 West Baltimore Street, Baltimore, MD, 21223.
Stephanie A
SA
Dean
Miami-Dade County Medical Examiner Department, 1851 NW 10th Ave, Miami, FL, 33136.
Benjamin
B
Mathis
Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA.
Leslie A
LA
Litzky
Burlington County Medical Examiner's Office, 4 Academy Dr, Westampton, NJ, 08060.
Ian C
IC
Hood
D000230:Adenocarcinoma / Q000473:pathology* / Q000556:secondary; D000328:Adult; D003645:Death, Sudden / Q000209:etiology*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology; D008175:Lung Neoplasms / Q000556:secondary*; D013274:Stomach Neoplasms / Q000473:pathology*; D057049:Thrombotic Microangiopathies / Q000209:etiology / Q000473:pathology*
adenocarcinoma; autopsy; death; forensic pathology; forensic science; hypertension; pulmonary; pulmonary tumor thrombotic microangiopathy; sudden