Sudden death of an elderly man with multiple malignant neoplasms

Our plain-English summary of Sudden death of an elderly man with multiple malignant neoplasms, by L.R. Boglioli, M.L. Taff, W.U. Spitz, et al (The American Journal of Forensic Medicine and Pathology, 1991).

The study

• Authors: L.R. Boglioli, M.L. Taff, W.U. Spitz, R.E. Gordon
• Journal: The American Journal of Forensic Medicine and Pathology
• Published: 1991;12(3):265-71
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

With the lengthening of the human life span, cancer has become an increasingly important medical problem for the aged. It is not uncommon to find multiple primary neoplasms in elderly individuals. We recently investigated the death of an elderly man who had died suddenly and had three incidental malignant neoplasms, including a pleural mesothelioma, first diagnosed at autopsy. The importance of performing a complete medicolegal autopsy for epidemiological and statistical purposes is emphasized.

In plain English

This was a case report from the Wayne County Medical Examiner's Office in Detroit, Michigan, about an 82-year-old white man found dead on the street. The authors attributed his death to acute cardiac failure from occlusive arteriosclerotic coronary artery disease. The autopsy also found three separate primary cancers that had not been diagnosed before death: a colon adenocarcinoma, a prostate adenocarcinoma, and a left pleural tumor. After special stains, electron microscopy and immunostaining, the pleural tumor was classified as a primary malignant mesothelioma. The case section reported asbestos body counts in the lung bases higher than background. The discussion instead stated that levels were within background for the general population, but that the left lower lobe had a significantly higher count than other lung areas. The authors suggested that a high body-to-fiber ratio indicated exposure long before death. The colon cancer and diaphragm were negative for asbestos bodies and fibers. Interviews with next-of-kin and inspection of his home and workplace found no history of asbestos exposure or cigarette smoking.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single autopsy)
• Who was studied: One 82-year-old white man found dead on the street and autopsied at the Wayne County Medical Examiner's Office (Detroit, Michigan); his medical and social history were unknown at autopsy
• Exposure: Asbestos exposure was assessed by digestion of lung, colon cancer and diaphragm tissue for asbestos bodies and fibers, and by interviewing next-of-kin and inspecting his home and workplace. No history of asbestos exposure or cigarette smoking was found. No fiber type is named.
• Main results:
  • The cause of death was attributed to acute cardiac failure due to occlusive arteriosclerotic coronary artery disease, associated with three primary malignant neoplasms of pleural, colonic and prostatic origin.
  • The tumor of the left pleural cavity was classified as a primary malignant mesothelioma. The authors considered the nodules in the lung below it probably to be spread from the mesothelioma through the blood.
  • The pleural tumor showed a large quantity of hyaluronic acid, negative mucin stains, long slender microvilli on electron microscopy, and was CEA-positive and weakly positive for keratin.
  • In the case section, asbestos body counts in the lung bases were reported as higher than background.
  • In the discussion, the authors stated that levels were within background for the general population, but that the left lower lobe (the probable site of the primary tumor) had a significantly higher asbestos body count than other areas of the lung.
  • Digestion of the colon cancer and the left diaphragm found no asbestos bodies or fibers.
  • The authors interpreted the high ratio of asbestos bodies to fibers as suggesting exposure a long time before death.
• The authors' conclusion: The authors concluded that the case illustrates the importance of complete autopsies to document underlying disease, and the need for medical examiners to obtain an occupational-environmental history when asbestos exposure is suspected. They also stated that asbestos exposure must be interpreted on an individual basis rather than from averages.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Neoplasm, Pleural Mesothelioma, Autopsy.

Related studies

• Sudden death due to a cystic atrio-ventricular node tumour — G. Maujean, A. Tabib, et al. (2010)
• Primary mesothelioma of atrioventricular node: cause of sudden death — E.H. Hemsted (1986)
• Sudden death as the initial manifestation of diffuse pleural mesothelioma — J.T. Lie (1989)
• Minute localized malignant pleural mesothelioma coexisting with multiple adenocarcinomas — R. Maeda, N. Isowa, et al. (2010)
• Asbestos exposure and multiple primary tumors — V.A. Dohner, R.G. Beegle, et al. (1975)
• Benign multicystic mesothelioma with concurrent colonic adenocarcinoma: a report of two cases — A. Husain, M. Ozdemirli (2012)

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