Post-Mortem Diagnosis of Lymphoma: Report of Five Cases with Review of the Literature and Discussion of Specialized Diagnostic Techniques
S Goel, AG Kahn, Z Zuo, KV Patterson. University of South Alabama, Mobile, AL; Springhill Hospital, Mobile, AL
Background: Lymphomas are often characterized by non-specific clinical presentations that can lead to misdiagnoses. Rapidly lethal cases of lymphoma may not be discovered during life, leaving only post-mortem examination as a possible source of correct diagnosis. We report a series of cases of primary post-mortem lymphoma, review the previously reported cases and discuss the use of special techniques in post-mortem studies.
Design: A retrospective review of 1942 autopsy cases performed at our institution over a period of 20 years yielded 5 cases with an autopsy diagnosis of lymphoma and a clinical diagnosis other than lymphoma. For these cases, autopsy reports including summary of ante-mortem course, hematoxylin and eosin (H&E) stained sections, immunohistochemical (IHC) stains and results of molecular techniques in one case were reviewed. A literature search was conducted for similar autopsy cases.
Results: The 5 cases included 3 males and 2 females, age ranging from 53 to 81 years. Antemortem clinical diagnoses included portal mass, cardiorespiratory failure, pneumonia, acute pancreatitis and one found dead. One case had an erroneous pre-mortem diagnosis of adenocarcinoma. H&E sections revealed mononuclear cell infiltrates suspicious for lymphoma in all cases. One case had involvement of the head of the pancreas; all other cases (4) had multiple organ involvement. Variable autolysis was seen in all cases that hindered morphologic evaluation. Antigen preservation was acceptable when IHC were performed. Final autopsy diagnoses included 2 peripheral T-cell lymphomas (CD3+, CD20-), 1 anaplastic large cell lymphoma (CD3-, CD20-, CD30+, CD45+/-), 1 diffuse and nodular large cell lymphoma (CD20+, CD3-), and 1 small cell lymphocytic lymphoma (morphology only). In 1 case of peripheral T- cell lymphoma PCR revealed T-cell gene rearrangement confirming the diagnosis.
Conclusions: In none of our cases was lymphoma clinically suspected prior to death. At least 3 published cases were similar to ours; additional published cases were clinically suspected but diagnosed at autopsy. Our series represents successful diagnosis and accurate classification of lymphoma at autopsy based on morphology (cytology and architecture) and ancillary techniques. While accurate post-mortem diagnosis may not benefit the patient, it can be invaluable for relatives wishing to know their own risk or for recipients of transplanted organs.
Monday, March 9, 2009 9:30 AM
Poster Session I Stowell-Orbison/Autopsy Award # 4, Monday Morning