Autopsy Findings in Sarcoma Patients Treated by a Multidisciplinary Group in the Current Era.
Shefali S Bhusnurmath, Corinne Fligner, Benjamin L Hoch. University of Washington Medical Center, Seattle
Background: Autopsy remains a valuable tool in understanding the course of disease. Autopsy studies on sarcoma patients have consisted of case reports or large series focused on specific subtypes of sarcoma published prior to more recent therapy protocols. We reviewed a series of autopsies on sarcoma patients often treated with aggressive therapy by a multidisciplinary sarcoma group in the current era.
Design: The institutional files from 1989-2010 were searched for autopsy cases with a diagnosis of sarcoma. 26 cases were identified. Autopsy reports and routine H&E slides were reviewed to confirm the diagnosis and determine the extent of disease, complications, cause of death, length of survival, and comorbidities. Comparison between clinical findings and autopsy findings was also performed.
Results: Patients ranged in age from 20-85 (mean 55) yrs. There were 18 males and 8 females. Sarcoma types included 6 leiomyosarcomas,6 angiosarcomas,3 pleomorphic undifferentiated sarcomas, 2 GISTs, and 1 case each of dedifferentiated liposarcoma, well differentiated liposarcoma, endometrial stromal sarcoma ,Ewing sarcoma, chondrosarcoma, extraskeletal osteosarcoma, MPNST, myxoid liposarcoma and histiocytic sarcoma. The diagnosis was revised at autopsy in 3 cases. The underlying cause of death was sarcoma in all but 2 cases. Immediate causes of death were pneumonia (7), metastatic disease (6), exsanguination (3), local disease (2), coronary artery disease (1), stroke (1), and pulmonary embolus (1). In 5 cases the immediate cause of death was iatrogenic including cardiac arrythmia from SVC stent placement, Adriamycin related cardiomyopathy, renal failure following aorta reconstruction, chemotherapy related lung injury, and radiation induced sarcoma. The most common complications included infections, DVT, pulmonary embolus, and cytopenias. Metastases were present in 25 patients with lung, liver and bowel being most common. In 20 cases the extent of sarcoma at autopsy exceeded what was reported clinically. The median survival time was 6.3 months.
Conclusions: Autopsies are performed on sarcoma patients due to unusual subtype, unexpected clinical course, or rapid demise. Pneumonia, metastatic disease and iatrogenic complications are the most common immediate causes of death. Extent of sarcoma at autopsy commonly exceeds clinically documented disease. Autopsy can allow for more definitive classification of sarcoma in some cases. A larger number of autopsies should be performed on sarcoma patients to better understand the course of disease and complications in the current era.
Monday, February 28, 2011 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 4, Monday Morning