Autopsy and Case Reports
https://app.periodikos.com.br/journal/autopsy/article/doi/10.4322/acr.2023.425
Autopsy and Case Reports
Autopsy Case Report

The autopsy is not dead: ongoing relevance of the autopsy

Alexia Vignau; Clara Milikowski

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Abstract

Background: Autopsy requests have been trending downward for a variety of factors. There are differences between pre- and postmortem diagnoses. Autopsies remain a tool for education, public health research, quality control, and closure for families.

Objective: We report two cases that illustrate the utility of autopsy for uncovering contributing factors in the death of these patients and highlight their ongoing importance.

Design: Clinical and autopsy investigation of two individuals and illustration of the importance of autopsy findings which, had they been diagnosed premortem, could have changed the outcome. Cases were evaluated using the Goldman criteria for discrepancies between premortem clinical diagnoses and postmortem autopsy findings.

Results: In the first case, the patient had been previously admitted due to a non-ST elevation myocardial infarction months before the fatal event. The autopsy showed an undiagnosed clear cell carcinoma of the ovary. She expired due to a massive myocardial infarction secondary to neoplasm induced hypercoagulable state. The degree of pre-mortem/postmortem diagnostic discrepancy makes this a Goldman Class I error.

In the second case, the patient presented to the emergency department with symptoms of Guillain-Barré Syndrome (GBS), for which he was treated. Abdominal masses were discovered; however, the patient decompensated before workup was completed. A high-grade B-cell lymphoma was confirmed but would not have altered the outcome, making this a Goldman class II error.


Conclusions: The autopsy remains a relevant and necessary tool for physicians and society. It assists in the establishment of diagnoses, measurement of treatment quality, the providence of public health metrics, and closure to the survivors.

Keywords

Clear cell carcinoma of ovary, hypercoagulability, B cell lymphoma, Guillain-Barré syndrome

References

1 Hamza A. Declining rate of autopsies: implications for anatomic pathology residents. Autops Case Rep. 2017;7(4):1-2. http://dx.doi.org/10.4322/acr.2017.036. PMid:29259925.

2 Dehner LP. The medical autopsy: past, present, and dubious future. Mo Med. 2010;107(2):94-100. PMid:20446515.

3 Goldman L, Sayson R, Robbins S, Cohn LH, Bettmann M, Weisberg M. The value of the autopsy in three medical eras. N Engl J Med. 1983;308(17):1000-5. http://dx.doi.org/10.1056/NEJM198304283081704. PMid:6835306.

4 Rusu S, Lavis P, Salgado VD, et al. Comparison of antemortem clinical diagnosis and post-mortem findings in intensive care unit patients. Virchows Arch. 2021;479(2):385-92. http://dx.doi.org/10.1007/s00428-020-03016-y. PMid:33580806.

5 Kurz SD, Sido V, Herbst H, et al. Discrepancies between clinical diagnosis and hospital autopsy: a comparative retrospective analysis of 1,112 cases. PLoS One. 2021;16(8):e0255490. http://dx.doi.org/10.1371/journal.pone.0255490. PMid:34388154.

6 Marshall HS, Milikowski C. Comparison of clinical diagnoses and autopsy findings: six-year retrospective study. Arch Pathol Lab Med. 2017;141(9):1262-6. http://dx.doi.org/10.5858/arpa.2016-0488-OA. PMid:28657772.

7 Fernandes CJ, Morinaga LTK, Alves JLJ Jr, et al. Cancer-associated thrombosis: the when, how and why. Eur Respir Rev. 2019;28(151):180119. http://dx.doi.org/10.1183/16000617.0119-2018. PMid:30918022.

8 Mukai M, Oka T. Mechanism and management of cancer-associated thrombosis. J Cardiol. 2018;72(2):89-93. http://dx.doi.org/10.1016/j.jjcc.2018.02.011. PMid:29588087.

9 Tamura R, Yoshihara K, Enomoto T. Therapeutic strategies focused on cancer-associated hypercoagulation for ovarian clear cell carcinoma. Cancers. 2022;14(9):2125. http://dx.doi.org/10.3390/cancers14092125. PMid:35565252.

10 Shahrizaila N, Lehmann HC, Kuwabara S. Guillain-Barré syndrome. Lancet. 2021;397(10280):1214-28. http://dx.doi.org/10.1016/S0140-6736(21)00517-1. PMid:33647239.

11 Seffo F, Daw HA. Non-Hodgkin lymphoma and Guillain-Barré syndrome: a rare association. Clin Adv Hematol Oncol. 2010;8(3):201-3. PMid:20400935.

12 Sheikh KA. Guillain-Barré syndrome. Continuum. 2020;26(5):1184-204. PMid:33002998.

13 Jiang QL, Pytel P, Rowin J. Disseminated intravascular large-cell lymphoma with initial presentation mimicking Guillain-Barré syndrome. Muscle Nerve. 2010;42(1):133-6. http://dx.doi.org/10.1002/mus.21648. PMid:20544922.

14 DeAngelis LM. Current diagnosis and treatment of leptomeningeal metastasis. J Neurooncol. 1998;38(2-3):245-52. http://dx.doi.org/10.1023/A:1005956925637. PMid:9696379.

15 McPhee SJ, Bottles K, Lo B, et al. To redeem them from death. Reactions of family members to autopsy. Am J Med. 1986;80(4):665-71. http://dx.doi.org/10.1016/0002-9343(86)90822-3. PMid:3963043.
 


Submitted date:
01/04/2023

Accepted date:
03/10/2023

Publication date:
05/11/2023

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