Sudden Unexpected Deaths Due to Intracranial Meningioma: Presentation of Six Fatal Cases, Review of the Literature, and A Discussion of the Mechanisms of Death

Gitto, Lorenzo; Bolino, Giorgio; Cina, Stephen J.

doi:10.1111/1556-4029.13626

Cited by 11 publications

(5 citation statements)

References 57 publications

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“…Histotypes included but were not limited to meningioma, astrocytoma, oligodendroglioma, glioblastoma, ependymoma, germinoma, teratoma, and adenoma [ 7 – 11 ]. The mechanisms of sudden death due to intracranial tumors are heterogeneous and can be attributed to the increase in intracranial pressure, direct compression of vital nervous centers, spontaneous intratumor hemorrhage, or brain invasion [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Sudden unexpected death in a 17-year-old boy due to unacknowledged adamantinoma-like Ewing sarcoma

Pigaiani

Ausania

Tudini³

et al. 2022

Forensic Sci Med Pathol

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A 17-year-old male with no previous medical history was admitted 2 days before his death to a local hospital after mild dyspnea. Electrocardiography, chest radiography, and blood analysis revealed no abnormalities. Blood oxygen saturation was 99%, and SARS-CoV-2 nasopharyngeal swabs tested negative; thus, he was discharged without prescriptions. After 2 days, the subject died suddenly during a pool party. Forensic autopsy was performed analyzing all anatomical districts. Cardiac causes were fully excluded after deep macroscopic and microscopic evaluation; lung and brain analyses showed no macroscopic pathology. Finally, a large subglottic solid mass was detected. The whitish neoplasm showed an aggressive invasion pattern to the thyroid and adjacent deep soft tissues and occluded the trachea. High-power microscopy showed sheets of small, uniform cells with scant cytoplasm; round nuclei; and small, punctate nucleoli, with immunohistochemical expression of CK8-18, AE1/AE3, and CD99. Using FISH analysis, the break-apart molecular probes (EWSR1 (22q12) Break – XL, Leica Biosystem, Nussloch, Germany) showed distinct broken red and green fluorochromes, diagnostic of Ewing sarcoma. The neoplasm was characterized as adamantinoma-like Ewing sarcoma, and the mechanism of death was identified as airway obstruction. The rarity of the case resides in the circumstances of death, which pointed to the possibility of sudden unexpected death due to heart disease, but an oncological cause and the underlying mechanism were finally diagnosed. The best method to perform autopsies is still complete, extensive, and systematic macroscopic sampling of organs and districts followed by histopathological analysis, in addition to immunohistochemical and molecular investigations in those cases in which they are necessary. In fact, when neoplasms are detected, the application of advanced techniques such as immunohistochemistry and molecular diagnostics is fundamental to accurately certify death.

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Section: Discussionmentioning

confidence: 99%

Sudden unexpected death in a 17-year-old boy due to unacknowledged adamantinoma-like Ewing sarcoma

Pigaiani

Ausania

Tudini³

et al. 2022

Forensic Sci Med Pathol

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“…Meningiomas are mostly benign meningothelial cell neoplasms, typically originating from the inner surface of the dura mater and represent 37.1% of all intracranial tumors [46]. Gitto et al reported a total of 12 cases with sudden unexpected death occurring due to unrecognized intracranial meningioma [52]. Postmortem examination reports different etiologies that demonstrate various mechanisms of death in cases of meningiomas [52].…”

Section: Primary Brain Tumorsmentioning

confidence: 99%

“…Gitto et al reported a total of 12 cases with sudden unexpected death occurring due to unrecognized intracranial meningioma [52]. Postmortem examination reports different etiologies that demonstrate various mechanisms of death in cases of meningiomas [52]. For instance, peritumoral brain edema, which causes increased intracranial pressure, was found to be the mechanism of death in a total of five cases [52].…”

Section: Primary Brain Tumorsmentioning

confidence: 99%

“…Postmortem examination reports different etiologies that demonstrate various mechanisms of death in cases of meningiomas [52]. For instance, peritumoral brain edema, which causes increased intracranial pressure, was found to be the mechanism of death in a total of five cases [52]. However, three of these cases showed complications of direct compression to the adjacent structures most commonly the cerebellum and the brainstem, which are crucial for monitoring metabolic processes and regulating other autonomic nervous system activities [52].…”

Section: Primary Brain Tumorsmentioning

confidence: 99%

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Central Nervous System Causes of Sudden Unexpected Death: A Comprehensive Review

Alotaibi¹,

Mahroos²,

Yateem³

et al. 2022

Cureus

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Sudden unexpected death due to central nervous system (CNS)-related pathologies though far less common than cardiac causes still account for a substantial proportion of sudden deaths that occur worldwide. This review covers the most common causes of sudden unexpected death due to CNS-related pathologies encountered by forensic pathologists. These include intracerebral hemorrhage, aneurysmal subarachnoid hemorrhage, ischemic stroke, epilepsy, brain tumors, and infectious causes. Related rare causes are not discussed and are beyond the scope of this review. The role of neuroimaging and genetic testing as autopsy ancillary investigations in such sudden deaths is also discussed.

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“…Unlike ruptured aneurysms, intracranial hemorrhages, traumatic head injuries, or other neurologic emergencies, meningiomas rarely lead to sudden death. Current literature of meningiomas directly contributing to rapid death consists mostly of case reports or series (4), which often cite mass effect (5) as the underlying cause. We present a series of meningiomas that resulted in death.…”

Section: Introductionmentioning

confidence: 99%

Lethal Complications of Meningiomas: A Case Series

Feng,

deJong,

Douglas

et al. 2024

Academic Forensic Pathology

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Background: Meningiomas are the most prevalent type of primary intracranial tumor in adults, comprising nearly one-third of all intracranial tumors. They are typically benign, slow-growing, and asymptomatic but may cause neurological symptoms as they expand due to mass effect. Classification is determined by World Health Organization (WHO) grades 1 to 3 following pathological examination corresponding to benign, atypical, and anaplastic (malignant), respectively, reflecting their rate of growth and risk of recurrence. The vast majority are WHO grade 1 and their slow growth permits timely presentation for elective resection; however, meningiomas in vulnerable locations and coexisting morbidities can result in sudden death. Objectives: We present a series of four adult patients with meningiomas which resulted in death, including a case of fatal seizure, midline hemorrhagic meningioma, postresection meningitis, and compression of the cerebellum. Research design: Retrospective review of the authors’ cases was conducted. Available pathology, medical, and autopsy records including gross images were reviewed in each case. The inclusion criteria were adult patients (>18 years old) and that the cause of death had to include meningioma. Subjects: The four patients included a 61-year-old male, an 84-year-old female, a 62-year-old male, and a 37-year-old female. Measures: Qualitative; autopsy reports describing cause of death and pathology report findings including gross and microscopic analysis. Conclusions: Meningiomas are often benign in nature but can rarely result in death. Size and location of the tumor and risk factors are contributory. Autopsy examination can be instrumental in identifying the cause and mechanism of deaths associated with meningiomas.

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Sudden Unexpected Deaths Due to Intracranial Meningioma: Presentation of Six Fatal Cases, Review of the Literature, and A Discussion of the Mechanisms of Death

Cited by 11 publications

References 57 publications

Sudden unexpected death in a 17-year-old boy due to unacknowledged adamantinoma-like Ewing sarcoma

Sudden unexpected death in a 17-year-old boy due to unacknowledged adamantinoma-like Ewing sarcoma

Central Nervous System Causes of Sudden Unexpected Death: A Comprehensive Review

Lethal Complications of Meningiomas: A Case Series

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