Summary
Only a small fraction of sudden unexpected deaths are caused by neoplastic disease and thus subject to medicolegal autopsy. The medicolegal autopsy forms an opportunity to study not only medically diagnosed and treated neoplasms, but also the natural evolution of untreated disease. In a series of 7,020 consecutive medicolegal autopsies in northern Sweden, we found 171 cases with malignant and/or intracranial neoplasms.
In 41 cases, sudden death was caused by previously unknown tumors. The most common mechanisms of death in this group were disseminated cancer, intracranial tumors, pulmonary thromboembolism, hemoptysis, and aspiration of blood, and the most common locations were the bronchi and the lung. In some of these cases, the mechanism was sometimes dramatic, raising a question of violent death or intoxication. In 30 cases, sudden unexpected death was caused by previously known tumors, and also in this group disseminated cancer was the most common cause of death, and the most common locations were the bronchi and the lung.
In 22 cases, tumors were found in suicidal cases; in 14 of these, the tumor was considered to be a major causative factor to the suicide, while in eight cases the tumor was considered to be an incidental finding. The expected number of cancers in the 1,060 suicides investigated in this series was 27, according to the official cancer prevalence data. Thus, a possible over-representation of suicides among persons with cancer seems doubtful and needs further exploration.
Zusammenfassung
Nur ein geringer Teil plötzlicher und unerwarteter Todesfälle ist Folge einer neoplastischen Erkrankung. Die in diesem Zusammenhang vorgenommenen rechtsmedizinischen Obduktionen geben damit Gelegenheit, nicht nur diagnostizierte und behandelte Tumor-Erkrankungen, sondern auch deren natürliche Entwicklung bei unbehandelten Erkrankungen zu untersuchen. Unter insgesamt 7020 rechtsmedizinischen Obduktionen im nördlichen Schweden haben wir in 171 Fällen maligne und/oder intrakraniale Tumore gefunden.
In 41 Fällen war der Tod durch den zuvor unbekannten Tumor verursacht worden. Die häufigsten Todesursachen waren in diesen Fällen Tumormetastasen, intrakraniale Tumore, Lungenembolie, Hämoptysis, Blutaspiration, am meisten waren Bronchien und Lunge betroffen. In einigen Fällen waren die Todesumstände derart dramatisch verlaufen, daß der Verdacht eines gewaltsamen Todes oder einer Vergiftung aufkam. In 30 Fällen war der plötzliche Tod durch bereits bekannte Tumor-Erkrankungen verursacht, wobei Bronchien- und Lungenmetastasen die häufigsten Todesursachen waren.
Bei 22 Suizidfällen wurden Tumore gefunden, wobei in 14 Fällen der Tumor als Grund für den Suizid anzusehen war; in acht Fällen stellten Tumore nur einen Nebenbefund dar. Nach der offiziellen Krebsstatistik würden 27 Tumorträger unter den 1060 Suizidfällen zu erwarten sein. Die Annahme einer Überrepräsentation von Suiziden bei Personen mit einer Krebserkrankung erscheint daher zweifelhaft und bedarf weiterer Untersuchungen.
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Gezelius, C., Eriksson, A. Neoplastic disease in a medicolegal autopsy material. Z Rechtsmed 101, 115–130 (1988). https://doi.org/10.1007/BF00200293
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DOI: https://doi.org/10.1007/BF00200293
Key words
- Neoplastic disease, medicolegal autopsy
- Sudden unexpected death, caused by unknown tumors
- Suicide, tumors in suicidal cases