Clinicopathologic Findings of Hematological Malignancy: a Retrospective Autopsy Study

Hematological malignancies exhibit many clinical presentations, from ambiguous systemic symptoms to rapid multi-organ failure. By identifying common clinical, laboratory, and autopsy findings in patients with a hematological malignancy, living patients may be diagnosed and treated earlier. We retrospectively reviewed our institution's 2003-2013 autopsy and respective medical records for patients with a hematological malignancy. Clinical, laboratory and autopsy findings were retrieved. 30 patients with hematological malignancy were identified, including 14 "new" cases, defined here as diagnosed either post-mortem (n=6) or within 4 weeks of death (n=8). 16 patients had a known prior diagnosis of greater than 4 weeks and/or received treatment. "New" patients most frequently presented with pain, dyspnea and gastrointestinal symptoms. Common laboratory findings for new lymphoma patients included elevated aspartate aminotransferase, prothrombin time (PT), lactate dehydrogenase (LDH), lactic acidosis, and cytopenia. New leukemia patients had peripheral smear findings, thrombocytopenia, elevated PT, lactic acidosis and elevated LDH. Patients with a prior diagnosis of hematological malignancy had similar findings to new patients with increased thrombocytopenia in prior lymphoma cases. Immediate causes of death were most frequently multi-organ failure through malignant organ infiltration and/or septic shock. With an increased awareness of hematological malignancy in a differential diagnosis, a timely diagnosis or clinical interventions can eventually save lives.