Sudden unexpected death with primary adrenal lymphoma
Yukiko Hata1, Shin Ishizawa2, Naoki Nishida1
1Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan.
Legal Medicine (Tokyo, Japan)
|September 23, 2018
Summary
Sudden unexpected death in an 82-year-old man was attributed to adrenal insufficiency caused by primary adrenal lymphoma. This rare condition, a diffuse large B-cell lymphoma, presented alongside moderate aortic stenosis.
Area of Science:
- Pathology
- Cardiology
- Oncology
Background:
- The case involves an 82-year-old male with a history of hypertension and mild aortic stenosis (AS).
- The patient experienced non-specific symptoms like fatigue, anorexia, and mild fever preceding death.
Observation:
- Autopsy revealed no external trauma or intoxication but identified a congenital bicuspid aortic valve (BAV) with moderate left ventricular hypertrophy.
- Distinctive brownish-red nodular lesions were found in both adrenal glands.
Findings:
- Immunohistochemical analysis confirmed the adrenal lesions were positive for B-lymphocyte markers (CD20, MAGE-1, CD79a), diagnosing primary adrenal lymphoma (PAL) with a diffuse large B-cell lymphoma phenotype.
- Despite moderate AS, the valvular calcification was restricted, suggesting BAV was not the primary cause of severe cardiac compromise.
Implications:
- This case highlights primary adrenal lymphoma as a potential, albeit rare, cause of sudden unexpected death due to adrenal insufficiency.
- The findings underscore the importance of considering rare oncological conditions in the differential diagnosis of unexplained sudden death, even in patients with pre-existing cardiovascular conditions.
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