Prof. Dr. Torsten Hansen, Chefarzt Institut für Pathologie, Klinikum Lippe

1. An interesting autopsy report:
83-year-old patient with recurrent
pleural effusions
Hansen T1
| Schulz B1
| Titze U1
| Weber M2
Klinikum Lippe GmbH | Institut für Pathologie1
| Klinik für Pneumologie2
| www.klinikum-lippe.de
Case Study
A 83-year-old female patient was admitted to hospital with increasing
dyspnea, decreasing vigilance and loss of weight in the last couple of
months. Hypothyroidism, hypertension and liver cysts were clinically
known pre-existing disorders. Computed tomography revealed a large
pleural effusion on the right side without evidence of tumor. Pleural
effusion cytology revealed carcinoma cells. The patient developed
fever and presented with clinical signs of sepsis. Finally, she succum-
bed to acute respiratory and renal failure despite intensive care
(including antibiotic therapy) four days after submission to hospital.
Primary Autopsy Findings
Further Critical Results
Computed tomography with extensive
pleural effusion on the right side
Adenocarcinoma of the lung;
TNM-stage (7th ed.): apT4,apN3,apM1b;G3;L1,V1
Molecular pathology applying strip as-
say method1 reveals BRAF V600E mu-
tation in tissue specimens of lung (I)
and colon tumor (II), but not in myo-
cardial tissue (III)
Adenocarcinoma of the coecum
TNM-stage (7th ed.): apT3,apN0,apM0;G2;L0,V0
Macroscopy of the thorax shows
thickening of the right pleura (arrows),
note large liver cysts (*)
Lung
TTF-1
Colon
TTF-1
Colon
cdx2
Discussion
The phenomenon of synchronous neoplasias harboring BRAF V600E mutation
has been previously described only in a few patients, mainly those with
malignant melanoma and hairy cell leukemia2-4. To our knowledge, this is the
first case report of a coexistent adenocarcinoma of the lung and of the colon
both tested positive for BRAF V600E mutation. Since other tissue specimens
analyzed failed to show this mutation, it can be assumed that this finding is not
due to germ cell line mutation, but does reflect a coincident occurence. Besides,
the high number of previously unknown diseases that became evident by the
post-mortem examination of that patient underlines the important role of
autopsies as an instrument of quality assurance and teaching.Recurrent myocardial infarction in the
posterior wall of the left ventricle
Abdominal aortic aneurysm
with dissection (arrow)
References Ausch et al. (2009) J Mol Diagn 11:508
Ghorbani-Aghbolaghi et al. (2017) Autops Case Rep 7:13
Mitsogianni et al. (2018) Case Rep Oncol 11:109
White et al. (2018) Cureus 10:e3600