Journal List > Korean J Leg Med > v.39(3) > 1087973

Kim, Kim, Park, and Lee: Undiagnosed Anaplastic Ganglioglioma Resulting in the Sudden Unexpected Death of a Young Woman

Abstract

Intracranial neoplasms usually have definitive symptoms, causing a need for medical intervention, but a few cases result in sudden unexpected death even before diagnosis. In these cases, autopsy or postmortem imaging may be the only way of identifying the existence of a tumor, so investigators or forensic specialists who participate in the postmortem inspection should be aware of these possibilities. We report on a case of a 26-year-old woman without any medical history found dead in her home. A 5-cm intraventricular tumor was found during autopsy, which was histologically consistent with anaplastic ganglioglioma a very rare type of neuroglial tumor with the potential for malignant behavior. The tumor showed the characteristic features of anaplastic ganglioglioma, such as increased cellularity, a high Ki-67 proliferative index, and necrosis. There were signs of increased intracranial pressure, including flattened gyri and dilated ventricles, which led to the conclusion that this brain tumor was the cause of death.

REFERENCES

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Fig. 1.
(A) Flattened gyri of the cerebral cortex are observed, implying increased intracranial pressure. (B) The tumor was located in the right lateral and third ventricle, resulting in ventricular dilation. The cut surface of the tumor shows focal hemorrhage and necrosis.
kjlm-39-78f1.tif
Fig. 2.
(A) Microscopic image showing the tumor border with a relatively distinct demarcation but without encapsulation. (B) Large multinucleated ganglion cells can be seen admixed with glial cells in the neutrophilic background. The ganglion cells show prominent nucleoli and abundant eosinophilic cytoplasm. Anaplastic changes can be observed, such as increased cellularity (C), a high Ki-67 proliferative index (D), and necrosis (E) in multifocal areas (A, H&E, 12.5; B, H&E, 200; C, H&E, 100; D, Ki-67, 100; E, H&E, 200).
kjlm-39-78f2.tif
Table 1.
Summarized cases of sudden unexpected death due to intracranial neoplasm reported in Korea for the past 10 years
Author Sex Age (yr) Medical history Premortem symptoms or signs Tumor size (cm) Tumor location Histologic diagnosis WHO grade Associated intracranial change
Huh et al. (2008) [7] F 56 Asymptomatic hypertension N/A 5.5 Olfactory groove Meningioma, meningothelial type I Edematous brain
Kim et al. (2009) [8] F 6 Mental retardation Vomiting, seizure 6.5 Anterior wall of the left lateral ventricle Ganglioglioma I Edematous brain, dilated left ventricle
Kim et al. (2009) [9] M 2 N/A Vomiting, dyspnea, LOC seizure N/A Cerebellar vermis (extending to the third, forth, and lateral ventricles) Medulloblastoma IV Severe brain edema, hydrocephalus
Kim et al. (2013) [10] F 51 Depression, Hyperlipidemia Small amoun of vomitus 5.5 Olfactory groove Meningioma, meningothelial type (with brain invasion) II Edematous brain, flattened gyri, tonsillar herniation
Present case F 26 Previously healthy N/A 5 In front of the optic chiasm (extending to the right lateral and third ventricles) Anaplastic ganglioglioma ventricles III Flattened gyri, dilated

WHO, World Health Organization; F, female; N/A, not available; M, male; LOC, loss of consciousness.

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