Article Figures & Data
Figures
- Figure 1
Length of hospital stay (from admission to death) of patients with tumours, thromboembolic events or pneumonia diagnosed by pathologists and clinicians. Significant differences between patients with thromboembolism and pneumonia (p<0.01). There was no significant difference in the treatment time of patients with malignancies diagnosed by the clinicians, and the patients whose tumour was diagnosed at autopsy.
Tables
- Table 1
Thromboembolic complications and direct cause of death in patients who had a stroke with malignancy, based on autopsy findings
Age and sex Tumour
(histopathology)Thromboembolic findings
(autopsy)Premortem antithrombotic therapy History of thromboembolic event Cause of death 76 years female Pancreatic ductal adenocarcinoma (not otherwise specified type), with metastatic lymph nodes No No Yes
(history of deep vein thrombosis)Myocardial infarction 69 years female Colon adenocarcinoma (mucinous type) No No No Pneumonia 67 years male Invasive squamous cell carcinoma of the lung, keratinising No No No Brainstem compression due to parenchymal haemorrhage 62 years female Papillary thyroid cancer No No No Brainstem compression due to parenchymal haemorrhage 66 years female Papillary renal cell carcinoma No Yes Yes
(history of myocardial infarction)Cardiorespiratory insufficiency 78 years female Papillary urothelial carcinoma, invasive (pelvic and ureteral), with metastatic lymph nodes No No No Brainstem compression due to parenchymal haemorrhage 78 years female Follicular thyroid carcinoma No No No Myocardial infarction 66 years female Colon tumour (histological examination was not performed) Yes No No Cardiorespiratory insufficiency - Table 2
Discrepancies between postmortem non-neuropathological findings and clinical diagnoses, and discrepancies between postmortem neuropathological findings and the last premortem CT scan
Discrepancy Postmortem non-neuropathological findings
Number (N)=534Class I discrepancy 8 (1.5%) malignancies
68 cases of (12.7%) thromboembolic events: in vivo non-diagnosed thrombosis in the femoral vein or in the periprostatic and periuterine venous plexus, embolus in the lung—without any antithrombotic therapy
36 cases of (6.7%) in vivo non-diagnosed pneumonia, without any antibiotic therapyClass II discrepancy 12 cases of (2.3%) thromboembolic events: in vivo non-diagnosed thrombosis in the femoral vein or in the periprostatic and periuterine venous plexus, embolus in the lung—with prophylactic antithrombotic therapy
37 cases of (6.9%) in vivo non-diagnosed pneumonia, but prophylactic antibiotic therapyClass III discrepancy 169 (31.6%) benign findings (cysts, myoma, etc) Postmortem neuropathological findings in patients with ischaemia
Number (N)=189Class I discrepancy 66 (34.9%) ischaemic lesions on the premortem CT scan, but haemorrhagic transformation of an infarct on brain autopsy - Table 3
Premortem-diagnosed and postmortem-diagnosed thromboembolic events (thrombosis in the femoral vein or in the periprostatic or periuterine venous plexus, embolus in the lung)
Number of patients Antithrombotic therapy Length of hospital stay (from admission until death) Premortem-diagnosed thromboembolic events 80 31* 13.0 (8.0–21.0) Postmortem-diagnosed thromboembolic events 80 12† 8.0 (5.0–13.0) *Forty-nine patients did not receive antithrombotic therapy (eg, due to the risk of haemorrhagic transformation of an infarct, enlargement of parenchymal haemorrhage, concomitant systemic bleeding, etc).
†Sixty-eight patients were not administered antithrombotic treatment partly due to the lack of clinical symptoms, and partly due to the fear of haemorrhagic transformation of an infarct and the fact that they had large parenchymal haemorrhage and terminal state.
- Table 4
Age differences between patients with cancer, thrombosis/embolus and pneumonia diagnosed by the pathologist and the clinician
Median (IQR), year P value Malignancy diagnosed only at autopsy (N=8) 68.0 (62.0–68.0) 0.839 Malignancy diagnosed by clinicians (N=26) 70.5 (63.0–76.0) Thromboembolic event diagnosed only at autopsy (N=80) 72.5 (62.5–80.0) 0.142 Thromboembolic event diagnosed by clinicians (N=80) 75.0 (69.0–81.0) Pneumonia diagnosed only at autopsy (N=73) 71.0 (60.0–79.0) 0.116 Pneumonia diagnosed by clinicians (N=262) 73.0 (65.0–81.0) - Table 5
The relationship between postmortem neuropathological findings and the immediate cause of death
Cause of death
(autopsy diagnosis)Postmortem neuropathological findings Ischaemic lesions
N=222Haemorrhagic transformation of an infarct
N=99Parenchymal haemorrhage
N=172Subarachnoid haemorrhage
N=41Herniation
(eg, due to haemorrhagic transformation of an infarct or expansion of bleeding)31 18 118 32 Cardiorespiratory insufficiency 44 23 14 2 Myocardial infarction 11 4 4 0 Pneumonia 81 31 24 6 Pulmonary embolism 55 22 12 1 Sepsis 0 1 0 0 - Table 6
Findings in the carotid and the vertebrobasilar system observed at brain autopsy
Brain autopsy findings N=534 Thrombus in the internal carotid artery 27 (5%) Hyaline degeneration of the basilar/vertebral artery 113 (21%) Mild atherosclerosis of the basilar/vertebral artery 57 (11%) Moderate atherosclerosis of the basilar/vertebral artery 137 (26%) Severe atherosclerosis of the basilar/vertebral artery 8 (28%) Basilar/vertebral artery aneurysm 28 (5%) Thrombus in the basilar artery 13 (2%) Dissection in the basilar artery/internal carotid artery 0
