The Post Mortem report follows.
DEPARTMENT OF PATHOLOGY
Southampton University Hospitals NHS Trust Tel: 023 80796443
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Surname : DICKINSON Forename: Patrick Sex ; Male DOB : 19 Feb 1957 DOD : 14 Aug 2005 |
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Clinician/GP: Examined At : * UNKNOWN * Autopsy No : P1602/05 Date of PM : 16 Aug 2005 Requested By: H.M.CORONER-HOSPITAL |
GP: Dr McGee.
Clinician: Dr DeSilva, SGH, D8.
CASE HISTORY: (As supplied by H.M. Coroner's Officer and
supplemented by hospital notes number 368 18 12)
This 48 year old man had a left orchidectomy for a testicular mass
at St Mary's Hospital on the Isle of Wight. This was diagnosed as a
plasmacytoma. Multiple other lesions were noted in the stomach,
pancreas and lungs.
He was transferred to Southampton General Hospital for further
investigation and treatment including specialist treatment for his
obstructive jaundice. Treatment also involved frequent drainage of
ascites Despite treatment with steroids, scans showed rapid
progression of the disease. He had increasing problems with
abdominal pain and distention of his small bowel. He died on 14
August 2005.
An occupational exposure to the following were reported, "Attelic D
Liquid, Attelic D Dust and Round Isp Spray."
EXTERNAL EXAMINATION:
The body was that of a middle-aged white male, height 186cm,
identified by name tags on the right and left wrists. He was
jaundiced and appeared cachetic. He had round blue tattoos over the
metacarpophalangeal joints of the left hand with an arrow over the
proximal phalanx of the left index finger. Linear blues tattoos were
present over the dorsal aspect of the left wrist. There was bruising
over the first interosseus muscle on both hands, 5x3cm on the left,
5 x 2.5cm on the right. There was a well healing surgical scar in
the left groin, 7cm in length. There were needle puncture marks
below the ribs on the left, two in the right lower quadrant of the
abdomen and one in the right side of the chest. There was an area of
bruising 3x3cm and a scar with a cruciate arrangement on the right
side of the chest near the needle puncture mark.
INTERNAL EXAMINATION:
RESPIRATORY SYSTEM:
Pleural Cavities: There was a large tumour mass at the apex of the
right lung, adherent to both the visceral and parietal pleura.
Larynx, Trachea & Bronchi: There were no bronchial lesions.
DEPARTMENT OF PATHOLOGY
Southampton University Hospitals NHS Trust Tel: 023 80796443
|
Surname : DICKINSON Forename: Patrick Sex ; Male DOB : 19 Feb 1957 DOD : 14 Aug 2005 |
|
Clinician/GP: Examined At : * UNKNOWN * Autopsy No : P1602/05 Date of PM : 16 Aug 2005 Requested By: H.M.CORONER-HOSPITAL |
Lungs: Left 1032g, right 944g. There were widespread, small, firm
deposits throughout both lungs. There was evidence of pulmonary
oedema. There was no evidence of consolidation or pulmonary emboli.
CARDIO-VASCULAR SYSTEM:
Pericardium: The pericardium contained approximately 50ml of a dark
straw-coloured fluid.
Heart: 366g. There were several tumour deposits on the epicardial
surface of the heart, the largest of which measured 3cm in maximum
dimension and was present just inferior to the left oracle. All
three main epicardial coronary vessels were patent. There was a
dominant right coronary circulation. The mitral, aortic, tricuspid
and pulmonary valves were normal. The left ventricle had a wall
thickness of 18mm at the level at the base of the papillary muscle.
The foramen ovale was closed. The aorta had a normal calibre. There
was no significant atherosclerosis in the aorta and there was no
evidence of renal artery stenosis.
ALIMENTARY SYSTEM:
Peritoneum: The peritoneal cavity contained 1.5L of straw coloured
fluid. There were widespread, nodular tumour deposits throughout the
greater omentum on the surface of the stomach, the small bowel and
small bowel mesentary, the lesser omentum and the colon.
Mouth, Tongue & Oesophagus: Normal.
Stomach & Contents: The gastric wall was thickened in places, up to
12mm. There were several large nodules, the largest of which was in
the region of a greater curvature. This mass projected into the
lumen of the stomach and was 5cm in maximum dimension. There were
patchy areas of gastritis.
Intestines & Contents: There were widespread metastatic deposits on
the serosal surface the small bowel and colon.
Liver: 2164g. There were no focal lesions within the parenchyma of
the liver itself, however there was a large tumour deposit at the
portahepatis encasing the gallbladder and extrahepatic biliary tree.
There was dilatation of the intrahepatic biliary system. The cut
surface of the liver had a nutmeg appearance.
Gallbladder & Biliary Tree: The gallbladder appeared normal,
although it was encased in tumour deposit. The common bile duct was
dilated with a circumference of 22mm.
Pancreas: The pancreas had a firm nodular texture, most marked
towards the head and there was a dilated pancreatic duct.
GENITO-URINARY SYSTEM:
Kidneys: Left 158g, right 130g. Both the kidneys had a smooth
capsular surface. The cut surface reveal a well demarcated cortical
DEPARTMENT OF PATHOLOGY
Southampton University Hospitals NHS Trust Tel: 023 80796443
|
Surname : DICKINSON Forename: Patrick Sex ; Male DOB : 19 Feb 1957 DOD : 14 Aug 2005 |
|
Clinician/GP: Examined At : * UNKNOWN * Autopsy No : P1602/05 Date of PM : 16 Aug 2005 Requested By: H.M.CORONER-HOSPITAL |
rim of 8mm.
Generative Organs: The left testicle was absent. The right testicle
did not contain any deposits. The prostate was small with no
nodules.
Bladder & Urine: Normal.
CENTRAL NERVOUS SYSTEM:
Skull & Scalp: No evidence of wounds or fractures.
Meninges: Normal.
Brain: 1452g. The circle of Willis was normal. There were no areas
of tumour deposition, haemorrhage or infarction. There was no
ventricular enlargement and the brainstem and cerebellum appeared
normal.
LYMPHO-RETICULAR SYSTEM
Spleen: 132g. There were no focal lesions within the spleen.
Lymph Nodes: There was lymphadenopathy in the right axilla.
Thymus: Not identified.
ENDOCRINE SYSTEM:
Pituitary: Not examined.
Thyroid: The thyroid was symmetrical with no nodules. The
parathyroid glands were not examined.
Adrenals: Normal.
POST MORTEM HISTOLOGY AND OTHER INVESTIGATIONS;
Sections from the bone marrow appear hypercellular. All three normal
cell lineages are identified and there is no overwhelming plasma
cell infiltrate. The appearances are of a reactive bone marrow only.
Sections from the omentum comprise sheet of neoplastic large cells
with a plasmacytoid appearance and have similar appearances to the
testicular specimen taken in life and are consistent with a high
grade plasma cell tumour.
SUMMARY OF FINDINGS:
This 48 year old man presented with a mass in the left testicle and
underwent a left orchidectomy three months before death. A diagnosis
of high grade plasmacytoma was made. A series of investigation were
preformed at St Mary's Hospital, Isle of Wight and Southampton
General Hospital. It appeared that the tumour had spread throughout
DEPARTMENT OF PATHOLOGY
Southampton University Hospitals NHS Trust Tel: O23 80796443
|
Surname : DICKINSON Forename: Patrick Sex ; Male DOB : 19 Feb 1957 DOD : 14 Aug 2005 |
|
Clinician/GP: Examined At : * UNKNOWN * Autopsy No : P1602/05 Date of PM : 16 Aug 2005 Requested By: H.M.CORONER-HOSPITAL |
the abdomen and chest, including the stomach, pancreas and lungs.
Post mortem examination concurred with these findings and in
addition widespread tumour deposition on the serosal surface of both
the small and large bowel and encasing the extrahepatic biliary
system. Deposits were also found in the heart. Histological
examination of post mortem tissue from the abdomen confirmed that
the process seen was the same as the diagnosis in life of a high
grade plasma cell tumour. There was no evidence of bone marrow
involvement.
Although some previous work has suggested that plasma cell tumours
may arise with greater frequency among workers exposed to certain
chemical substances (e.g. farmers), plasma cell tumours also arise
within individuals without any clear occupational history of this
nature. Therefore, in our opinion it would be extremely difficult to
identify a direct link between occupation and tumour development in
this case.
CONCLUSIONS AND CAUSE OF DEATH:
1a. DISSEMINATED PLASMA CELL TUMOUR
[signed M Johnson A Bateman]
Dr M Johhson MRCS MRCSI
Specialist Registrar in Histopathology/
Dr A Bateman BSc MD FRCPath
Consultant Histopathologist
Southampton General Hospital
18th August 2005