Death from massive pulmonary thromboembolism in ovarian neoplasm : a medico-legal case report

Introduction : Pulmonary thromboembolism is a serious complication in ovarian tumors, especially if associated with large uterine fibroids that favour the compression of large venous districts facilitating stasis. The increased risk of developing deep vein thrombosis (DVT) is not related to tumor size, but rather to age and body mass index (BMI) of patients that need to be, respectively, more than 50 years and 25. The purpose of this report is to present a particular case of fatal pulmonary thromboembolism caused by pelvic compression by ovarian cancer. The case A 74-year-old woman, weighing 103 kg and 172 cm tall, was found dead at her home. From judicial acts it was resulted that she suffered from hypertension and was reluctant to undergo medical treatment, but that she would have to perform some health checks because she was a carrier of a massive ovarian cyst. The judicial authorities ordered the autopsy two days after the discovery of the body. Necropsy findings The corpse showed a proper nutritional state at the dissecting table and was well-preserved, with obvious abdominal globosity. No signs due to any harm were evident to external examination. The systematic examination of the organs showed formations completely occluding the lumen of the hilar pulmonary vessels, bilaterally; their morphological characteristics (mottled appearance, opacity, friability, tenacious adhesion to the vessel wall) permitted to identify their thromboembolic nature. Abdominal cavity dissection evidenced a voluminous neoformation (104 cm/15 kg), interesting adnexal structures, that occluded large part of the pelvic cavity with compression of the organs below. The exploration of the pudendal plexuses showed the origin of the material found in the pulmonary vessels. The cause of death was identified as massive pulmonary thromboembolism in a woman with massive ovarian neoplasm. Results Histopathological investigation was carried out on organs and on the material occluding the hilar vessels and pudendal plexuses, removed during autopsy and fixed in 10% buffered formalin. The results have confirmed the same thrombotic nature and chronology of entity analyzed in the two vascular beds, making it possible to recognize the massive ovarian neoplasm, histologically identified as an "Atypical Proliferative (Borderline) Mucinous Tumor", as the risk factor for the venous thrombosis and subsequent embolization. Conclusions Authors describe a case of death caused by massive pulmonary thromboembolism originated from a voluminous ovarian mass that has given rise to venous stasis of the pelvic district