Pediatric sudden unexpected death due to undiagnosed mediastinal T‐cell lymphoblastic lymphoma: A series of three cases

• Published in: Journal of forensic sciences 2022-03, Vol.67 (2), p.795-801
• Main Authors: Santos Martins, Celeste, Felo, Joseph
• Format: Article
• Language: English
• Subjects: airway compression; anterior mediastinal mass; Arteries; Autopsies; autopsy; Bronchi; Children; Compressing; Death; Dyspnea; Forensic pathology; Lymphoma; Neoplasms; pediatric sudden unexpected death; Pediatrics; superior vena cava compression; Tumors; T‐cell lymphoblastic lymphoma
• ISSN: 0022-1198; 1556-4029
• DOI: 10.1111/1556-4029.14901

The literature on pediatric sudden unexpected death (SUD) due to unrecognized mediastinal neoplasms is limited to a small number of case reports with several cases confirmed to be secondary to T‐cell lymphoblastic lymphoma (T‐cell LBL). Mediastinal T‐cell LBL can be rapidly progressive and potentially fatal due to the compression and obstruction of the airway and/or the great vessels. The clinical presentation is nonspecific with a predominance of respiratory symptoms that are more apparent when the patient is supine. We presented three cases of pediatric SUD attributed to forensic autopsy‐diagnosed anterior mediastinal T‐ cell LBL. Case 1 involved a 2‐year‐old girl who presented with 9 days of cough and dyspnea. Postmortem examination revealed a firm rubbery mass surrounding the heart and compressing the bronchi. Case 2 involved a 3‐year‐old girl who suffered from a respiratory tract infection over several days. Autopsy revealed a firm nodular mass compressing the superior vena cava. Case 3 involved a 2‐year‐old boy who was found unresponsive, lying prone in his crib. He had cold‐like symptoms for several days before his death. Postmortem examination revealed a firm, rubbery anterior mediastinal neoplasm surrounding the superior vena cava and great arteries. These three cases demonstrate the importance of identifying children with mediastinal masses that could potentially lead to life‐threatening presentations and pediatric SUD. The forensic pathologist should consider a hematologic neoplasm at the time of autopsy in a previously healthy child who dies suddenly.