Autopsy report Patient N, 76 уears

SUMMARY OF CLINICAL HISTORY:
Patient N, 67 years old, suffered from ovarian cancer.
She underwent bilateral laparoscopic adnexectomy.
Microscopic and IHC examination : undifferentiated endometrioid carcinoma, CEA 4 +, HER2neu-negative
Received polychemotherapy since July 2020.
In September her condition significantly deteriorated.
Was hospitalized
Was diagnosed with carcinomatosis of the peritoneum. Ascites. Metastasis in S 10 of the right lung.

EXTERNAL EXAMINATION:
The body of 77 year old women, well developed, well nourished.
Skin: pale gray
On the anterior surface of the chest and lower third of the lower limbs - multiple petechial hemorrhages
In the projection of the thyroid cartilage there is an old scar 4 cm long, corresponding to the scar after hemithyroidectomy
In the epigastric, umbilical and left hypochondriac regions there are scars up to 2 cm in diameter, corresponding to the laparoscopy
cadaveric spots situated on the back of the body, pale purple, turn pale when pressure

INTERNAL EXAMINATION

Heart
Size – 11х9х5 cm
Weight– 336 g
Wall thickness of the left ventricle 1.5 cm, right 0.3 cm.
Epicardium and pericardium are smooth, shiny, with moderate adipose tissue deposition
Heart valves are smooth, shiny, perimeter within normal limits
Myocardium is pale brown, foci of uneven blood supply. In the lateral wall of the left ventricle, a focus of irregular shape, dense, whitish colour, size -4x3x1 cm

Heart
Heart valves cusps are thin, translucent coronary arteries with whitish-yellow spots and stripes, as well as single smooth whitish yellow plaques, stenosing the lumen of the proximal parts of both coronary arteries by 25.
There is a stent in the right coronary artery.

Peritoneum
Visceral and parietal sheets of the peritoneum are dull, moist
On the surface there are multiple grey thread-like overlays.
Multiple nodules , gray-black on section, which have solid consistency with a diameter of 0.3 to 1.5 cm in the parietal and visceral sheets, merging in places into conglomerates up to 4 cm

Lungs
In the right pleural cavity - 200 ml, in the left - 700 ml of a clear yellowish liquid
The mucousa of the trachea and bronchi is pale pink
The airiness is increased in the upper lobes, with pressure, folds that do not expand for a long time remain
Pleura: thin, smooth, shiny, translucent
The lung tissue on the section is red, a large amount of foaming pinkish fluid flows from the cut, there are extensive hemorrhages in the lower lobes of the right and left lungs, mainly subpreleurally.

Lungs
Bronchi: protrude above the cut surface, their walls are thickened, dense, whitish
Hilar and paratracheal lymph nodes are gray-black on the cu, the maximum size of is 2x1x1 cm.

Large vessels
Aorta: intima of the thoracic and abdominal region with yellow plaques, fibrous plaques, up to 0.5 cm .
Pulmonary arteries: intima is smooth, ivory colour.
Large veins: liquid blood in the lumen

Gastrointestinal tract
Esophagus: mucousa is gray, with longitudinal foldings
Veins of the lower third are not dilated
Stomach: mucousa is pale gray, with foldedings, in the lumen there is a small amount of digested food
Small intestine:the loop of the small intestine in the upper third of the purple color, the intestinal wall, edematous, flabby consistency, the zone of demarcation inflammation is not clearly expressed. Section revialed a thrombus in the lumen of the branch of the superior mesenteric artery. rest of the mucous membrane is gray, smoothed, in the lumen there are liquid yellowish-brown masses.
Сolon: the mucous membrane is pale gray, folded, the lumen is filled with faeces.

Small intestine

Small intestine

Gastrointestinal tract
Liver. Size - 23х17х12х6 cm. Weight - 1045 g.
Cut section shows alternating red areas representing congested and dilated hepatic vein and paler areas of fatty change giving the appearance of Nutmeg kernel. There are white, single, rounded inclusions with a maximum diameter of 0.5 cm
Pancreas. Size - 13x4x2 cm, elastic consistency, in the cut - gray-pink, lobed sctructure

Brain
Size – 17х16х7 cm, weight – 1067 g.
Consistence: soft, flabby
The major vessels at the base of the brain have a usual anatomic distribution and there is no atherosclerosis.
The border between gray and white matter is preserved
The ventricles are not dilated, contain a transparent cerebrospinal fluid.

Kidneys
Size: left kidney - 10,5х5х3 cm, right kidney – 9,5x4x3 cm
Weight: left kidney - 100 g, right - 140 g
On the cross sectioning have dense consistency, a smooth surface

Kidneys
Dark, full-blooded pyramids, pale gray cortical substance.
Hemorrhage in the renal fascia on the right. In the right kidney there is a cyst with a diameter of 1 cm, with thin walls, filled with transparent liquid.
The mucous membrane of the renal pelvis is gray, smooth, dull, with vascular injection

Organs of the urogenital system
Bladder. The mucous membrane is grey, has foldings.
Uterus - 7x3x2cm, grey, has firm consistency, with is a cyst d=0.7 cm in the mucous membrane .
And a neoplasm, which has grey colour and a thick pedicle, size - 1x0.5x0.5 cm
Fallopian tubes and ovaries : are resected

Splin
Size - 11x8x3 cm
Weight - 112 gWith a smooth capsule Flabby consistency
Dark cherry colour on section
The character of pulp scraping is insignificant

Endocrine system
Thyroid. Size: the right lobe – 1,5x1x1 cm, the left lobe – is resected, elastic consistency, the surface is smooth, brown, on the cut - fine-grained, brown.
Adrenal glands. Leaf-shaped, the cortex is yellow, the medulla is brown.

Microscopic examination

Peritoneal lesions, H&E, х100

Peritoneal lesions, H&E, х200

Peritoneal lesions, H&E , х00

Peritoneal lesions, H&E , х400

Mesenteric lymph node, H&E , х400

Heart, H&E, х200

Heart, H&E, х400

Heart, H&E, х200

Infarction of the Intestine, H&E, х100

Lungs, H&E, х200

Lungs, H&E, х200

Lungs, H&E, х200

Lungs, H&E, х200

Hilar lymph node, H&E, х100

Brain, H&E, х200

Liver, H&E, х400, x200

Kidney, H&E, х400

Uterus, H&E, х200

Thyroid, H&E, х200

Final clinical diagnosis:
The underlying disease. Ovarian cancer T3N1M1, III A2: histologically - undifferentiated endometrioid adenocarcinoma RE4 +, HER 2-neu-negative. Carcinomatosis of the peritoneum. Ascites. Metastasis in S 10 of the right lung. 2 courses of PCT according to the RS scheme from July 2020 to September 2020.
Concomitant disease. Ischemic heart disease: angina pectoris II FC. Postinfarction cardiosclerosis from 2012 and 2018. RCA stenting in the distal region, aspiration of thrombi from the PTA RCA in the distal region from November 17, 2018
Background disease. Hypertension stage III, grade 3, risk of CVC 4.
Accompanying illnesses. D12.5 Sigmoid tubulovillous adenoma with moderate epithelial dysplasia.
Accompanying illnesses. Chronic pyelonephritis. Nodular goiter. Hypothyroidism Hemithyroidectomy on the left, resection of the right lobe of the vanilla from 2008. Arthrosis of both shoulder joints.
Complications. Acute pulmonary heart failure. Tumor intoxication. Mild anemia. Myocardial infarction type II. Thromboembolism of the branches of the pulmonary artery. Stress-induced erosion and stomach ulcers with possible development of gastrointestinal bleeding. Bilateral hydrothorax. Pulmonary edema. Cerebral edema. Resuscitation measures. Indirect cardiac massage

Pathological diagnosis (primary):
The underlying disease. Ovarian cancer with parietal and visceral peritoneum carcinomatosis, liver metastases Operation of laparoscopic bilateral adnexectomy (date unknown). 2 courses of polychemotherapy from 08.2020. pTxN1M1.
Complications. Thrombosis of the branch of the superior mesenteric artery. Wet gangrene of the loop of the small intestine. Fibrinous peritonitis. Shock of mixed etiology. Hemorrhagic syndrome: multiple petechial hemorrhages on the skin, parietal and visceral peritoneum; imbibition with blood of the lower lobes of both lungs. Fatty degeneration of the liver and myocardium. Shock kidneys. Ascites (3000 ml). Bilateral hydrothorax (700 ml in the left pleural cavity, 200 ml in the right pleural cavity). Pulmonary edema. Cerebral edema.
Resuscitation measures: chest compressions.

Accompanying illnesses. Chronic obstructive mucous bronchitis. Diffuse reticular pneumosclerosis. Chronic obstructive pulmonary emphysema. Large focal cardiosclerosis in the lateral wall of the left ventricle. Atherosclerosis of the aorta (fat spots and stripes), coronary arteries of the heart (fat spots and stripes). Operations of stenting of the right coronary artery in the distal part, aspiration of blood clots from the posterior lateral branch of the right coronary artery, stenting of the posterior lateral branch of the right coronary artery in the distal part, 11/17/2018 (clinically). Nodular goiter (clinically). Operation of hemithyroidectomy on the left, resection of the right lobe of the thyroid gland (2008). Endometrial polyp.
The clinical and pathological diagnoses coincided. Notes on patient management: the last blood test performed was dated 08/28/2020, the date of death was 09/15/2020.
The immediate cause of death is peritonitis.
Pathological diagnosis (primary):

CLINICOPATHOLOGIC CORRELATION
Patient N, 67 years old, suffered from ovarian cancer with carcinomatosis of the peritoneum and metastases to the liver for a long time, the patient underwent bilateral laparoscopic adnexectomy (at autopsy: both fallopian tubes and both ovaries were absent, on the anterior abdominal wall there were scars from laparoscopic access). The patient developed tumor coagulopathy, manifested by thrombosis of the coronary arteries of the heart in the distal regions, which led to the development of myocardial infarction and later - large-focal cardiosclerosis, as well as thrombosis of the superior mesenteric artery branch, complicated by moist gangrene of the loop of the small intestine and fibrinosis. The immediate cause of death is fibrinous peritonitis. The peculiarity of the case is a pronounced tumor coagulopathy, which led to the development of large-focal cardiosclerosis and intestinal gangrene.

Pathological diagnosis after histological examination:
.
The histological examination confirmed the pathological diagnosis. Clarified the nature of the focus in the liver - a focus of sclerosis with calcification.