Expert: Claes-Gustaf Nordquist, M.D. - 3/6/2011

Question
My husband died unexpectedly at 58 y/o.Since it has been 2 years since his death, his heme/onc MD is finally going to meet with me. He was seen every month one year prior to his death for persistent leukocytosis (14,000). He had all the typical studies for leukemia. His DX was always probable myeloproliferative DO, unclassifiable.The plan was wait and see. I am (was) a Physician Assistant and was always doubtful of this DX.  From the beginning, his Lap score was high.  I think inflammatory process?? tests continue; neg.BCR-ABL,neg.Philadelphia chromosone,neg.clonal B cells, neg. aberrant phenotype on T cells.  Bone marrow suggests mild panhyperplasia with peripheral granulocytosis.  Again, I think Inflammatory state??? Cyto genetics revelas acquired trisomy 21. I came home from work to find him dead. Preliminary coroner's report: cerebral neoplasm, midline between anterior communicating arteries, SAH. 2 months later, final report states:diffuse SAH, a 1 cm. soft yellow, hemorrhagic tumor at midline.  Tumor is encircled by the anterior cummunicative cerebral vessels. A portion of the tumor is necrotic and hemorrhagic, undoubtedly leading to SAH. Cause of death: SAH due to large sacular aneurysm. I called the coroner for clarification.  He told me that he thought it was a tumor, but when he looked at it under the microscope, it was just blood vessels.  Asked why he repeatedly states "tumor" in his report, he replies that tumor means "bulging".  In my mind, this area had been oozing for some time, thus walling itself off. this caused an increase in leukocytes and mild left shift.  If inflammatory state had been  explored and worked up, maybe it would have been found.  I wouldn't think that a microscope would be needed to differentiate neoplasm from blood vessels.  I am interested in your opinion, because this is my one chance ask my questions and get everything resolved in my mind. May then I can move forward. Thank you for any insight that you would be willing to share with me.

Answer
Well all tumors are as you know not cancer. But I myself would hardly call a blood vessel aneurysm a tumor. To try to give you the best possible answer I need to read the pathology report from his autopsy by the coroner/medical examiner. You can copy it here. Your theory is interesting but I can not with certainty claim that it is correct. Maybe I can do more after I have read that report, but I can not promise that either. With such a vague clinical picture I think that the chance that his aneurysm would have been found in time probably is a rather small one even if your theory is correct. I'm also surprised that the pathologist did not think of an aneurysm already during his autopsy when such a typical bleeding was found in his brain. Sub arachnoidal hemorrhages (SAH) are normally caused by such burst aneurysms.


You can also reach me at: http://www.liveperson.com/professional/expert-profile.aspx?gsBMQvSJ0S4K1haAm6AtH
There is no limit to the number of questions there. Please note: NEW SITE!