T-cell lymphomas are a rare cause of sudden and unexpected death. Histologically, the differential diagnosis of lymphoma is both wide and complex. We report two cases of previously undiagnosed T-cell lymphoma and our approach to investigation. The first case was a 60-year-old male with a sudden witnessed cardiac arrest and unsuccessful cardiopulmonary resuscitation (CPR). The post-mortem examination demonstrated lymphadenopathy, hepatosplenomegaly (liver 2370 grams and spleen 2860 grams), and approximately 1200 mL haemoperitoneum with a splenic laceration. The overall histological and immunohistochemical pattern was suggestive of hepatosplenic T-cell lymphoma. The second case was a 30-year-old male, also, with a sudden witnessed cardiac arrest and unsuccessful CPR. The post-mortem examination demonstrated an anterior mediastinal mass (824 grams), hepatosplenomegaly (liver 2004 grams and spleen 713 grams), and approximately 1500 mL haemoperitoneum with a splenic laceration. The overall histological and immunohistochemical pattern was suggestive of T-cell lymphoblastic lymphoma. Key considerations for forensic pathologists in the assessment of T-cell lymphomas include distinguishing resuscitation artefact, mechanisms of death, and the ordering and interpretation of immunohistochemistry in the setting of prolonged post-mortem interval.
Hambly et al. (Sun,) studied this question.