Unsuspected Lung Pathology in Autopsies of Children with Cancer.

BACKGROUND

Although pulmonary involvement is common in patients with cancer, its frequency and nature is seldom reported in the medical literature.

OBJECTIVE

To determine the frequency and type of lung pathological conditions revealed by autopsy in children with cancer.

METHODS

All reports from autopsies performed in children with cancer from 1989 to 2012 in a pediatric hospital were reviewed.

RESULTS

In the analyzed period, 118 autopsies (10.2% of all autopsies) corresponded to children who died with cancer; 76 had complete information and were included in the analysis. Children were seen in the Hematology (41 cases) or the Oncology (35 cases) services. Their median age at decease was 7 years (range, 15 days to 16.1 years) and 46.1% were females. Main diagnoses were acute lymphoblastic (31 patients) or myeloblastic (10 patients) leukemias and tumors of the central nervous system (12 patients). A pathological respiratory condition was diagnosed antemortem in 31 (40.8%) patients, and at autopsy in 62 (81.6%) cases. Omitted diagnoses occurred in 58 (76.3%) children, being pneumonia (24 cases) and pulmonary hemorrhage (23 cases) the most frequent omissions. Nine patients had clinically unsuspected tumor infiltration or metastases.

CONCLUSIONS

In these children with cancer, more than 80% of autopsies revealed some lung pathology, mainly of infectious or hemorrhagic nature. Thus, pulmonary involvement should be investigated in all children with cancer in a timely and intentional manner.