Forensic Science International: Reports (Jul 2021)
Glioblastoma multiforme masquerading as an intracerebral hemorrhage on postmortem computed tomography: Investigating a case of maternal death during pregnancy
Abstract
Glioblastoma multiforme (GBM) is the most common primary intracranial neoplasm. Although maternal mortality in Japan is among the lowest in the world, the main cause of maternal mortality is pregnancy-related intracranial hemorrhage. This case reports a 30-year-old female pregnant patient who suddenly died at 30 weeks of gestation. She had complained of headache from early stages during pregnancy and reported a headache and stiff neck starting two weeks before her death. Postmortem computed tomography revealed an intracerebral hematoma. The autopsy of the brain revealed severe swelling. The left frontal lobe contained a cavity filled with clear fluid, and a hematoma weighing 24 g. There was also widespread cerebral edema. The histological findings after evaluation of the cavity wall material were indicative of malignancy, and positive immunostaining for alpha thalassemia/mental retardation syndrome X-linked (ATRX), p53 and isocitrate dehydrogenase (IDH-1), was consistent with a diagnosis of GBM. There are studies that indicate pregnancy can promote the clinical and radiological advancement of glioma. The acceleration of tumor growth during pregnancy has been found to depend on several factors (e.g., hormonal factors, growth factors, and hemodynamic changes). Increased cardiac output and blood volume have been shown to promote the size of vascular tumors during pregnancy. Although headaches and neck stiffness are often considered pregnancy-related, this case highlights the importance of its prompt diagnosis, which can also save the fetus’ life. It also emphasizes the need for forensic pathologists to further evaluate intracerebral hematomas identified during investigations of maternal deaths during pregnancy.
