A 48-YEAR-OLD man presented at the hospital and described a 22.5-kg weight loss and progressive difficulty swallowing over the past 6 months. The following day, an esophageal biopsy showed squamous cell carcinoma. Radiographic studies indicated liver metastases. The tumor was judged to be inoperable and palliative treatment included placement of an esophageal endoprosthesis (a metallic metal mesh tube) and chemotherapy with fluorouracil and cisplatin. One week later the patient had an episode of major hematemesis and cardiopulmonary arrest that could not be reversed with resuscitation. It was apparent that the underlying cause of death was most likely esophageal squamous cell carcinoma, but the patient's physician requested an autopsy to determine the immediate cause of death and the cause of the terminal gastrointestinal hemorrhage, with special interest in evaluating whether death resulted from a mechanical complication of the stent or its placement.
Davis A, Fields A, Hill C, Hanzlick R, and the Autopsy Committee of the College of American Pathologists. Unavoidable Outcomes vs Misadventures. Arch Intern Med. 1999;159(7):646-647. doi:10.1001/archinte.159.7.646