We report a forensic autopsy case of brain germinoma in a 26-year-old man who was severely wasted and initially suspected of fatal neglect. He had a history of nocturnal wandering and was confined by his parents. Neuropathological examination showed germinoma in the hypothalamus and neurohypophysis. The cause of death was certified as hypothalamo-hypophyseal insufficiency due to germinoma. Because hypothalamic lesions may dysregulate feeding behavior and sleeping rhythms, germinoma was considered the causative lesion of the anorexic wasting and nocturnal wandering. Confinement was a preventive measure of the patient's wandering. The findings in this case indicated that hypothalamic tumors should be recognized as a cause of wasting in autopsies suspected of fatal neglect.
From the *Department of Legal Medicine, School of Medicine, Tokyo Women’s Medical University, Tokyo, Japan; the †Department of Pathology, Kurume University School of Medicine, Kurume, Japan; and the ‡Department of Forensic Medicine, Faculty of Medicine, Saga University, Saga, Japan.
Manuscript received May 4, 2007; accepted July 1, 2007.
Supported, in part, by a grant (16390195) from the Japan Society for the Promotion of Science (to K.K.).
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Reprints: Kazuhiko Kibayashi, MD, Department of Legal Medicine, School of Medicine, Tokyo Women’s Medical University, 8-1 Kawada, Shinjuku, Tokyo 162-8666, Japan. E-mail: firstname.lastname@example.org.