Role of Histopathological Examination in Medicolegal Autopsies in Unravelling Precise Causes of Mortality

Abstract

Introduction: Medicolegal autopsies are performed to determine the cause and manner of death. Histopathological examination is reserved for only those cases where Cause Of Death (COD) is not readily apparent on autopsy. However, there are conflicting views regarding the utility of histopathological examination in medicolegal cases. Aim: To examine the role of histopathological examination in unravelling specific causes of mortality in two settings: 1) where collaborative clinical history and gross autopsy findings were available; 2) where definitive cause could be discovered only at the time of microscopic examination, thus altering its legal implications. Materials and Methods: This was a retrospective observational study including all medicolegal autopsy cases, in which histopathological examination was requested and sample was received at the Pathology Department, Dr Baba Saheb Ambedkar Medical College, New Delhi, India. Since this was a retrospective study, the data was compiled from medicolegal cases received by the department in two years i.e., from January 2018 to December 2019. Histopathological examination was performed in 96 cases out of which 10 were excluded due to autolysis (n=86). Haemotoxilin and Eosin (H&E)-stained slides were examined and special stains and Immunohistochemistry (IHC) applied wherever required. Gross and histopathological findings were recorded along with autopsy findings and clinical history. The results were tabulated and statistical analysis was done using the Chi-square and Fischer’s test to look for any significance and association between gross and microscopic findings in various organs. The p-value of <0.05 was considered significant. Results: Histopathological examination was conclusive in ascertaining the specific COD in 30/86 cases (35%). These were categorised as pulmonary causes (27) including one case each of fat embolism and Amniotic Fluid Embolism (AFE) and cardiac causes (3). In 8 of these cases (9%), the cause was discovered only on microscopy in clinically and grossly unsuspected cases, which would have been missed otherwise if not submitted for histopathological examination. Conclusion: Histopathological examination is definitive in pointing towards the specific causes of death in considerable number of autopsies and can completely alter the legal implications.

Fatal rupture of hepatic adenomatosis: Autopsy case and review of the literature

“…In the presented case, histopathology was the most important and valuable means of diagnosing liver disease. Many incidental findings have been identified during a histopathological examination conducted in the setting of a medicolegal autopsy in the literature [27][28][29][30]. The medicolegal autopsy provides an opportunity for studying different patterns of silent disease, especially those that do not cause any functional derangement.…”