jiafm, 2010-32(2) april-june. - forensic medicine

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ISSN 0971-0973 J Indian Acad Forensic Med, 32(2)Original research paperHisto-Pathology Examination in Medico-legal AutopsyPros & Cons*Dr. Akhilesh Pathak, ** Dr. H.M. MangalAbstractMedico legal autopsy examination is performed by the forensic expert with a view to searching primarilyfor the cause of death. It is performed on the instructions of legal authority in circumstances relating to suspicious,sudden, obscure, unnatural, litigious or criminal deaths and the information so derived, to be applied for legalpurpose to assist the course of justice. Medico legal autopsies differ in the purpose and procedure from pathologicalautopsies but sometimes they overlap with each other at various levels. Histopathology examination is commonlyasked by autopsy surgeon to establish the cause of death when he recognizes any morbid anatomical changes intissues and suspect that it may be the reason for cessation of vital functions of deceased. During the period of threeyears from 2005-2007, a retrospective study was conducted at PDU Medical College, Rajkot to know weatherroutine histo-pathological examination is essential in medico legal autopsies or it is creating only an extra burdenover the pathologists, autopsy surgeon and law enforcing agencies in any way.Key Words: - Autopsy, Histopathology, Cause of death, MedicolegalIntroduction:An Autopsy, literally meaning self study ofa dead body, is carried out for clinical as well asmedico-legal purposes. Clinical autopsy, looselytermed as pathological autopsy, is carried out todiagnose the disease which has caused the mortalitywhen ante-mortem efforts have failed. Many a timesclinical autopsy is done despite the cause of deathhaving been established ante mortem, to study thedisease process in situ, thus enriching medicalknowledge. Medico-legal autopsy is performed withthe aim of providing answers to questions about theidentity, cause of death, time of death, circumstancesof death, etc. thus helping the law enforcing agenciesto solve the crime.Although the procedure of both theautopsies is same, they differ from each other inmany aspects. Usually the clinical autopsy isperformed by the pathologist and Medico-legalautopsy by a Forensic expert._______________________________________Corresponding Author:Dr. Akhilesh Pathak*Associate Professor,Forensic Medicine Department, Govt. MedicalCollege,Vadodara. (Gujarat)E-mail: dr.akhilesh_pathak@yahoo.co.in** Professor, Forensic Medicine Department,PDU Medical College, RajkotHowever on occasions, especially in ArmedForces Medical Services (AFMS) setup and inMalaysia, the pathologist may have to perform aMedico-legal autopsy. On the other hand an autopsystarted as Medico-legal autopsy by a forensic expertmay turn out to be a purely clinical autopsy, e.g. incases of sudden death [1].Forensic histopathology is a very importantbranch of Forensic Medicine. It deals with themicroscopic analysis of various changes atcellular/tissue level throwing light on cause of death,solving a crime mystery. It is microscopic study oftissues of the deceased. To be complete histopathologist,one has to be competent in handlingmicroscopes and histo-techniques [2].The utility of histopathological findings indeath due to electrocution and poisoning has beenreported by various authors[3,4,5] while the otherauthors[6,7] believe that histopathologicalexamination is not of much useful modality in casesof medicolegal postmortem examination. Gupta et al[6] and Jani et al [7] have reported in their studiesthat histopathology examination in postmortemexamination should be used in a manner which ismore rational and not defensive. Mollina et al [8]have reviewed brain, heart, and liver, kidney, andlung sections on 189 routine forensic cases andcompared the results to the gross anatomic findings.They have also reported almost same conclusion inher study in which microscopic examination affectedthe cause of death in only 1 case out of 189 studiedcases, while in no case the manner of death wasaffected by it.128
J Indian Acad Forensic Med, 32(2) ISSN 0971-0973Material and Method:Rajkot is a district in Gujarat withpopulation of 10 lakes as per 1991 census in an areaof 13,582 Sq. Km. We have conducted aretrospective study in the Department of ForensicMedicine, P.D.U. Medical College Rajkot, during theperiod of 3 years from 1 st January 2005 to 31 stDecember 2007. All cases of autopsy, in which histopathologyexamination was requested, were selectedfor the present study and routine viscera werepreserved for histo-pathology examination in 10%formalin solution, which were sent to pathologydepartment of same institute for further proceedings.We reviewed the histo-pathological findingsof five major organs e.g. Brain, Heart, Lungs, Liver,Kidneys and compared the results with grossanatomical findings observed during post-mortemexamination. We tried to find out whether histopathologyexamination is affecting the cause of deathand legal status of the case in any way or it can beavoided in routine autopsy examination. Thecomparison was carried out with other such similartypes of studies (Indian and foreign authors) andfruitful conclusions were hence drawn.Results:Age and sex wise distribution of casesshows that the incidences were higher in 3 rd and 4 thdecades of life. Males were more prone to death bydiseases (63.33%) as compared to females (36.67%).Our study shows that in maximum cases thepathology was detected either in Cardio-VascularSystem (40% cases) or in Respiratory System (30%cases). The other systems were less commonlyinvolved as shown in Table-2. Table-3 shows thecomparative study of the pathological findingsobserved during autopsy examination and histopathologicalexamination.On comparison of these findings, congestionwas observed in maximum number of cases duringautopsy which was also noticed duringhistopathology examination in different ratio asshown in table three. Atherosclerosis with narrowingof coronary arteries was observed during autopsy in23.33% cases which was also confirmed byhistopathology in almost same number of cases(25.55%). Lungs edema was noticed during autopsyin 37.78% cases and confirmed by histopathology in33% cases.Tubercular changes in lungs were noticed in8.89% cases and confirmed by histopathology in13.33% cases. Pneumonic changes were observed inlungs during autopsy in 31.11% cases whileconfirmed by histopathology in only 24.44% cases.After conducting autopsy we could make out thecause of death in 82.22% cases by combining effectsof history, inquest papers and postmortemexamination, while in 17.78% cases the cause ofdeath could not be revealed by all efforts. In all thesecases the sample of routine viscera were sent for thehisto-pathology examination.After receiving the histopathologyexamination report no discrepancy was foundregarding the cause of death in 94.44% while in only5.56% cases it was found. Table-5 shows the effect ofhisto-pathology examination on legal status of thecase. It shows that even after receiving the histopathologyexamination report, the legal status of allautopsy cases weather it was Natural or UN-Natural,remained same as it was during the autopsyexamination.Discussion:Medicolegal autopsies are commonlyconducted in cases of sudden and unexpected deathsprimarily to establish the cause of death in caseswhere such deaths have occurred in apparentlyhealthy individuals under suspicious circumstances.The outcome may quite often reveal some naturaldisease, the presence of which may trigger issues likeassociation of the disease with trauma, work, crimeetc. and its relative contribution towards death [9].About 1800-1900 postmortems per year aregoing on in Mortuary of P. D. U. Medical College,Rajkot. During the span of 3 years (2005-2007)histopathology examination was requested byautopsy surgeon in total 90 cases and all these caseswere selected for the present study. Age and sex wisedistribution of cases show that the incidences werehigher in Males as compared to female during 3 rd and4 th decades of life, similar to others [6,7]. Inmaximum cases major pathology was detected eitherin Cardio-Vascular System (40% cases) or inRespiratory System (30% cases) as compared to othersystems, which was also mentioned by other authors[9, 10].We reviewed the histopathological findingsof five major viscera (Brain, Heart, Lungs, Liver andKidneys) and compared the results with grossanatomical findings of autopsy examination, whichshows that the morbid anatomical features observedin viscera during autopsy examination were alsonoticed in majority of the cases during histopathologyexamination. Table-4 shows that during autopsy wecould reveal the cause of death in 82.22% cases bycombining effects of history, inquest papers andpostmortem examination of the deceased while in17.78% cases the cause of death could not berevealed by all efforts during autopsy.Aftercomparison of histopathology report with grossfindings of autopsy no discrepancy was foundregarding the apparent cause of death in 94.44%while in only 5.56% cases some discrepancy wasfound.129
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