Background: Autopsies are done to know the identity, manner, cause of death and approximate time since death. The condition of internal organs can be revealed by Autopsy and is often followed by histopathological examination of tissues from various organs to relate the cause of death with associated pathology and the correlation between the two. The present study was taken to determine lung lesions in relation to age and sex and to identify the histopathological alterations spectrum in lung specimens, irrespective of cause of death and sex. Methods: This study was retrospective and done on 117cases of autopsies in last one year i.e August 2023 to July 2024. The tissue specimens were properly fixed and processed. Routine paraffin sectioning was done followed by staining with Hematoxylene and Eosin (H and E). Special stains were done whenever required. Clinical and postmortem findings, gross and histopathological examination findings were studied. Results: After thorough Histopathological examinations, of total 117 cases. Most commonly affected age group was 30-50 years, followed by age group of >60 years. Majority of diseased were males 83. The predominant finding was chronic venous congestion seen in 36 cases – 30.78% followed by pulmonary edema with 26 cases – 22.22% and changes in interstitium seen in 17 cases – 14.53%. Cause of death was known in 99 cases (84.62%) of pathological lesions. Poisoning, 41 cases (35.04%) was the most common followed by sudden death (11.11%) Conclusion: Autopsy is an important tool useful for identifying, recognizing pathology and pathogenesis of disease regardless of recent advances in diagnostic technology. Autopsy study reveals the true prevalence of infectious diseases and also suggests the need and emphasis of timely diagnosis and treatment of these diseases to reduce mortality due to these diseases.
Autopsies are done to know the identity, manner, cause of death and approximate time since death.[1] The condition of internal organs can be revealed by Autopsy and is often followed by histopathological examination of tissues from various organs to relate the cause of death with associated pathology and the correlation between the two. [2]
Lungs are one of the vital ingenuous organs in our body and participate in exchange of gases between inspired air and blood and which has dual supply of blood circulation. [3,4]
Lung diseases present with complex & variable clinical and radiological presentation which are nonspecific and inspite of advanced technology medically and scientifically some lesions like pneumonia & tuberculosis are undetectable during life time, hence prompt pathology investigations and diagnosis are essential to improve patient’s survival and reduce further morbidity and mortality. [5]
Pathological examination of autopsy specimen of lungs gives valuable information like hidden disease, stage of disease and improves clinical diagnosis in spite of modern technologies and helpful for conclusion of cause of death. [6]
The present study was taken to determine lung lesions in relation to age and sex and to identify the histopathological alterations spectrum in lung specimens, irrespective of cause of death and sex.
This is retrospective study conducted on post mortem lung specimens in Department of Pathology, Government Medical College, Srikakulam. Study period was from August 2023 to July 2024. All the autopsy lung specimens irrespective of age, sex and cause of death were included in the study and those which were autolysed were excluded from the study. Patient information regarding age, sex, brief history of illness, any medical/clinical findings/investigations, and in situ postmortem findings were obtained from the request form.
All specimens were adequately fixed in 10%formalin. Gross examination of lungs included size, weight, color, consistency, presence of consolidation, nodule, necrosis/infarction, fibrosis/scarring, edema, secretion, status of bronchi was recorded. Sections from representative areas were taken. After routine processing and paraffin embedding, section was cut and stained with H and E stain according to standard procedure. Special stains were used whenever required. All the histological sections were examined microscopically, and findings were noted.
Statistical analysis: Standard methods of statistical analysis were utilized appropriately. Chi- Square test and p-value were done. p-value< 0.001 was considered statistically significant. Excel software was used and results were demonstrated in the form of tables and graphs.
A total of 117 autopsy lung cases were received during the period of study along with relevant clinical details and autopsy findings. Histopathological examination was done in each case and significant microscopic finding were evaluated. Out of these, 83were males and 34 were females with Male: Female ratio of 2.4:1.
Median age of the cases was 40years with age range from 0 to 80 years. (Table 1) The majority of the lung samples belonged to autopsies carried out in adults between 30 to 40 years age group – 29.91%.
Table 1: Age wise distribution of cases.
|
AGE GROUP |
NO OF CASES |
Percentage |
|
0-10 |
3 |
2.57 |
|
10-20 |
9 |
7.69 |
|
20-30 |
23 |
19.66 |
|
30-40 |
35 |
29.91 |
|
40-50 |
10 |
8.55 |
|
50-60 |
9 |
7.69 |
|
60-70 |
18 |
15.38 |
|
70-80 |
10 |
8.55 |
|
Total |
117 |
100 |
The various Histopathological changes seen in autopsy lung specimens (Table 2) with wide varieties of microscopic findings were seen in lungs which included oedema and congestion, inflammation (acute, granulomatous), changes in interstitium, emphysema and acute respiratory distress syndrome (ARDS).
The predominant finding was chronic venous congestion(fig1) seen in 36 cases – 30.78% followed by pulmonary edema with 26 cases – 22.22%. These cases showed congested blood vessels and intra-alveolar haemorrhages, alveoli distended with protein rich fluid.
Another commonest pathology was changes in interstitium seen in 17 cases – 14.53%. There was broadening of inter- alveolar septae due to mononuclear infiltrate, interstitial fibrosis and increased alveolar macrophages in these cases. Two cases of granulomatous inflammation(fig2) were also seen in 2 cases. Caseous necrosis was present in these two cases and these were diagnosed to be suffering from pulmonary tuberculosis.
There were 15 cases having acute respiratory distress syndrome(fig3) which showed congestion, intra-alveolar oedema, inflammation, fibrin deposition. Few alveoli were lined by waxy hyaline membrane. (12.83%)
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