Lung pathologies in autopsies at a tertiary care centre in india: a retrospective histological analysis

Background: Autopsy examination provides an opportunity to identify pulmonary abnormalities that may remain unsuspected during life and to characterise lesions that may not be apparent on gross examination. Pulmonary findings may also contribute to interpretation of the circumstances and cause of death. The present study examined the spectrum of pulmonary histopathological abnormalities encountered in medico-legal autopsies. Objective(s): To evaluate the spectrum and frequency of pulmonary histopathological lesions in medico-legal autopsy specimens and to describe their distribution according to age and sex, with assessment of clinicopathological correlation. Methods: A retrospective observational study was conducted in the Department of Pathology, Dr. S. N. Medical College and Associated Hospitals, Jodhpur, Rajasthan, India. Archived lung specimens from 350 medico-legal autopsies were evaluated. Tissue was routinely fixed in 10% neutral buffered formalin, processed for paraffin embedding, sectioned at 4–5 µm and stained with haematoxylin and eosin. Ziehl–Neelsen staining and selected immunohistochemistry were performed when required. Demographic details, cause of death, gross findings, microscopic lesions, final histopathological diagnoses and clinicopathological correlation were recorded. Age- and sex-wise distributions were assessed descriptively. Data were analysed using IBM SPSS Statistics version 29.0. Results: Among 350 cases, 191 (54.6%) were males and 159 (45.4%) were females; individuals aged >60 years constituted the largest age group [98 (28.0%)]. Poisoning was the most frequent recorded cause of death [113 (32.3%)], followed by coronary artery disease [93 (26.6%)] and trauma [82 (23.4%)]. Pulmonary oedema [157 (44.9%)] and congestion [136 (38.9%)] were the predominant microscopic findings, followed by diffuse alveolar damage [113 (32.3%)], hemosiderin-laden macrophages [104 (29.7%)] and haemorrhage [82 (23.4%)]. Pneumonia and aspiration pneumonia were each identified in 20 (5.7%) cases, tuberculosis and granulomatous inflammation in 11 (3.1%) cases each, silicosis in 3 (0.9%) and metastatic involvement in 2 (0.6%) cases. Clinicopathological correlation was documented in 17 (4.9%) cases. Age- and sex-wise distributions demonstrated variation across the spectrum of pulmonary diagnoses. Conclusions: Lung histopathology at medico-legal autopsy demonstrated a broad spectrum of pulmonary abnormalities, including common non-specific changes as well as infectious, chronic, occupational and neoplastic lesions. Systematic histopathological examination can provide additional diagnostic information and may identify unsuspected pulmonary disease. Findings should be interpreted in conjunction with the complete autopsy examination and circumstances of death.