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Introduction

  • Reinhard B. Dettmeyer
Chapter

Abstract

The importance of histological and immunohistochemical investigations in the establishment of cause of death is undisputed. The same is also, and more particularly, true of forensic cause-of-death determination. One frequently sees rare and unusual causes of death in forensic practice, causes that are able to explain in particular the suddenness of death. Added to this are the histopathological findings that arise from the specific spectrum of causes of death in forensic medicine: alcohol- and drug-induced fatalities; a wide variety of intoxications; fatalities due to heat, cold, electricity, and gases; as well as fatalities due to the effects of trauma. The histopathological classification of findings and the potential for age estimation are of particular relevance. For example, the age of a pulmonary embolism, a myocardial infarction, a lung infection, or peritonitis can be equally as interesting as the age of skin wounds and other wounds. From the perspective of the expert appraiser, this enables questions to be answered relating to the onset and course of pathological changes. This is important, for example, in the case of homicides, fatal accidents in the home, and traffic accidents or in the context of claims of medical malpractice in which an alleged medical error is believed to have caused death. Occasionally, fatalities that are relevant from an insurance/legal perspective need to be investigated, e.g., following asbestos exposure or fatal accidents in the workplace. Forensic histopathology also helps to determine the postmortem interval and identify tissue types in individual cases. Finally, in the spectrum of natural causes of death, a number of possible fatal infections need to be considered, or basic histopathological research is required to make progress relating not only to establishing causes of death. An example here would be the diagnosis of sudden infant death syndrome (SIDS). Last but not least, forensic histopathological investigations also help to identify iatrogenic causes of findings, thus contributing to quality assurance in the interests of patient safety.

References

  1. Ambepitiya SGH, Michiue T, Bessho Y, Kamikodai Y, Ishikawa T, Maeda H (2010) An unusual presentation of thoracic aortic aneurysm rupturing into the esophagus: an autopsy case report. Forensic Sci Med Pathol 6:121–126CrossRefPubMedGoogle Scholar
  2. Banaschak S, Du Chesne A, Brinkmann B (2000) Multiple interchanging of tissue samples in cases of breast cancer. Forensic Sci Int 113:3–7CrossRefPubMedGoogle Scholar
  3. Bernardi FDC, Saldiva PHN, Mauad T (2005) Histological examination has a major impact on macroscopic necropsy diagnoses. J Clin Pathol 58:1261–1264CrossRefPubMedPubMedCentralGoogle Scholar
  4. Bird LM, Billmann GF, Lacro RV, Spicer RL, Jariwala LK, Hoyme HE, Zamora-Salinas R, Morris C, Viskochil D, Frikke MJ, Jones MC (1996) Sudden death in Williams syndrome: report of ten cases. J Pediatr 129:926–931CrossRefPubMedGoogle Scholar
  5. Bohnert M, Thierauf A, Große Perdekamp M, Böhm N (2003) Das Williams-Campbell-Syndrome—eine seltene Todesursache bei Neugeborenen. 19th spring meeting—Southern Region. German Society of Forensic Medicine, Heidelberg, Germany, 26–27 Feb 2003Google Scholar
  6. Brinkmann B (1999) Harmonisation of medico-legal autopsy rules. Int J Legal Med 113:1–14CrossRefPubMedGoogle Scholar
  7. Byard RW, Winskog C (2012) Histology in forensic practice: required or redundant? Forensic Sci Med Pathol 8:56–57CrossRefPubMedGoogle Scholar
  8. Byard RW (2014) Endobronchial/tracheal metastasis and sudden death. J Forensic Sci 59:1139–1141CrossRefPubMedGoogle Scholar
  9. Campobasso CP, Dell’Erba AS, Addante A, Zotti F, Marzullo A, Colona MF (2008) Sudden cardiac death and myocardial ischemia indicators. A comparative study of four immunohistochemical markers. Am J Forensic Med Pathol 29:154–161CrossRefPubMedGoogle Scholar
  10. Casewell MW, Philpott-Howard J (1983) Septicaemia from inadvertent intravenous administration of enteral feeds. J Hosp Infect 4:403–405CrossRefPubMedGoogle Scholar
  11. Cecchi R (2010) Estimating wound age: looking into the future. Int J Legal Med 124:523–536CrossRefPubMedGoogle Scholar
  12. Chan D, O’Donnell C, Parsons S (2017) Sudden cardiac death from aortoesophageal fistula: an autopsy case report of a rare complication of thoracic aortic aneurysm. Forensic Sci Med Pathol 13(4):504–507CrossRefPubMedGoogle Scholar
  13. Churg A (1982) Fiber counting and analysis in the diagnosis of asbestos-related disease. Hum Pathol 13:381–392CrossRefPubMedGoogle Scholar
  14. Cordner S (2012) Histology in forensic practice. Forensic Sci Med Pathol 8:71–72CrossRefGoogle Scholar
  15. de la Grandmaison GL, Charlier P, Durigon M (2010) Usefulness of systematic histological examination in routine forensic autopsy. J Forensic Sci 55:85–88CrossRefPubMedGoogle Scholar
  16. de Giorgio F, Vetrugo G (2014) Is histological examination always necessary to determine a cause of death? Of course it is! Forensic Sci Med Pathol 10:477–478CrossRefGoogle Scholar
  17. Davis GJ (2012) Histology in forensic practice. Forensic Sci Med Pathol 8:60–61CrossRefGoogle Scholar
  18. Dettmeyer R (2009) Unterlassene Aufklärung eines akuten Myokardinfarktes als Vergehen der fahrlässigen Tötung gemäß § 222 StGB. Anmerkung zum Urteil des AG Potsdam v. 12.03.2007—84 Ds 486 Js 6255/05. In: Dettmeyer R (ed) Rechtsreport, Rechtsmedizin, vol 19, pp 106–108Google Scholar
  19. Dean DE, Jamison JM, Lane JL (2014) Spontaneous rupture of the gall bladder: an unusual forensic diagnosis. J Forensic Sci 59:1142–1145CrossRefPubMedGoogle Scholar
  20. Dettmeyer R, Verhoff MA, Schütz H (2013) Forensic medicine: fundamentals and perspectives. Springer, Heidelberg Dordrecht London New YorkGoogle Scholar
  21. Dettmeyer R (2014) The role of histopathology in forensic practice: an overview. Forensic Sci Med Pathol 10:401–412CrossRefPubMedGoogle Scholar
  22. Dettmeyer R (2016) Histopathology. In: Payne-James J, Byard RW (eds) Encyclopedia of forensic and legal medicine, vol 3, 2nd edn, pp 35–46CrossRefGoogle Scholar
  23. Dettmeyer R, Madea B (1999) Rechtsmedizinische Gutachten in arztstrafrechtlichen Ermittlungs-verfahren. Medizinrecht 17:533–539CrossRefGoogle Scholar
  24. Dettmeyer R, Preuß J (2009) Medical malpractice charges in Germany—a survey. Legal Med 11:S132–S134CrossRefPubMedGoogle Scholar
  25. Dettmeyer R, Schmidt P, Grellner W, Madea B (1998) Postoperative urämische Epikarditis und Pneumonitis nach irrtümlicher Nephrektomie wegen eines Angiomyolipoms. Urologe [B] 38:370–373CrossRefGoogle Scholar
  26. Dettmeyer R, Schmidt P, Grellner W, Madea B (1999) Lethal transurethral resection syndrome (TUR-syndrome)—morphological and medicolegal aspects. Rechtsmedizin 10:39–42CrossRefGoogle Scholar
  27. Dettmeyer R, Drieverf F, Becker A, Wiestler OD, Madea B (2001) Fatal myeloencephalopathy due to accidental intrathecal vincristine administration: a report of two cases. Forensic Sci Int 122:60–64CrossRefPubMedGoogle Scholar
  28. Dettmeyer R, Preuß J, Madea B (2004) Malpractice—role of the forensic pathologist in Germany. Forensic Sci Int 144:265–267CrossRefPubMedGoogle Scholar
  29. Dettmeyer R, Egl M, Madea B (2005) Medical malpractice charges in Germany—role of the forensic pathologist in the preliminary criminal proceeding. J Forensic Sci 50:423–427CrossRefPubMedGoogle Scholar
  30. Dettmeyer R, Preuss J, Madea B (2006) Behandlungs-fehlervorwürfe nach Koronarangiographien. In: Kauert G, Mebs D, Schmidt P (eds) Kausalität—rechtsmedizinische, naturwissenschaftliche und juristische Beiträge. Festschrift für H-J, Bratzke, pp 67–76Google Scholar
  31. Duan Y, Liu L, Liu Y, Sunnassee A, Liu Q (2013) Sudden death due to lupus-induced pancarditis diagnosed after necropsy: a case report. Forensic Sci Int 232:e9–e11CrossRefPubMedGoogle Scholar
  32. Farkaš D, Špak L, Švajdler M, Iannaccone SF, Sihotsky V, Katuchová J, Ginelliová A (2015) Traumatic pseudoaneurysm of descendent thoracic aorta solved by aortal stent graft repair followed by development of fatal aortoesophageal fistula. Soud Lek 60:46–50PubMedGoogle Scholar
  33. Fattouh M, Buschmann CT, Thamm OC, Sperhake JP, Püschel K, Tsokos M (2015) Pressure ulcers and wound healing. Immunohistochemical analysis of leucocyte and endothelial adhesion molecules. Rechtsmedizin 25:299–308CrossRefGoogle Scholar
  34. Fechner G, Du Chesne A, Ortmann C, Brinkmann B (2002) Death due to intravenous application of enteral feed. Int J Legal Med 116:354–356PubMedGoogle Scholar
  35. Ferrara SD, Bajanowski T, Cecchi R, Snenghi R, Case C, Viel G (2010) Bio-medical guidelines and protocols: survey and future perspectives in Europe. Int J Legal Med 124:345–350CrossRefPubMedGoogle Scholar
  36. Fineschi V, Neri M, Di Donato S, Pomara C, Riezzo I, Turillazi E (2006) An immunohistochemical study in a fatality due to ovarian hyperstimulation syndrome. Int J Legal Med 120:293–299CrossRefPubMedGoogle Scholar
  37. Fronczek J, Hollingbury F, Biggs M, Rutty G (2014) The role of histology in forensic autopsies: is histological examination always necessary to determine a cause of death? Forensic Sci Med Pathol 10:39–43CrossRefPubMedGoogle Scholar
  38. Goel CM, Badenoch DF, Fowler CG, Blandy JP (1992) Transurethral resection syndrome. Eur Urol 21:15–17CrossRefPubMedGoogle Scholar
  39. Gupta P, Tobias JD, Goyal S, Miller MD, Melendez E, Noviski N, De Moor MM, Mehta V (2010) Sudden cardiac death under anesthesia in pediatric patient with Williams syndrome: a case report and review of literature. Ann Card Anaesth 13:44–48CrossRefPubMedGoogle Scholar
  40. Hadžisejdić I, Mustać E, Krstulja M, Franjić N, Štimac D (2012) Thoracic aortic aneurysm rupture into the esophagus. Forensic Sci Med Pathol 8:327–329CrossRefPubMedGoogle Scholar
  41. Hecht L, Lamprecht A (2010) Intramuscular administration of extended release drugs. Uncommon histological finding at autopsy. Rechtsmedizin 20:510–514CrossRefGoogle Scholar
  42. Hinderberger P, Fliss B, Thali MJ, Schweitzer W (2017) Fatal bronchovascular fistula after lobectomy visualized through postmortem computed tomography angiography: a case report. Forensic Sci Med Pathol 13:234–239CrossRefPubMedGoogle Scholar
  43. Hunsaker JC (2012) Histology in forensic practice. Forensic Sci Med Pathol 8:66–68CrossRefGoogle Scholar
  44. Janssen W (1988) Morphologische Untersuchungen in der Rechtspflege—Anspruch und Wirklichkeit. Z Rechtsmed 100:5–17CrossRefPubMedGoogle Scholar
  45. Klintschar M, Bilkenroth U, Arslan-Kirchner M, Schmidke J, Stiller D (2009) Marfan syndrome: clinical consequences resulting from medicolegal autopsy of a case of sudden death due to aortic rupture. Int J Legal Med 123:55–58CrossRefPubMedGoogle Scholar
  46. Kondo T (2007) Timing of skin wounds. Legal Med 9:109–114CrossRefPubMedGoogle Scholar
  47. Krous HF, Wahl C, Chadwick AE (2008) Sudden unexpected death in a toddler with Williams syndrome. Forensic Sci Med Pathol 4:240–250CrossRefPubMedGoogle Scholar
  48. Langlois NF (2006) The use of histology in 638 coronial post-mortem examinations of adults: an audit. Med Sci Law 46:310–320CrossRefPubMedGoogle Scholar
  49. Lau G (2012) Histology in forensic practice. Forensic Sci Med Pathol 8:58–59CrossRefGoogle Scholar
  50. Luchini D, Meacci F, Oggioni MR, Morabito G, D’Amato V, Gabbrielli M, Pozzi G (2008) Molecular detection of Leptospira interrogans in human tissues and environmental samples in a lethal case of leptospirosis. Int J Legal Med 122:229–233CrossRefPubMedGoogle Scholar
  51. Madadin M, Molah R, Cordner S (2017) Autopsy histopathology where the prosector is not a histopathologist: a proposal. Forensic Sci Med Pathol 13:383–387CrossRefPubMedGoogle Scholar
  52. Maeda H, Zhu B, Ishikawa T, Michiue T (2010) Forensic molecular pathology of violent deaths. Forensic Sci Int 203:83–92CrossRefPubMedGoogle Scholar
  53. Molina DK, Wood LE, Frost RE (2007) Is routine histopathologic examination beneficial in all medicolegal autopsies? Am J Forensic Med Pathol 28:1–3CrossRefPubMedGoogle Scholar
  54. National Association of Medical Examiners (2006) Forensic autopsy performance standards. Am J Forensic Med Pathol 27:200–225CrossRefGoogle Scholar
  55. Nogami M, Takatsu A, Endo N, Ishiyama I (2000) Immunohistochemical localization of P-selectin in the glomeruli from forensic autopsies. Legal Med 2:21–25CrossRefPubMedGoogle Scholar
  56. Ondruschka B, Habeck JO, Hädrich C, Dreßler J, Bayer R (2016) Rare cause of natural death in forensic setting: hemophagocytic syndrome. Int J Legal Med 130:777–781CrossRefPubMedGoogle Scholar
  57. Platt MS, Kohler LJ, Ruiz R, Cohle SD, Ravichandran P (2002) Deaths associated with liposuction: case reports and review of the literature. J Forensic Sci 47:205–207CrossRefPubMedGoogle Scholar
  58. Podduturi V, Guileyardo JM (2015) Sickle cell trait as a contributory cause of death in natural disease. J Forensic Sci 60:807–811CrossRefPubMedGoogle Scholar
  59. Pomara C, D’Errico S, Riezzo I, de Cillis GP, Fineschi V (2005) Sudden cardiac death in a child affected by Prader-Willi syndrome. Int J Legal Med 119:153–157CrossRefPubMedGoogle Scholar
  60. Pollanen MS (2012) Histology in forensic practice. Forensic Sci Med Pathol 8:69–70CrossRefGoogle Scholar
  61. Randall BB, Fierro MF, Froede RS (1998) Practice guidelines for forensic pathology. Arch Pathol Lab Med 122:1056–1064PubMedGoogle Scholar
  62. Roll P, Beham A, Beham-Schmid C (2009) Post-mortem histopathological investigation of the bone marrow in forensic medicine: an important issue for both the forensic and clinical pathologist. Forensic Sci Int 186:e17–e20CrossRefPubMedGoogle Scholar
  63. Roulson J, Benbow EW, Hasleton PS (2005) Discrepancies between clinical and autopsy diagnosis and the value of post mortem histology: a meta-analysis and review. Histopathology 47:551–559CrossRefPubMedGoogle Scholar
  64. Schmidt P, Dettmeyer R, Madea B (2001) Septisch-toxischer Schock nach Liposuktion. Rechtsmedizin 11:275–279CrossRefGoogle Scholar
  65. Schmidt P, Dettmeyer R, Madea B (2002) Commentary on: Platt MS, Kohler LJ, Ruiz R, Cohle SD, Ravichandran P. Deaths associated with liposuction: case reports and review of the literature. J Forensic Sci 47:205–207Google Scholar
  66. Sheriff FE, Bridges LR, Sivaloganathan S (1994) Early detection of axonal injury after human head trauma using immunocytochemistry for beta-amyloid precursor protein. Acta Neuropathol 87:55–62CrossRefGoogle Scholar
  67. Stellato TA, Danziger LH, Nearman HS, Creger RJ (1984) Inadvertent intravenous administration of enteral diet. J Parenter Enteral Nur 13:453–455CrossRefGoogle Scholar
  68. Suárez-Mier MP, Morentin B (1999) Supravalvular aortic stenosis. Williams syndrome and sudden death. A case report. Forensic Sci Int 106:45–53CrossRefPubMedGoogle Scholar
  69. Tong F, Liang Y, Zhang L, Li W, Chen P, Duan Y, Zhou Y (2016) Fatal liver cyst rupture in polycystic liver disease complicated with autosomal dominant polycystic kidney disease: a case report. Forensic Sci Int 262:e5–e8CrossRefPubMedGoogle Scholar
  70. Tsokos M, Delling G, Lockemann U, Heinemann A, Püschel K (2000) Incidence and extent of osteomyelitis in advanced grade pressure sores—a histomorphological analysis following non-decalcified preparation of the Os sacrum. Rechtsmedizin 10:56–60CrossRefGoogle Scholar
  71. Türk EE, Tsokos M, Delling G (2003) Autopsy-based assessment of extent and type of osteomyelitis in advanced-grade sacral decubitus ulcers: a histopathologic study. Arch Pathol Lab Med 127:1599–1602PubMedGoogle Scholar
  72. Wang Q, Ishikawa T, Quan L, Zhao D, Li DR, Michiue T, Chen JH, Zhu BL, Maeda H (2009) Immunohistochemical distribution of basic fibroblast growth factor (bFGF) in medicolegal autopsy. Legal Med 11:S161–S164CrossRefPubMedGoogle Scholar
  73. Wessel A, Gravenhorst V, Buchhorn R, Gosch A, Partsch CJ, Pankau R (2004) Risk of sudden death in the Williams-Beuren syndrome. Am J Med Genet A 127A:234–237CrossRefPubMedGoogle Scholar
  74. Williams AS, Little DL, Herath J (2015) Sudden unexpected death as a result of primary aortoduodenal fistula identified with postmortem computed tomography. Forensic Sci Med Pathol 11:596–600CrossRefPubMedGoogle Scholar
  75. Woitowitz HJ, Manke J, Breit S, Brückel B, Rödelsperger K (1986) Asbest- und sonstige Mineralfasern in der menschlichen Lunge. Pathologe 7:248–257PubMedGoogle Scholar
  76. Zaitoun AM, Fernandez C (1998) The value of histological examination in the audit of hospital autopsies: a quantitative approach. Pathology 30:100–104CrossRefPubMedGoogle Scholar
  77. Zhu BL, Tanaka S, Ishikawa T, Zhao D, Li DR, Michiue T, Quan L, Maeda H (2008) Forensic pathological investigation of myocardial hypoxia-inducible factor-1alpha, erythropoietin and vascular endothelial growth factor in cardiac death. Legal Med 10:11–19CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Reinhard B. Dettmeyer
    • 1
  1. 1.University Hospital Giessen Institute of Forensic MedicineGiessenGermany

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