HISTOPATH: POST-MORTEM EXAMINATION breakdown of the organelles within the cell that

Lectured by: Ms. Kristine Abegail Aninon have been expelled

CELLULAR DEATH The lysosomes
 Biological cell ceasing to carry out its functions  Nuclear changes
 All bodies undergo some degree of post-mortem change o Karyolysis
after death.  nuclear fading and chromatin
 Changes starts in the molecular level  microscopic  dissolution due to the action of the
gross morphology DNAse and RNAse
 With the persistent or excessive ___ of exposures in o Pyknosis
terms of cell death. Injured cells pass through the point of  Nuclear shrinkage
no return and undergo cell death  DNA condenses into shrunken
 Although there are no definitive or biochemical correlates basophilic mass
of irreversibility, it is consistently characterized by three  Nuclear fragmentation- pyknotic
phenomena: nuclear membrane ruptures and
o Inability to restore the mitochondrial function in nucleus undergo fragmentation
where the oxidative phosphorylation and ATP o Karyorrhexis
generation even after their resolution of the
original injury
o Alter structure and function of the plasma
membrane and intracellular membrane
o DNA damage and the lost of chromatin
structural integrity

Types of Cellular Death:

1. Apoptosis- programmed cell death
a. Regulated cell death because it is mediated by  Cytoplasmic changes
defined molecular pathways that are activated o Increased eosinophilia
under specific circumstances and deal with
surgical precision without inflammation or the Feature Necrosis Apoptosis
associated collateral damage Cell Size Enlarged Reduced
2. Necrobiosis- physiologic death (swelling) (shrinkage)
3. Necrosis- pathological death Nucleus Pyknosis  Fragmentation into
karyorrhexis  nucleosome-sized
a. Accidental cell death reflecting severe injuries
karyolysis fragments
that irreparably damages so many cellular
Plasma Membrane Disrupted Intact; may be
components that the cells simply fall apart. released in
b. When cells die by necrosis, there is a local apoptotic bodies
inflammatory response that clears the scene of Cellular contents Frequent No
the accident Adjacent Invariably Often physiologic
inflammation pathologic means of
Basic Morphologic Changes in Necrosis (culmination of eliminating
 Necrosis irreversible cell unwanted cells;
o focal death along with degradation of tissue by injury) may be pathologic
hydrolytic enzymes liberated by cells. It’s after some forms of
invariably accompanies by an inflammatory cell injury,
reaction. specifically DNA
o Cell death to lethal injury and protein
damage
o Unregulated and accidental form of cell death
caused by exogenous causes associated with
Types of Necrosis
damage to cell membranes and loss of ion
Necrosis is the death of body tissue and it occurs when
homeostasis
too little blood flows to the tissue and thus can be from injury,
o When the membranes are severely damaged,
radiation, and chemicals. It can also result from injury, illness,
lysosomal enzymes, which we describe under
disease, or lack of blood flow to tissues
waste disposal in cells, manage to escape and
destroy the cell from the inside causing
1. According to the location or extent
morphological changes known as necrosis
2. According to morphologic changes
o Cell organelles can escape through the broken
membrane and into the extracellular space
Types of Necrosis: According to morphologic changes
where they cause a host reaction
 Coagulative Necrosis
o necrosis associated to inflammation. The
o Underlying tissue architecture is preserved at
lysosomes of leukocytes summon as a result of
least for some time even though the constituent
the inflammatory responses then aid in the
cells are dead.
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 o Characteristic of hypoxia-induced cell death
caused most commonly by a loss of blood
supply, ischemia
o The resultant necrosis called infarction is also
seen in most solid organ such as the heart and
kidneys
o Most common type of necrosis caused by
irreversible focal injury
o Less often bacterial and chemical agents
o The organs commonly affected are: HEART,
KIDNEY, AND SPLEEN
o Foci of coagulative necrosis in the early stage
are:
 Pale
 Firm
 Slightly swollen
If with progression, they become more
yellowish, softer, and shrunken
o Pattern of microscopic changes results from two
processes which are:
 Denaturation of proteins
 Enzymatic digestion of the cell
 Liquefaction Necrosis
o It occurs commonly due to ischaemic injury and
bacterial or fungal infections
o It occurs due to degradation of tissue by the
action of powerful hydrolytic enzymes
o Examples: infarct brain and abscess cavity
o The dead cells are digested by the released
enzymes and this is seen from necrosis
resulting in bacterial and fungal infection.
o The affected area is soft with a liquefied center
containing necrotic debris. Later, a cyst wall is
formed
o The cystic space contains necrotic cell debris
and macrophages filled with phagocytosed
material
o The cyst wall is formed by proliferating
capillaries, inflammatory cells and gliosis in the
case of the brain and proliferating fibroblasts in
the case of the abscess cavity
 Gangrenous Necrosis
o The type of necrosis is usually coagulative due
to ischemia
o It is characterized by primarily inflammation
provoked by virulent bacteria
o Clinical term for the death of soft tissue and is
often applied to a limb that has lost its blood
supply and thus undergo coagulative necrosis
involving multiple tissue layers. It results form
ischemia
Types of Gangrenous Necrosis:
 Dry gangrene
a. if the dead tissue remains intact
b. the affected part is dry, shrunken and dark
black, resembling the foot
c. it is black due to the liberation of haemoglobin
from hemolysed red blood cells
 Wet gangrene
a. if the tissue liquefies as is common following the
superimposed bacterial infection
b. the affected part is soft, swollen, putrid, rotten,
and dark
 Gas gangrene
a. The affected area is swollen, edematous,
painful and crepitant due to the accumulation of
gas bubbles within the tissues
b. The affected tissue becomes dark black and foul
smelling
c. Microscopic: at the periphery, a zone of
leukocytic infiltration, edema, and congestion
are found
 Caseous Necrosis
o Found in the center of foci of tuberculosis
infections
o It combines features of both coagulative and
liquefactive necrosis
o It resembles dry cheese and is soft, granular,
and yellowish
o The necrosed foci are structureless,
eosinophilic and contain granular debris.
o The dead tissue breaks down creating a cheesy
consistency on gross-examination.
o Microscopically, the necrotic focus is a
collection of fragmented or lysed cells with an
amorphous, granular, pink appearance. Cellular
outline cannot be discerned and there is often a
peripheral collection of macrophages forming a
granuloma
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  Fat Necrosis
o Special form of cell death peculiar to fatty tissue
o These are ACUTE PANCREATIC NECROSIS
and TRAUMATIC FAT NECROSIS (breast)
o In the case of pancreas, there is liberation of
pancreatic lipase from injured or inflamed tissue
that results in necrosis of the pancreas
o Fat necrosis in either of the two instances
results in hydrolysis of neutral fat present in
adipose cells into glycerol and free fatty acid
o It appears as yellowish, white, and firm deposits.
The formation of calcium soaps imparts the
necrosed foci firmer and chalky white in
appearance
o Necrosed fossils have cloudy appearance and
are surrounded by an inflammatory reaction
o Refers to focal areas of fat destruction typically
resulting from the release if activated pancreatic
lipases into the substance of the pancreas and
the peritoneal cavity. This occurs in acute
pancreatitis
o Fatty acids are released in combine with
calcium to produce a grossly visible chalky white
areas which enable the surgeon and the
pathologist to identify the lesions.
o On histologic examination, the foci of the
necrosis contains shadowy outlines of necrotic
fat cells surrounded by basophilic calcium
deposits and inflammatory reaction
 Fibrinoid Necrosis
o Characterized by deposition of fibrin-like
material which has the staining properties of
fibrin
o It’s encountered in various examples of
immunologic tissues injury, arterioles in
hypertension, peptic ulcer, etc.
o Does not have any distinctive gross appearance
o Its characteristic microscopic findings seen
most commonly in immune reactions in which
complexes of antigens and antibodies and
extravasated plasma proteins are deposited in
the walls of the blood vessels where they have
a bright pink, amorphous appearance
reminiscent of a fibrin
o It is identified by brightly eosinophilic, hyaline-
like deposition in the vessel wall or on the
luminar surface of peptic ulcer
o The local hemorrhagic may occur due to the
rupture of these blood vessels.
SOMATIC DEATH
 Complete cessation of metabolic and functional activities
of organism
Primary changes:
 Circulatory failure- immediate death
o Cardiac function ceases evidenced by the
absence of pulse rate and heart rate
 Respiratory failure- absence of oxygen
o Accumulation of carbon dioxide with loss of
oxidative processes that is necessary for life
 Nervous failure- loss of reflexes
o Loss if coordination of all body functions
characterized chiefly by the loss of reflexes
 It is essentially characterized by three primary changes
characterized by the discontinuation of cardiac activity
and respiration and eventually it leads to death of all the
body cells by the lack of oxygen through approximately 6
minutes after somatic death
 A period referred to as clinical death is a person’s vital
organs have not been damaged may be revived.
However, achievements of a modern biotechnology have
enabled the physician to artificially maintain clinical
functions for indefinite period
Secondary changes: after death and observed during post-mortem
examination
 Algor mortis
o Algor- coldness; Mortis- death (coldness of
death)
o First demonstrable change observed: cooling of
the body
o “death chill” and it is marked by a steady decline
in body temperature and continuous until the
corpse reaches the ambient temperature or
matches the temperature of its surrounding
o Determining the correct time of death by way of
body temperature can be difficult due to the
stability or fluctuation of ambient temperature
o Temperature plateau- the thermal conductivity
of the surface of the corpse. Its high variable
period of time in which the body does not cool
 Rigor mortis
o Stiffening of the muscles
o The stiffness of the body during the phase of
rigor mortis is caused by build-up of lactic acid
which causes chemical changes within muscles.
o In life, lactic acid or milk acid plays various roles
in the body’s biochemical processes
o The myosin and actin, proteins involved in
muscle movement, then begin to harden
causing the muscles of the body to harden for a
period of time
o Begins within 2-6 hours of death
o Starting with the eyelids, neck and jaw before
spreading throughout the rest of the body over
the following 4-6 hours
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 o Sometimes, all of the hardening and contracting
of muscles can cause an involuntary post-
mortem ejaculation in a male corpse
o Factors affecting rigor mortis: age, nature of
death, muscular state, and atmospheric
condition
 Livor mortis
o Bluish color of death; hypostasis; darkening of
death; post-mortem staining
o Begins when circulation stops and blood
vessels become more permeable due to the
decomposition and blood settles through the
corpse
o Red blood cells, which are very dense, travel
and pull into the lowest areas possible staining
the tissue
o In hanging death, discoloration may be seen in
the feet, fingertips, and earlobes.
o There will be purplish discoloration or lividity of
the skin in the dependent portions of the body
due to the stasis and settling of blood in the
dependent vessels which usually delayed due to
the lost in muscle tone.
o The discoloration disappears under pressure
and reappears when pressure is released
o On incision, the oozing of the blood is observed
 Post-mortem clotting
o Occurs slowly, immediately after death
o In contrast to antemortem thrombi and post-
mortem thrombi that show definite settling and
separation of the red cells from the plasma
o This arise from blood clots within the vessels
after death and must be distinguished from
thrombosis
o Unlike thrombi post-mortem clots that are not
attached to the vessel wall and they have a
slimy surface
o Not attached to the endothelium and they are
gelatinous, rubbery, dark red, ____ in yellowish
elsewhere
 Desiccation
o Drying and wrinkling of cornea
AUTOPSY / Post-Mortem Examination
 Process of taking pieces of tissue from a dead person
o The post-mortem drying of mucous membrane
and delicate skin surfaces may result in
artifactual(?) changes in color or texture
o This desiccation process begins immediately
upon death and may progress rapidly in
normally moist mucous membranes
o Drying and wrinkling of the cornea and anterior
chamber of the eye due to the absorption of the
aqueous humor
 Putrefaction
o Production of foul-smelling gases
o Greenish blue discoloration
o Softening of the muscles
o Retraction of the cornea
o Loss of rigor mortis
o Peeling of the skin with crepitation
o It is brought on by the early effects of true
decomposition. It is the time that proteins begin
to be broken down by bacteria into smaller and
smaller elements until tissues are no longer
cohesive and most organs turn to liquid
o When the rotting of flesh becomes evident both
in appearance and smell.
o Before this stage, most of the excess gas build
up and is contained within internal organs while
they may be released through the same
avenues that they do in life.
o Putrefaction is where the body has softened to
the point that these gases begin seeping
through blood vessels and the body causing
severe bloating of the torso and the limbs
 Autolysis
o Cell-digestion of the cells
o Late post-mortem changes
o An intrinsic activity brought about by the
breakdown of cells and tissues of the human
body because of the constituents of the cells
o After death, the cell membranes break down
and release enzymes that start self-digestion
o Showing autolytic changes: GIT kidney liver
 brain  spleen  heart
o Skinny skeletal muscles appear more resistant
to autolysis
o Self-digestion of the cells by their own is
eventually undergone by tissues in the body
o The ______ bacteria which diffuse from their
intestinal location into the surrounding tissues
enhance the destruction of the cells
o Evokes no inflammatory or cellular response so
characteristic of the antemortem necrosis of the
cells with progressive desiccation, putrefaction
and autolysis will eventually produce total
digestion of the soft tissues
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  Purpose:
o Determine cause of death
o Investigate cause of death
o To preserve this tissue
 Medical examination of a dead body to determine the
exact cause of death and it is carried out by a pathologist
 Pre-requisite of autopsy procedure:
o Written consent
o Type of autopsy to be performed
o Apparatus or instruments needed
o Pathologist on duty

Types of Autopsy Other Techniques of Dissection

According to Purpose
1. Routine Hospital Autopsy
a. Done in private hospitals for ascertaining the
cause of death of the person especially if the
cause cannot be determined clinically or the
cause of death is problematic to the physician
2. Medico-Legal Autopsy / Forensic / Coroner’s
a. Done in NBI or other government institutions for
the purpose of prosecution
3. Anatomical or Academic
According to its Completeness of the Procedure/Technique
1. Partial
a. Autopsy request involving only the examination
of a region or regions of the body
b. Head only, thorax only, or abdomen only
2. Complete
a. The examination of the body from head to foot
for complete diagnosis and investigation
According to Manner of Incision or Opening the Cadaver
1. Y-Shaped Incision-Shoulder-Xiphoid-Pubis
a. The cadaver is opened from both shoulder
regions down to xiphoid area and down to the
pubis
b. Commonly done in adults and female
 Rudolf Virchow’s- one by one removal of the organs
o Method widely used often with some
modifications
o Originally, the first step is to expose the cranial
cavity, from the back, the spinal cord, thoracic
cavity, cervical cavity, and abdominal organs
 Anton Ghon’s- organs are removed by block
o Thoracic and cervical organs, abdominal organs
and the urogenital systems are removed as
organ block.
 M. Letulle’s- organs are removed “en masse”
o Thoracic, cervical, abdominal, and pelvic organs
are removed together subsequently dissected
into large organs
 Carl Rokitansky’s- In situ dissection + en bloc removal
Common Apparatuses or Instruments Needed During Autopsy
Procedures
 Bone marrow borer
 Electric saw for bones
 Different sizes and types of forceps
 Knives, scissors
 Sterile syringes and needles
 Culture medium
 Clean dry slide
 Alcohol lamp
 Spatula
 Specimen bottles with fixatives
 Weighing scale
 Surgical gloves
 Surgical masks

Normal Weight Organs

 Brain- 1300 grams
 Heart- 300 grams
 Kidney- 150 grams
2. Straight Cut Incision-Suprasternal-Pubis
 Liver- 1500 grams
a. The cadaver is opened from the middle of the
 Lungs- 550/450 grams
body from the suprasternal notch down to the
 Uterus- 50/100 grams
pubis
 Ovary- 10 grams
b. Commonly done in children and infants
 Prostate- 20 grams
 Pancreas- 100 grams
 Pituitary- 0.7 grams
 Spinal cord- 25 grams
 Spleen- 150 grams