Natl. J. Physiol. Pharm. Pharmacol. (2025), Vol. 15(6): 308–313

Original Research

10.5455/NJPPP.2025.v15.i6.2

Histopathological findings in autopsy cases in a medical college: A cross-sectional study

Priyanka Jain¹, Anamika Nath², Kamal Kishore Chelleng¹ and Suraj Pegu¹

¹Department of Pathology, Tezpur Medical College and Hospital, Tezpur, India

²Department of Forensic Medicine and Toxicology, Tezpur Medical College and Hospital, Tezpur, India

*Corresponding Author: Anamika Nath. Department of Forensic Medicine and Toxicology, Tezpur Medical College and Hospital, India. Email: arachneliya [at] gmail.com

Submitted: 06/03/2025 Revised: 28/04/2025 Accepted: 06/05/2025 Published: 30/06/2025

---

Abstract

Background: Autopsies are essential for retrospective quality assessment of clinical diagnoses and medical education, providing insights into disease pathology and treatment efficacy. Despite advancements in diagnostic techniques, autopsies remain crucial for validating diagnoses and overlooked conditions.

Aim: This study explores the histopathological findings of autopsies at a tertiary care medical college in Northeastern India, highlighting prevalent diseases and demographic distributions.

Methods: This retrospective cross-sectional study analyzed 115 autopsy samples collected from April 2022 to April 2024 at a teaching hospital in Northeast India. Properly preserved samples were included. Ethical clearance was obtained, and data on patient history, socio-demographic details, and histopathological findings were collected. The variables analyzed included age, sex, gross evaluation, and histopathology. Data were expressed as frequencies and percentages, and the relationships between demographic variables and disease patterns were evaluated using the chisquare test with SPSS version 23.0.

Results: Of the 115 cases, 53.9% were male and 46.1% were female, with the highest frequency in the 21–30 years age group (27.8%). The most common liver pathology was steatosis (37.8%), followed by hepatitis (11.1%) and haemorrhage (8.9%). In the lungs, alveolar haemorrhage (43.2%) and pigment deposition (27%) were predominant. Acute tubular necrosis (75%) was the most common kidney finding, whereas the heart showed mostly unremarkable findings (86.7%). Cerebral oedema was the most common brain pathology (16.7%).

Conclusions: This study provides insights into the histopathological findings of autopsy cases in Northeast India. The results align with other regional and global studies, underscoring the importance of autopsies in understanding disease patterns and informing public health strategies. Further research is needed to confirm these findings and explore regional variations.

Keywords: Autopsy, Histopathology, Disease Patterns, Epidemiology.

---

Introduction

Autopsy has long been considered the “gold standard,” serving as the most crucial tool for retrospective quality assessment of clinical diagnoses and as a key educational resource, providing invaluable insights into disease pathology, treatment efficacy, and population health trends (Kuijpers et al., 2014; Buja et al., 2019; Nweke et al., 2022). Despite advances in diagnostic imaging and laboratory techniques, autopsies remain indispensable for validating antemortem diagnoses, identifying overlooked conditions, and contributing to medical education. Goal-directed autopsies remain essential for studying and evaluating disease processes and serve as a critical tool for quality assurance. Histopathological examinations of autopsies frequently reveal natural diseases, which may raise issues related to trauma, work, crime, and their relative contributions to death, especially in cases of sudden death (Sarvaiya et al., 2014; Subitha 2021; Sharmila et al., 2023). Medical colleges often serve as centers for autopsy examinations, facilitating research, training, and clinical practice. This cross-sectional study aimed to explore the histopathological findings of autopsy cases conducted at a tertiary care medical college in Northeastern India, elucidating prevalent diseases, demographic distributions, and implications for clinical practice and education.

---

Materials and Methods

Study design

This was a retrospective cross-sectional study. Study setting: This study included 115 samples that were sent for histopathological examination over a 2-year period from April 2022 to April 2024 in a teaching hospital in Northeast India.

Inclusion criteria

All samples from autopsied cadavers with proper labelling and those that were preserved properly were included in this study within the specified timeframe.

Exclusion criteria

We excluded samples from decomposed cadavers and those without proper labelling.

Ethical consideration

Ethical clearance was received from the Institutional Ethical Committee vide 2024/082/TMC&H, dated 22/06/2024. Free voluntary written consent was obtained from the next of kin of the study participants.

Study tools

History from a patient or their attendant, sociodemographic data, laboratory investigation reports, chemical examiner’s report on poisoning, and case sheets.

Study variables

For the demographic profile, the variables taken into consideration were age and sex. Age was categorized into age groups of 0–10, 11–20, 21–30, 31–40, 41–50, 51–60, 61–70, and above 71 years. Sex was categorized into male, female, and others. The gross evaluation included variables such as size, nature, consistency, external surface, cut section, inner surface, and suspicious area. Histopathology-related variables included the identification of tissue, any deviation from normal histomorphology, and any pathologic findings. The diagnosis was categorized according to disease type and organ system involvement.

Study procedure

After receiving the sample, in proper fixative, standard methods of grossing, histopathologic tissue processing, sectioning, and staining were followed as described by J D Bancroft and Marilyn Gamble (Bancroft and Gamble 2008). All routine sections and sections from grossly suspicious organ areas were obtained. After staining with conventional Hematoxylin and Eosin stain, sections were mounted in DPX and examined under a microscope.

Data analysis

Data are expressed as frequency, percentage, or mean. The relationship between the demographic variables and patterns of diseases was evaluated by the chi-square test using SPSS (Statistical Package for the Social Sciences) version 23.0 (Released 2015, IBM Corp, Armonk NY) software (IBM Corp 2015). As per requirements, these inferences were compared with other similar studies.

---

Results

A total of 115 autopsy cases were included in the analysis, comprising 53.9% male and 46.1% female individuals (Table 1) with a median age group of 21–30 years. The age-group distribution of the cases is presented in Table 2. Organ system-wise distribution with the percentage of cases showing predominant pathology is mentioned in Tables 3–12. The most common system involved and pathological findings were analyzed in Tables 3–12.

Table 1. Distribution of cases based on sex.

Table 2. Distribution of cases according to age group.

---

Discussion

Pathological autopsies are a well-established tool for both education and quality assurance (Moorchung et al., 2013; Ramos et al., 2021). Medicolegal autopsies are frequently performed in cases of sudden and unexpected deaths, primarily to determine the cause of death in seemingly healthy individuals under suspicious circumstances (Akilesh and Mangal 2007; Mukherjee et al., 2025; Shubhendu et al., 2025). Medicolegal autopsies and hospital autopsies differ not only in terms of purpose but also in procedural protocols. Molina et al. (2007) stated that in only 1 case there was a discrepancy in the cause of death after microscopical examination, and none in the manner of death, and believe that macroscopic examination is enough in the majority of the cases (Molina et al., 2007; Beer et al., 2023). In our study, we included cases in which the cause of death could not be determined after autopsy, and then organs/tissues were sent for histopathological examination.

In our study of 115 autopsy cases in Northeast India over the last 3 years, the majority of cases were male (53.9%), with females constituting 46.1% of the cases (Table 1). This male predominance is consistent with other studies conducted in India and globally, which also reported higher mortality rates and autopsy cases among males. For instance, a study in South India observed a similar male predominance with 61.2% male cases in their autopsy findings (Reddy et al., 2013). The age distribution of our cases showed the highest frequency in the 21–30 years age group (27.8%), followed by the 11–20 years age group (24.3%), and the 31–40 years age group (19.1%) (Table 2). This distribution indicates a higher number of autopsies in young adults, which may reflect the higher incidence of trauma and violence in this age group. Similar findings have been reported in other regions of India, where young adults constitute a significant proportion of autopsy cases. Globally, studies have reported a higher number of young adults in autopsy cases, which is soften attributed to accidents, violence, and substance abuse (Sharma et al., 2001; Värnik et al., 2008).

Table 3. Distribution of cases based on pathological findings in the Liver (total-45).

Fig. 1. Liver - Steatosis.

Table 4. Distribution of cases based on pathological findings in the lung(total -37).

Fig. 2. Lung - alveolar hemorrhage and pumlonary edema.

Table 5. Distribution of cases based on pathological findings in the Kidneys (total-32).

Fig. 3. Kidney-acute tubular necrosis.

In our study, the most common liver pathology was steatosis (37.8%), followed by hepatitis (11.1%) and hemorrhage (8.9%) (Table 3). The high prevalence of steatosis is consistent with other Indian studies, which reported non-alcoholic fatty liver disease as a common finding in autopsies, reflecting the rising prevalence of obesity and metabolic syndrome in the population (Sarin et al., 2020). Globally, steatosis is also a frequent finding in autopsy studies, particularly in developing countries where lifestyle diseases are prevalent (Starley et al., 2010). Alveolar was the most common lung pathology (43.2%), followed by pigment deposition (27%) and vascular congestion (16.2%) (Table 4). These findings are consistent with autopsy studies in other parts of India, where pulmonary and congestion are common findings, often associated with respiratory infections and tuberculosis (Nayak et al., 2018). Similar pulmonary findings are reported internationally, though the aetiology may vary depending on regional health issues (Bisschops et al., 2000). The kidneys showed acute tubular necrosis (75%) as the most common finding, with haemorrhage present in 31.3% of cases (Table 5). Acute tubular necrosis is frequently reported in autopsy studies worldwide, often related to systemic conditions, such as shock, sepsis, and drug toxicity (Malbrain et al., 2014; Basu et al., 2010). This finding aligns with global data, in which kidney pathologies often reflect underlying systemic diseases (Prasad and Singh 1998). In the heart, unremarkable findings were predominant (86.7%), with left ventricular hypertrophy (10%) and myocardial infarction (3.3%) being less frequent (Table 6). The low incidence of myocardial infarction in our study may be attributed to the younger age distribution of our cases. Studies from other parts of India and globally have shown higher incidences of coronary artery disease in autopsy findings, particularly in older populations (Biswas et al., 2007). Cerebral oedema was the most common finding in the brain (16.7%), with congestion, infarction, and autolysis accounting for 6.7% of cases (Table 7). These findings are in line with other studies in India, where cerebral edema is frequently reported in autopsies of individuals with head trauma and other acute conditions. Globally, cerebral oedema is also a common autopsy finding, particularly in cases of traumatic brain injury and stroke (Thurman et al., 1999).

Table 6. Distribution of cases based on pathological findings in the Heart (total-30).

Table 7. Distribution of cases based on pathological findings in the Brain (total-30).

Table 8. Distribution of cases based on pathological findings in the Spleen (total-20).

Fig. 4. Spleen–congestion.

Table 9. Distribution of cases based on pathological findings in the Uterus (total-17).

Fig. 5. Uterus - pregnancy.

Fig. 6. Polycystic kidney (Gross).

Table 10. Distribution of cases based on pathological findings in the Intestine (total-4).

Table 11. Distribution of cases based on pathological findings in thePancreas (total-2).

Table 12. Distribution of cases based on pathological findings in the gallbladder (total-1).

---

Conclusion

Our study provides valuable insights into the histopathological findings of autopsy cases in Northeast India. The sex and age distribution, as well as the prevalence of various pathologies, were largely consistent with other studies conducted in different regions of India and globally. These findings highlight the importance of autopsies for understanding disease patterns and causes of death, which can inform public health strategies and clinical practice. Further research with larger sample sizes and comprehensive data collection is needed to confirm these findings and explore regional variations in autopsy results.

---

Acknowledgment

We are thankful to our histopathology technicians and mortuary attendants for assisting us during the conduct of this research.

Conflict of interest

There are no conflicts of interest for this research work.

Funding statement

No funding has been received from any organization, individual, or party for this research.

Authors’ contribution

All the authors have significantly contributed in concept, study designing, data acquisition, data analysis, and writing of the manuscript.

Data availability

Data are available with the authors and can be retrieved as an when asked.

---

References

Akilesh, P. and Mangal, H.M. 2007. Histopathology examination in medico-legal autopsy pros and cons. J. Indian Acad. Forensic Med. 32(2), 128–131.

Bancroft, J.D. and Gamble, M. 2008. Histopathologic tissue processing, sectioning, and staining. 7th ed. Philadelphia, PA: Churchill Livingstone, 2008.

Basu, G., Mansukhani, R., Ghosh, A., Mohapatra, S. and Pahari, H. 2010. Acute kidney injury in India: a perspective. Nephrology (Carlton) 15(5), 456–461.

Beer, T., Bäckström, B., Ottosson, A. and Byard, R.W. 2023. The utility of histology in assessing the cause of death in medico-legal autopsies in selected trauma deaths: suspension, immersion, fire, and traffic-related. J. Forensic Sci. 68(2), 509–517; doi: 10.1111/1556-4029.15193

Bisschops, R., Teunissen, C., van Heerde, P., Aerts, J., van Leeuwen, J., van Dieijen-Visser, M. 2000. The pathology of pulmonary complications of bone marrow transplantation. Histopathology 37(5), 487–499.

Biswas, G., Saha, M. and Biswas, S. 2007. Pattern of fatal head injuries in north-eastern India. J. Indian Acad. Forensic Med. 29(2), 61–67.

Buja, L.M., Barth, R.F., Krueger, G.R., Brodsky, S.V. and Hunter, R.L. 2019. The importance of the autopsy in medicine: perspectives of pathology colleagues. Acad. Pathol. 6, 2374289519834041; doi: 10.1177/2374289519834041

IBM Corp. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp, 2015.

Kuijpers, C.C.H.J., Fronczek, J., Van de Goot, F.R.W., Niessen, H.W.M. and Van Diest, P.J., Jiwa, M. 2014. The value of autopsies in the era of high-tech medicine: discrepant findings persist. J. Clin. Pathol. 67(6), 512–9.

Malbrain, M.L., Marik, P.E., Witters, I., Cordemans, C., Kirkpatrick, A.W., Roberts, D.J. and Regenmortel, N. 2014. Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice. Anaesthesiol. Intensive Ther. 46(5), 361–380.

Molina, D.K., Wood, L.E. and Frost, R.F. 2007. Is routine histopathological examination beneficial in all medicolegal autopsies? Am. J. Forensic Med. Pathol. 28, 1–3.

Moorchung, N., Singh, V., Mishra, A., Patrikar, S., Kakkar, S. and Dutta, V. 2013. Is necropsy obsolete-an audit of the clinical autopsy over six decades: a study from Indian sub continent. Indian J. Pathol. Microbiol. 56(4), 372–377.

Mukherjee, B., Ropmay, A.D., Slong, D., Das, P., Patowary, A.J., Khonglah, Y. and Naidu Jr, L.R.V. 2025. Role of histopathology in determining the cause of death in medicolegal autopsies. Cureus 17(3), e81055; doi: 10.7759/cureus.81055

Nayak, V., Kotian, M.S., Neeta, S. and Sreejith, S. 2018. Pattern of histopathological lesions in lung autopsies of medicolegal cases. Indian J. Pathol. Microbiol. 61(3), 408–414.

Nweke, M.C., Omenai, S.A., Fatunla, E., Olusanya, A., Onakpoma, F., Ezenkwa, U.S., Salami, A.O., Abu-Okolo, C. and Ogun, G.O. 2022. The importance of the autopsy in ascertaining the cause of death and as an audit tool at the University College Hospital, Ibadan. Niger Postgrad. Med. J. 29(1), 43–50; doi: 10.4103/npmj.npmj_503_21

Prasad, K. and Singh, M.B. 1998. Autopsy proven coronary atherosclerosis in north-western India (Rajasthan). Indian Heart J. 50(5), 532–536.

Ramos, S.G., Ottaviani, G., Peres, L.C., Rattis, B.A.C., Leão, P.S., Akel, T.N. and Dias, E.P. 2021. Why should clinical autopsies continue to exist?. Diagnostics, 11(8), 1482; doi: 10.3390/diagnostics11081482

Reddy, S.S., Murty, O.P., Ugrappa, S., Kalyan, G.S., Raju, P.V.S., Reddy, C. 2013. Study of pattern of unnatural deaths in a medical college, Hyderabad. J. Forensic Med. Sci. Law. 22(1), 1–5.

Sarin, S.K., Kumar, M., Eslam, M., George, J., Al Mahtab, M., Akbar, S.M.F. and Chen, D.S. 2020. Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission. Lancet Gastroenterol. Hepatol. 5(2), 167–228.

Sarvaiya, A.N., Panjvani, S.I., Shah, N.R. and Shah, C.K. 2014. Incidental and interesting histopathological findings in medicolegal autopsies. Int. J. Sci. Res. 3(1), 372–734.

Sharmila, G., Charles, D.P. and Uma, V. 2023. Interesting and incidental insights of pathological autopsy in a tertiary care hospital. Int. J. Pharm. Clin. Res. 15(11), 1122–1132.

Sharma, B.R., Harish, D., Sharma, A. and Vij, K. 2001. Road-traffic accidents—a demographic and topographic analysis. Med. Sci. Law. 41(3), 266–274.

Shubhendu, K., Mundri, S., Kumar, S. and Kumar, A. 2025. The impact of histopathology on medical board autopsies. Cureus. 17(2), e78675; doi: 10.7759/cureus.78675

Subitha, K. 2021. Incidental and interesting pathologies diagnosed at autopsy – a case series. Saudi J. Pathol. Microbiol. 6(7), 240–245.

Starley, B.Q., Calcagno, C.J., Harrison, S.A. 2010. Nonalcoholic fatty liver disease and hepatocellular carcinoma: a weighty connection. Hepatology 51(5), 1820–1832.

Thurman, D.J., Alverson, C., Dunn, K.A., Guerrero, J. and Sniezek, J.E. 1999. Traumatic brain injury in the United States: a public health perspective. J. Head Trauma Rehabil. 14(6), 602–615.

Värnik, A., Kõlves, K., van der Feltz-Cornelis, C.M., Marusic, A., Oskarsson, H., Palmer, A. and Hegerl, U. 2008. Suicide methods in Europe: a gender-specific analysis of countries participating in the “European Alliance Against Depression”. J Epidemiol and Community Health 62(6), 545–551.