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The Importance of Histological Evaluation in Death Investigation: Two Cases of Fatal Proximal Airway Masses

Lochmuller, Christopher M. MD

American Journal of Forensic Medicine & Pathology: September 2011 - Volume 32 - Issue 3 - pp 266-268
doi: 10.1097/PAF.0b013e3182186f22
Original Articles

A recent prospective study published in the American Journal of Forensic Medicine and Pathology concluded that routine histopathologic examination lacked value. We disagreed with this assertion as we have found routine microscopic examination to be fruitful by documenting gross findings and by revealing interesting and unexpected findings.

We designed a retrospective study to determine the benefit and cost of routine histopathologic examination at our institution. Forensic autopsy cases from January 2004 through June 2007 with lethal gross findings were reviewed to determine the number of cases in which microscopic examination provided the definitive cause of death. Cost was based on the average number of hematoxylin-eosin-stained slides per autopsy.

One case was found in which the microscopic findings determined the correct cause of death despite compelling history and the initial impression from the autopsy findings. The cost of routine histopathologic examination during this period was approximately $39,000.

We conclude that routine histopathologic examination has value. Despite having a low yield, the information it provides is nonetheless important, and its cost is not prohibitive. Furthermore, there are benefits gained from routine microscopic examination as exemplified in the 2 case reports presented in this article.

From the Department of Pathology, The University of Tennessee Graduate School of Medicine, Knoxville, TN.

Manuscript received March 31, 2008; accepted August 14, 2008.

The authors report no conflicts of interest.

Reprints: Christopher M. Lochmuller, MD, Department of Pathology, The University of Tennessee Graduate School of Medicine, 1924 Alcoa Higway, Knoxville, TN 37920. E-mail: Clochmuller@utmck.edu.

© 2011 by Lippincott Williams & Wilkins.