BACKGROUND: Histopathological examination, although mostly limited to scenarios where the cause of death is not readily apparent during the autopsy, possesses substantial significance in medico-legal autopsies conducted by medical boards, as it provides essential insights into both the causation and circumstances contributing to death. Diverse viewpoints persist about how histopathology is utilized in the context of medico-legal autopsies. This study examines the significance of histopathology in elucidating particular causes of death in medico-legal autopsies conducted by a medical board of doctors, with a predominant proportion of cases of custodial deaths. MATERIALS AND METHODS: The study concentrated on examining medico-legal autopsies, which were conducted by a panel of doctors from April 2015 to March 2020 in the Department of Forensic Medicine and Toxicology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, that necessitated histopathological evaluation. Tissues were processed for histopathological examination in 177 (67.5%) cases during the five-year period among 262 medical board autopsies. The number of specimens obtained during each autopsy varied between one and six (mean = 03
mode = 02), resulting in a total of 511 specimens collected. The exhaustive analysis of various organs delineated in the initial autopsy documentation was contrasted with the histopathological findings articulated in the final report. Any discrepancies discovered were systematically classified, along with an organized categorization of differences between macroscopic and microscopic diagnoses and modifications to the ascertained cause of death following histopathological assessment. In situations where the cause of death remained unresolved during gross examination, the extent to which histopathological analysis contributed to the ultimate conclusions was evaluated concerning the detailed autopsy report. RESULTS: Pathological manifestations were predominantly detected within the gastrointestinal system. The most pronounced divergence between gross and histopathological assessments was identified in the specimens related to the cardiovascular system. The organ system that most frequently required microscopic examination to establish a conclusive diagnosis was the genitourinary system. The highest levels of concordance between macroscopic and microscopic evaluations were recorded within the nervous system. The definitive cause of death was either clarified or revised after microscopic evaluation in 33 (19.2%) cases, while the underlying indirect cause was clarified or altered in 7 (4.1%) cases. Histopathological findings corresponded with the established cause of death and provided additional insights in 65 (37.8%) cases, whereas they provided corroborative evidence in 66 (38.4%) cases. The pathological conditions frequently associated with altering the cause of death following histopathological evaluation encompassed pneumonia, tubular/interstitial nephritis, and pulmonary edema. CONCLUSIONS: Histopathology constitutes a pivotal element of medico-legal autopsies, yielding indispensable information on the cause of death while also functioning as an educational instrument. Nevertheless, its effectiveness may fluctuate depending on the specific circumstances and death classification, emphasizing the necessity for a careful case-by-case methodology.