Department of Forensic Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan; Tokyo Medical Examiner's Office, Tokyo, Japan.
Tokyo Medical Examiner's Office, Tokyo, Japan; Department of Forensic Medicine, Saitama Medical University, Saitama, Japan.
Leg Med (Tokyo). 2022 Sep;58:102079. doi: 10.1016/j.legalmed.2022.102079. Epub 2022 Apr 26.
Forensic pathologists often encounter autopsies that require an assessment of antemortem general conditions (e.g., infection, metabolic disorders). To establish evaluation clues for such cases, we quantitatively examined macrophages and the general pathology of bone marrow in samples from 180 forensic autopsy cases of decedents with various conditions. Hematoxylin-eosin staining, Berlin blue staining, and immunostainings for CD163, CD138, and CD61 were performed. We determined the numbers per field (density) of total macrophages, swollen macrophages, macrophages with hemophagocytosis, and hemosiderin-laden macrophages. Each density was standardized by identifying its ratio to the total number of macrophages. The decedents' background data (cause of death, other pathological findings, postmortem interval, antemortem symptoms, and presence of resuscitation) were extracted. No correlations were found between the postmortem interval and the other decedent data, indicating that these data are not affected by postmortem changes. In the group in which inflammatory disease was the cause of death, there were significant elevations in the ratio of the swollen macrophage density to total macrophages. Significantly higher ratios of the density of swollen and hemophagocytic macrophages were observed in the group in which conditions with a prolonged agonal period were the cause of death. The group with a return of spontaneous circulation to resuscitation showed a significantly higher ratio of macrophage density with hemophagocytosis. This study provides the first statistical analysis focused on bone marrow histopathology in forensic autopsies. The results will be useful for elucidating causes of death and agonal-period conditions.
法医病理学家经常遇到需要评估生前一般状况（例如感染、代谢紊乱）的解剖案例。为了为这类案例建立评估线索，我们对 180 例有各种情况的死亡法医解剖案例的骨髓样本中的巨噬细胞和一般病理学进行了定量检查。进行了苏木精-伊红染色、柏林蓝染色以及 CD163、CD138 和 CD61 的免疫染色。我们确定了总巨噬细胞、肿胀巨噬细胞、具有噬血细胞作用的巨噬细胞和含铁血黄素巨噬细胞的每个视野数量（密度）。通过确定其与总巨噬细胞数量的比例，将每个密度标准化。提取了死者的背景数据（死因、其他病理发现、死后间隔、生前症状和复苏存在）。死后间隔与其他死者数据之间没有相关性，表明这些数据不受死后变化的影响。在以炎症性疾病为死因的组中，肿胀巨噬细胞密度与总巨噬细胞的比例显着升高。在以濒死期延长为死因的组中，观察到肿胀和噬血细胞巨噬细胞密度的比例显着更高。在有自主循环恢复的复苏组中，具有噬血细胞作用的巨噬细胞密度的比例明显更高。这项研究提供了针对法医解剖中骨髓组织病理学的首次统计分析。研究结果将有助于阐明死因和濒死期情况。
