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Background/aims The aim of this study is to share autopsy findings of COVID-19-positive cases and autopsy algorithms for safely handling of suspicious bodies during this pandemic. Methods COVID-19-positive cases of Istanbul Morgue Department were retrospectively analyzed. Sampling indications for PCR tests in suspicious deaths, macroscopic and microscopic findings obtained in cases with positive PCR tests were evaluated. Results In the morgue department, 345(25.8%) of overall 1336 autopsy cases were tested for COVID-19. PCR test was found positive in 26 cases. Limited autopsy procedure was performed in 7 cases, while the cause of death was determined by external examination in the remaining 19 cases. Male-to-female ratio was found 3.3:1 and mean age was 60.0 ± 13.6 among all PCR-positive cases. Cause of death was determined as viral pneumonia in fully autopsied cases. Most common findings were sticky gelatinous fluid in cavities and firm and swollen lungs, varying degrees of consolidation. In microscopy, diffuse alveolar epithelial damage, type-II pneumocyte hyperplasia, hyaline membrane formation, fibrinous exudate, and fibrinous plaques in the alveoli were the most common findings. Conclusions In COVID-19 autopsies, pulmonary findings were found to be prominent and the main pathology was pneumonia. Older age and findings of chronic diseases indicate that the cases were in the multirisk group in terms of COVID-19 mortality.

Background/Aim: The most common cause of death in COVID-19 is acute respiratory distress syndrome. Diffuse alveolar damage is the histological characteristic and counterpart of acute respiratory distress syndrome. Histopathological findings, accompanied by immunohistochemical findings, can provide valuable information in the pathogenesis of Covid-19. We aimed to investigate the histopathological findings by supporting our results with immunohistochemical staining in SARS-CoV-2 positive autopsies.Methods: A total of 101 autopsy cases with positive postmortem SARS-CoV-2 rt-PCR tests between May 2020-May 2021 were investigated in this retrospective cohort study. Cases with negative postmortem swab samples on rt-PCR and those with severe autolysis were excluded from the study. Pathological changes in the lung were examined with hematoxylin and eosin-stained preparations. Immunohistochemical assay with pancytokeratin, TTF-1, IL-6, CD68, CD3, CD8, and antibodies against the SARS-CoV-2 nucleocapsid protein were also performed for further evaluation. Results: Diffuse alveolar damage findings were present in 58 (61.7%) out of 94 cases in our study. Seventeen (18.1%) showed findings compatible with the exudative phase, 37 (39.3%) were in the proliferative phase, and 4 (4.3%) were in the fibrotic phase of diffuse alveolar damage. Pulmonary perivascular lymphocytic infiltrates contained more CD3 (+) T lymphocytes than CD8 (+) T lymphocytes, immunohistochemically. Conclusion: The finding of more CD3 positive T lymphocytes than the CD8 positive T lymphocytes in the perivascular lymphocytic infiltrate correlates with the hypothesis of the direct destruction of CD8 (+) T lymphocytes or through impairment of cellular immunity by SARS-CoV-2 induced mediators. Detection of immunohistochemical staining with IL-6 in COVID-19 supports the cytokine storm mentioned in the previous studies and the role of IL-6 in cytokine storm in SARS-CoV-2 infection. The limited number of immunohistochemical studies on SARS-CoV-2 increases the importance of our study, which evaluates IL-6, CD3, and CD8 expressions at the tissue level. Autopsy research is important and contributes to the development of protective, diagnostic, and therapeutic modalities.

The vast majority of sudden and unexpected natural deaths are related to cardiovascular diseases, especially coronary artery diseases. In this study, we aimed to reveal the epidemiological differences between men and women and to investigate the most common pathologies that cause cardiac deaths. Five thousand seven hundred sixty-eight autopsy cases that were done in 2016 were reviewed for the autopsy information and histopathological findings. Of the 5768 autopsies performed, 866 were due to cardiac causes. Eight hundred thirty-two cases were reviewed due to lack of autopsy information in 34 cases. One hundred sixteen (13.9%) were female, and 716 (86.1%) were male. Coronary artery disease was detected in 760 of 832 cases. There were findings of acute or previous myocardial infarction in 595 (71.5%), perivascular and interstitial fibrosis in 159 (19.1%), myocardial rupture and tamponade in 31 (%3.7), valvular disease in 6 (0.7%), cardiomyopathy in 4 (0.5%), and congenital heart disease in 3 (0.4%). In the study, it was observed that the mean age of death due to cardiac pathology other than coronary artery disease was significantly lower than deaths due to coronary artery disease (p

Embolism of cerebral tissue to pulmonary circulation is a rare entity. It can be occur because of penetrating or closed head trauma at any age or during difficult vaginal deliveries at any age. We present a case of cerebral tissue pulmonary embolization after severe head trauma in a male adult. The autopsy revealed multiple skull fractures, subdural hematoma, subarachnoid hemorrhages, and contusions. Microscopically, we observed cerebral tissue inside the branches of the pulmonary arteries. Embolism of cerebral tissue to the pulmonary circulation is a rare condition. It should always be kept in mind in sudden unexpected deaths during delivery and head trauma cases at any age.

Sarcina ventriculi is a gram-positive anaerobic coccus with characteristic tetrad morphology. Sarcina ventriculiis identified by light microscopy with features of basophilic staining, cuboidal shape, tetrad morphology, and refractile nature. There have been very few case reports of Sarcina ventriculi reported in the literature. We present a case of a 53-year-old male, with gastric ulcer perforation where peritonitis was incidentally found to harbor Sarcina ventriculi in postmortem histopathological examination. Most of the cases exhibit abdominal pain, nausea, vomiting and delayed gastric emptying. It has also fatal life-threatening complications, such as gastric perforation and emphysematous gastritis. The histopathological examination has a key role for identification of the bacteria. The pathologist must always keep it in mind these bacteria as a cause of gastric ulcer perforation in the differential diagnosis. We want to present a case of a 53-year-old male gastric ulcer perforation who was found dead in his bed.

Volatile substance addiction and toxic gas inhalation are now an important health problem. The pleasure-based inhalation of butane gas, also known as lighter refill gas, is especially prevalent among children and young people. The most important reasons for this situation are that they are cheap and easy to obtain and lack of legal supervision. The exhaled gas is absorbed through the alveolar surface and rapidly enters the bloodstream and leads to clinical signs. It can cause dizziness, nausea, vomiting, confusion, hallucinations, and euphoria in the acute phase. In severe cases, bronchospasm, hypoxia, ventricular arrhythmia, cardiopulmonary arrest, and death can occur. Our case is one of the rare cases in the literature that was diagnosed by postmortem histopathological examination. Our case is a 15-year-old girl who was found in front of a tobacco product store. On gross examination, there was a hemorrhagic area under the aortic valve that continued to interventricular septum. There was no coronary artery lesion. Histopathological examination revealed hypereosinophilia and contraction band necrosis in myocardial fibers, which was more intense in papillary muscle. Immunohistochemical studies also supported early myocardial ischemic changes. Upon toxicological examination, butane gas was detected in lung and blood samples.

Lower respiratory infections are commonly due to viruses and are the third largest cause of death. Respiratory tract viruses have a tendency to target the specific regions in the lung and can harm the host via direct effect of the virus and the host's inflammatory response. In this study, relationships between morphologic changes in the lung and the viral agent type isolated in the lung by the polymerase chain reaction technique were investigated. This study was performed retrospectively at 113 autopsy cases in the Council of Forensic Medicine in Istanbul. Slides from the lung tissues diagnosed as interstitial pneumonia and detected viral agent in polymerase chain reaction were evaluated and reviewed under light microscope by 2 pathologists simultaneously according to predetermined bronchiolar, alveolar, and interstitial findings. Alveolar findings were detected in 108 cases (95.6%), whereas interstitial and bronchiolar findings were detected in 91 (80.5%) and 38 (33.6%) cases, respectively. Intra-alveolar edema was the most common alveolar finding. Some findings such as multinucleated syncytial cells and smudge cells can aid the search for etiologic agent. Interstitial inflammation was the most common histopathologic finding in the lung in viral infections and the most prominent clue to viral infections in the lung histopathologically without discrimination of viral agent type.

Pneumocystis jiroveci is the most common and serious opportunistic infection in acquired immune deficiency syndrome patients. It is detected in approximately 80% of human immunodeficiency virus (HIV) infected individuals. In this paper, we present a case of pneumocystic jiroveci pneumonia in a 32-year-old HIV-infected patient who committed suicide. We also present histopathological findings in the lung and aim to draw attention to suicidal tendency in HIV-infected individuals.

As an opportunistic pathogen with high mortality rates, Cytomegalovirus (CMV) may lead to fatal disseminated CMV infection of the premature and newborn; thus necessitating the demonstration of CMV-DNA with clinical history and/or histopathological findings of CMV infection and defining other bacterial and viral infection agents with real-time polymerase chain reaction (RT-PCR) in udden unexpected death in infancy (SUDI) cases as we aimed in this study. 314 (144 female, 170 male) SUDI cases were prospectively investigated from January 2013 to January 2015 in Istanbul Forensic Medicine Institution. The study includes 87 tissue samples of 39 cases for post-mortem histopathological examination of interstitial pneumonia, myocarditis, meningitis, encephalitis, hepatitis, colitis or tubulointerstitial nephritis and/or accompanying chronic sialadenitis. CMV-DNA was found positive in 35 (40.2%) salivary gland, 19 (21.8%) lung, 1 (1.1%) tonsil, and 1 (1.1%) brain tissues. CMV sialadenitis and/or CMV pneumonia associated with other viral and/or bacterial agents were detected in 23 (60%) of 39 infant cases. The demonstration of CMV-DNA would significantly clarify the cause of death and collection of epidemiological data in SUDI cases with clinical history and histopathological findings of CMV infection accompanying chronic CMV sialadenitis. Furthermore, CMV suppresses the immune system, and may predispose to other bacterial and/or viral infections in these cases. Post-mortem molecular investigations are useful in explaining cause of death in SUDI with a suspicion of infection in forensic autopsies., Highlights • CMV may lead to fatal disseminated CMV infection of the premature and newborn. • Our study is the first comprehensive study investigating CMV infections in SUDI. • CMV suppresses the immune system, and may predispose to other infections. • Postmortem molecular investigations are useful in explaining cause of death in SUDI.

The number of cases with spontaneous coronary artery dissection (SCAD) is considered to be being underestimated because of a large amount of SCAD leading to sudden death without previous diagnosis. Besides, not only in clinics but also in autopsy practice, correct diagnosis of SCAD is important to prevent forensic malpractice.The article is intended to discuss the pathological findings through the forensic point of view for improving the malpractice expertise in scope of clinicians' timely antemortem diagnosis according to risk factors and in scope of forensic pathologists' the cause of death determination ability according to macroscopical and microscopical findings of the autopsy.In 3 cases reported, the main characteristics were the female sex, pregnancy history and a sudden death without any trauma. However, although there are many women giving birth or using oral contraceptives, only some of them are facing with SCAD. This suggests the possibility of some hereditary factors, whereas hereditary characteristics may be understood in many different ways like hormone-releasing regulating mechanisms as well as immunity, morphology, or any other mechanism. For instance, autoimmunity has been also a hereditary underlying factor for vessel injury considered in presented cases.

Background: Human bocavirus (HBoV) is a virus belonging to the Parvoviridae family, which has been newly discovered to be associated with respiratory tract infections in children. There are many reports worldwide on the endemicity of this virus. Since it is relatively new, it is not routinely detected in clinical laboratory investigations. Case Report: We demonstrated that HBoV infection caused the death of a 5-month-old girl with a history of high fever and wheezing. Human bocavirus (HBoV 1/2/3/4) was found in a nasopharyngeal swab, paraffin-embedded lung tissue and stool samples by multiplex PCR methods using postmortem microbiological analysis. Conclusion: This case suggests that lower respiratory tract infections due to HBoV may cause severe and life-threatening diseases. Postmortem microbiology is useful in both clinical and forensic autopsies, and allows a suspected infection to be confirmed. To our knowledge, this report is the first document of a HBoV postmortem case in Turkey

WOS: 000382182000019 PubMed: 27389692 A lithopedion is a rare complication of pregnancy that occurs when a fetus in an intraabdominal location dies, and it is too large to be reabsorbed by the body. The case was an 87-year-old woman, and she was transferred to the morgue department in April 2014 to determine the cause of death. During autopsy, an intraabdominally located calcified dead fetus and a 12-cm diameter calcified cyst in the right ovary were incidentally detected. It was aged 25 to 29 weeks (according to femur and humerus measurements) with a size of 12.5 x 8 x 5 cm and a weight of 227 g. According to investigation reports, her husband died in 1990, and she had 3 deliveries, the most recent of which was in 1946. Because the menopause age of the case was not exactly known, the retention time of the lithopedion was supposed to be 24 to 68 years according to the date of the most recent pregnancy and the date of her spouse's death. It is the first case that has been incidentally detected and identified during an autopsy in Turkey and also one of the oldest cases in the literature.

Tuberculosis (TB) is one of those infections with high morbidity and mortality in all around the world. Hundreds of people died from this disease without diagnosed or due to resistant strains in Turkey. Therefore, it is important to identify postmortem cases who have died from tuberculosis. Molecular methods have been widely used as well as conventional methods in the diagnosis of tuberculosis. The aim of this study was to compare the two different real-time polymerase chain reaction (Rt-PCR) system in the postmortem diagnosis of Mycobacterium tuberculosis infections in paraffin-embedded tissues. A total of 40 paraffin-embedded tissue samples [lung (n= 35), brain (n= 2), heart (n= 2), lymph node (n= 1)] in which histopathologic findings consistent with TB (necrotizing granulomatous inflammation, gelatinous caseous pneumonia, necrotic fibrous nodul) obtained from 37 autopsy cases (31 male, 6 female; age range: 25-85 yrs) were included in the study. Paraffin-embedded tissues were deparafinized with xylene and ethyl alcohol and then DNA isolation was done with QIAsymphony DSP Virus/Pathogen Midi kit in the QIAsymphony device. DNA amplification process was performed by Rt-PCR using the kit Artus® M. tuberculosis RG-PCR in the Rotor-Gene® Q device (Qiagen, Germany). Likewise, after deparafinization process, samples placed in the cartridge and isolation and Rt-PCR was performed by Xpert® MTB/RIF (Cepheid, USA) system, simultaneosly. Seventeen and 20 out of the 40 paraffin-embedded tissues yielded positive results with Qiagen and Xpert system, respectively. M.tuberculosis DNA was found positive in 13 (32.5%) and negative in 16 (40%) of the samples by both of the systems, exhibiting 72.5% (29/40) of concordance. On the other hand, seven (17.5%) samples that were positive with Xpert system yielded negative result with the Qiagen, while four (10%) samples that were positive with Qiagen yielded negative result with the Xpert system. Of the 20 positive cases detected with Xpert MTB/RIF system, 15 were found rifampicin-susceptible, and three were rifampicin-resistant. In two samples in which M. tuberculosis DNA was low positive, rifampicin resistance could not be detected. The identification of M.tuberculosis infections in postmortem cases will contribute epidemiological data in Turkey. In these cases, effective sampling and diagnosing of M.tuberculosis infections by acid-fast stain and culture methods are crucial. However, in cases without microbiological sampling the detection of M.tuberculosis DNA in paraffin-embedded tissues with PCR, although there are differences between PCR systems has diagnostic value. In conclusion, our data indicated that Xpert MTB/RIF system is more favourable to detect M.tuberculosis DNA in paraffin-embedded tissues, with the advantages of determination of rifampicin resistance, and detection of more positive results within a shorter time.

Cryptococcus neoformans is a highly mortal opportunistic yeast causing pneumonia and meningoencephalitis in cases with HIV infection. In rare cases, it causes systemic infections, spreading to organs like the spleen, liver, and kidneys. In this paper we present the post-mortem evaluation results of a systemic cryptococcal infection in a HIV-positive case found dead at home. A 30-year-old, 167 cm tall, 57 kg Chinese man found dead at home was sent to the Morgue Department for autopsy. In the anogenital region, multiple papular lesions,which were found 1 cm in diameter, off-white, having hard consistency, and raising from surface, were found. In autopsy, edema was found in the brain and cerebellum and cerebellar tonsils were prominent. The brain weighed 1561 g. Right lung was found 943 g and left lung 800 g in weight. Yeast growth was observed in the aerobic cultures of CSF, lung and spleent issue. The yeast form was defined as C. neoformans with API 32 C and Maldi-T of method. In addition, Serratia marcescens grew in blood and lung tissue culture. Plenty of gram-negative bacilli were seen in the Gram stain of tissue smear. In the post mortem histopathological examination of the tissues, histiocytic-pneumonia caused by cryptococcus and bacterial bronchopneumonia findings were seen in lungs and the parenchyma of the brain, and other organs were reported to be widely in vaded with cryptococcus. HIV-RNA was found positive in high quantitation in the blood sample of the case. HIVpositive immunocompromised people often die due to opportunistic infections. Our case died due to pneumonia infection caused by C. neoformans and secondary infection with S. marcescens and meningo encephalitis caused by systemic cryptococcus infection. Therefore, AIDS and related opportunistic infections should be strongly considered in cases where there is death of a foreign person at home with unknown clinical data and stories.

Hydatid disease is a parasitic infestation caused by ingestion of eggs of echinococcal species. For Echinococcus granulosus, the definitive host is the dog, and sheeps are the usual intermediate hosts. Humans are accidental intermediate hosts, infected by ingestion of food contaminated with eggs shed by dogs or foxes. The most common organs that hydatid disease encountered are the liver and lungs. Involvement of the kidney is rare and usually accompanies the other organ involvements. Cardiac involvement of echinococcosis is also very rare. We report the case of a 31-year-old woman with a 6-year history of asthma who collapsed after strenuous activity and died despite the interventions carried out. At autopsy, cystic masses were detected in the apex of the heart, in the right kidney, and in the liver. There were no macroscopic pathologic findings in the other organs. Microscopic examination revealed the diagnosis of hydatid cyst in the heart, right kidney, and liver besides medial hypertrophy of the lung vessels. Cause of death was attributed to hydatid cyst and its complications. Patients who have symptoms akin to asthma at clinical presentation have to be further investigated for organic cardiac and pulmonary diseases such as hydatid cyst, especially in endemic countries.

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Colchicine is derived from Colchicum autumnale and Gloriosa superba and is used to treat acute gout and familial Mediterranean fever (FMF). Musculoskeletal adverse effects range from myopathy to rhabdomyolysis. An 18-year-old woman, with a 2-year history of FMF treated with colchicine, took 9 colchicine pills (4.5 mg) to relieve severe abdominal pain. On the sixth day of hospitalization, the patient's condition worsened, and she died. As this was a case of fatal poisoning, a forensic autopsy was performed, and the cause of death was determined to be complications of muscle destruction due to colchicine intoxication with the findings of myocytolysis, positive antimyoglobin antibody staining kidney tubules. Colchicine toxicity begins with gastrointestinal symptoms. Multiorgan effects follow the gastrointestinal effects. Serious outcomes of colchicine toxicity are rhabdomyolysis, bone marrow suppression, and disseminated intravascular coagulation. In chronic diseases that require lifelong treatment with medications, adverse effects can arise with long periods of use. Our patient had been treated for FMF with colchicine for 2 years but took too many colchicine pills to relieve her severe abdominal pain. Warning patients about the effects of high doses of drugs and providing information about their toxic effects and what to do "in case" of overuse could be lifesaving.