Autopsy study of spectrum of lung lesions in Tertiary care hospital.

BACKGROUND: Inflammation, Infections, occupational diseases and neoplastic lesions are common in lungs. In Autopsy internal organs including lungs are studied to decide cause of death and figure out prevalence of various lung lesions. So, prophylactic prevention plan can be prepared for prevention of various lung lesions induced mortality and reducing need for invasive biopsy as well. AIM &
OBJECTIVE: To find out frequency of various lung lesions in relation to age and sex and analyze histopathological spectrum of lung lesions. MATERIAL &
METHODS: Non interventional, record based cross sectional, retrospective autopsy study was done on 139 cases of lung autopsy samples at department of pathology of tertiary care hospital, Bhavnagar, Gujarat for 2 years on samples received from January 2016 to January 2018. Lungs were fixed in 10% formalin & processed. Paraffin wax embedding was done & sections stained with H&E stain. Gross and microscopic examination of samples done and diagnosis was done. All findings were recorded and tabulated.
CONCLUSION: Pneumonia is most common observed pathological lung lesion in our study which suggest that infections of lungs are common cause for mortality. Therefore, we suggest effective implementation of measures to prevent hospital acquired pneumonia may reduce mortality. Smoking was associated in nearly 70% patients. Autopsy study of such lung lesions can provide vision to plan preventive strategy to reduce mortality due to lung pathology. Copyright:

Introduction

Autopsy is a medical practice in which thorough body examination done after death and internal organs studied grossly and histopathologically to determine cause or manner of death. Forensic expert gives final cause of death after correlating histopathological examination report.[123]

Inflammation, Infections, occupational diseases and neoplastic lesions are common pathology observed in lungs.[45] Clinical history, laboratory tests and radiological study support diagnosis of lung lesions but invasive biopsy for histopathological examination is necessary sometime for confirmation and deciding prognosis of lung lesions.[6]

Modern diagnostic tests are costly and sometime clinicians have less time for diagnostic work up due to rapid progression of disease. Therefore, it is very important to determine common cause of death and prevalence of various lung lesions to prepare prophylactic plan for prevention of such lung lesions induced mortality[12] In that manner, need of invasive procedure like lung biopsy can be minimized.[7]

Aims and Objectives

To evaluate frequency of various lung lesions in relation to age and sex and to understand epidemiology of lung pathology.

To find out common cause of death due to lung pathology to analyze histopathological spectrum of lung lesions.

Materials (Subjects) and Methods

Non interventional, record based cross sectional, retrospective autopsy study was done on 139 cases of lung autopsy samples at department of pathology of tertiary care hospital, Bhavnagar, Gujarat. Study was done for 2 years on samples received from January 2016 to January 2018. Ethical committee approval taken from ethical committee of government medical college, Bhavnagar and my EC approval No. is 1009/2020.

Inclusion criteria for study: All cases of lung lesions were included in study irrespective of age, sex and cause of death. Exclusion criteria for study: Autolyzed lung specimens were excluded from study. Lung autopsy specimens in which only congestion and edema present were also excluded from study.

Lungs were fixed in 10% buffered formalin and weight with dimensions were measured before doing grossing of specimen. Lungs were grossly examined for colour, consistency, presence of bullae, consolidation, scar, nodules, necrotic area, cavity, pleural adhesions, mass and infarcted area. Irrespective of gross findings, minimum two sections given per lungs, so total 4 sections given and sections were given from grossly looking abnormal pathological areas as well if present.

Sections were processed and finally paraffin tissue embedding was done to prepare tissue blocks. 5 mm thickness sections were cut in microtome and all prepared sections slides were stained with Hematoxylin and eosin stain and mounted and examined microscopically. Special stains done wherever necessary to confirm diagnosis.

Final diagnosis was given after microscopic examinations of all sections and after correlating all microscopic finding with gross examination as well. All findings were recorded and tabulated.

Results

A total 139 lung lesions were studied according to our inclusion criteria from January 2016 to January 2018. Among all included cases 90% were males and 10% were females. History of tobacco smoking was present in nearly 70% males. Maximum deaths were seen in age group 50-60 year. Pneumonia was commonest finding observed in our study (33.8%). Second and third common lung lesion observed in our study were emphysema (15.8%) and chronic Granulomatous inflammation Tuberculosis (12.9%).

Interstitial Fibrosis and Lung malignancies were observed in 2.1% and 5% cases, respectively. Pulmonary edema, pigment deposition, etc. like nonspecific findings were observed in 30.2%. All data entered in tabulated form and detailed discussion with conclusion done as below [Tables 1 and 2].

Table 1

Age wise distribution of lung autopsy cases

Lung Lesions (diagnosis)	Age group in years (%)
	0-9	10-19	20-29	30-39	40-49	50-59	60 or above	Total cases
Pneumonia	01	02	04	06	10	22	02	47 (33.8%)
Emphysema	03	01	01	05	07	02	03	22 (15.8%)
Granulomatous Inflammation-Tuberculosis	00	00	01	01	04	12	00	18 (12.9%)
Pulmonary edema, pigment deposition and terminal event induced lung changes	00	03	07	11	10	10	01	42 (30.2%)
Interstitial fibrosis	00	00	00	01	00	00	02	03 (2.1%)
Lung Malignancies (primary or metastatic)	00	00	00	01	02	04	00	07 (5.0%)

Table 2

Sex wise distribution of autopsy lung cases

Lung lesions (diagnosis)	Male	Female	No of cases
Pneumonia	44	03	47
Emphysema	18	04	22
Granulomatous Inflammation-Tuberculosis	16	02	18
Pulmonary edema, pigment deposition and terminal event induced lung changes	37	05	42
Interstitial fibrosis	02	01	03
Lung Malignancies (primary or metastatic)	07	00	07

Discussion

In present study, we observed that lung pathology was more common in male. Similar findings were also observed in study done by Puneet et al.[8] Rupali et al.[9] and Selvambigai et al.[10]

Present study shows 33.8% cases of pneumonia which was comparable to Udayshankar et al.[1] and Selvambigai et al.[10] but in Nirali et al.[11] and Rupali et al.[9] study pneumonia cases were nearly 20%. Prolonged hospitalization increase chances of pneumonia is the reason for higher prevalence in our study.

In present study tuberculosis cases were 12.9%. Similar findings were observed in study done by Nirali et al.[11] and Udayshankar et al.[1] In our study, emphysema cases were 15.8% which was almost exactly comparable to Selvambigai et al.[10] In other studies, done by Nirali et al.[11] Pratima et al.[12] and Chandani et al.[13] cases of emphysema were 6.5%, 8.9% and 4.3%. The reason we found is due to geographical variation of study population. In our study area tobacco consumption in various forms was higher.

In present study malignancies were only 5% which is comparable to Pratima et al.[12] study.

Interstitial fibrosis was observed in 2.1% cases. Pulmonary edema, pigment deposition and other terminal events induced lung changes were 30.2% which are not morbid lung pathology.

Summary and Conclusion

Pneumonia is most common observed pathological lung lesion in our study which suggest that infections of lungs are common cause for mortality. Therefore, we suggest effective implementation of measures to prevent hospital acquired pneumonia may reduce mortality.

Smoking has strong association with many lung lesions which is evident in our study as well, so people should be educated to stop smoking habit. Primary care physician should enforced to screen periodically for such high-risk persons for early detection and treatment of underlying lung pathology.

Autopsy study of such lung lesions can provide vision to plan preventive strategy to reduce mortality due to lung pathology.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.