Thread by @JulianBurton15

Hmmm. Where am I? What is going on?

ANSWER:

Well, this has been interesting and shows the challenge that PM histology can present.

Lots of thoughts as to where this was from: Liver, Muscle, Pancreas, Fat and Lung all featured.

Well done to @PMccoubrie, @kriyer68, @MLegiste and @bansar7 - THIS IS LIVER 1 / n

What is going on? Suggested answers included autolysis, necrosis and fatty liver disease/steatohepatitis.

Well done @PMccoubrie for getting there first - this is autolysis/putrefaction. 2 / n

At first glance (and at low power) it looks remarkably like steatosis/fatty liver affecting acinar zones 2 and 3 but look closer.

First, autolysis has markedly disrupted cellular morphology, and architectural morphology is now also disturbed. 3 / n

What about the "fat". Well, white space in liver is often fat, but not this time. The white space is extracellular and is due to putrefactive gas formation. There is no steatosis or steatohepatitis here.

There is no necrosis - all autolysis.

4 / n

There was no history of liver disease or its risk factors. This patient died from cardiac disease, and had probably been dead for 2-3 weeks prior to autopsy. Marked bloating, skin discolouration/slippage.

5 / n

When there is marked putrefaction, histological interpretation can be difficult (and sometimes impossible). It is worth doing - sometimes you will still find a cause of death. But keeping a record of which block is which is important and makes it a lot easier.

6 / fin