OtopsH
erdc Saptanan
K
aracig
er Bulg
ulan
SERI\!ET
K
o('
.
LMRE A.LBEK . CX\SER <,:AK,\URA,
SI.DXI NALAi' C()I<(,EN :1), RAtli~ KESKi~ <1)Anahtlim
LIVER FINDIM;S I:-.J
MEDICOLEGAL
AUTOPSIESSummary
Among 2224 autopsies pcrformed in tile Mortuary Section of the CouncIl oC Forensic Medicine in Istanbul in 1994, traumatic )csions
or
the liver contributinQ to the fatal outcome accountee! for a totidor
I ~O (X.09 %) cases, whereby 101 were caused by blunt traum,,,''vIacro.scopic and/or microscopic lesions oithe Itver were detected in 671 (30.17 'Yo) of 2224 autopsies. Apart frolll <iiseasc-rcl'ltcd lesions, in 10 of 671 cases traumatic findings of the liver were present firearm wounding, and incisive-perforating trallIDa accounted for fOllr injuries each, whereas the remaining IWO were caused by hlunt trauma.
Tissuc specimcn.s from 41
n
elSeS submitted for histopathological assessment were evaluated after Heillatoxylin-Eoslll stai11111g. the routi11c method applied in the Mortuary Section. 63 (15.36 IX,) of thc cases lacked any rinding. whereas 220 (53.65 11,,) displayed postmortem changes. Passive hyperemia was observed in X6, tally degeneratl(lll in 42, cirrhOSIS in II, neoplaSllc changes in 5. chtlllse necrosis in X, evidence of hepatitIS in 10 and cholangitis/cllOi:tngioiJtis In .\ c'lses; cystIC and capsular lesions were detected in 3 Glses each.Assessing the cascs
or
hepatitiS again, granulomatous inl1ammation was detected in three cases. The remaining Cases could not be claSSified because no clinical ami laboratory data were available.All casc.s were evaluated in detail with regard to the came of death as well as to macroscopic and microscopic finding.-.; of the liver.
Key Words: U\'l'l, J!1I1i1olng\', 1100{IIlIl,ji)I(,IIS{C {{IIIIII>'\'\'
OZd
istanbul Adli Tip Kurulllll Morg ihtisas Dairesi'nde 1994 ydlnda yapdan 2224 otopsi olgusu i~il1de kar;lcigerdc saptanan travlllatik Iczyonlann saYlsl 10 I 'i klint travmalara bagll olmak lizcre j XO ('Yo X.(9)'clir.
2224 otopsinin 671 'inlie (% 30.17) makroskobik ve/vcya mikroskobik nontravmatik karaeiger lczyol1u saptand" 67. olgLlnun IO'unda karaClgerdc hir hastaligln ya111stra 4\1 atqli silah, 4'li kesici-deliei alct ve 2'si kimt tipte olm.,k llzerc yara mcvcutlu.
Histopatolujik incclemesi Y'lptian 410 olgu A TK Morg !htisas Dairesi'nde rutin incclcmelcrde kullallllan H/E ile boyanarak degerlcndirildi. 63 olguua (% 15.36) lm iizellik bulllnmaYlp, 220\inde (% 53,()S) postmortem degi~iklikler saptanlrken: ~6 olgllda pasif hipercmi, 42 olgllda yaglanma, II olgllda siroz. 5 olgllcla neoplazl. ~ olgllda nekroz bulgulan, 10 olguua kronik hepatit, 3 oluda kolanjit/kolanjiolit, 3 olgllcla kistik lezyolliar ve 3 olgllcla cla kapslil lezyonlan saptandr.
Hepatit olgllian tchar dcgcrlclldirildigindc, 3 olgllda graniilomalliz iltihap saptancir. Digcr olgulann klinik vc laboratuvar verileri elde eciilemedii!,inden slntl1andtnlamadr.
Him olglliann (illim ncdcnlcri Illakr<~skobik ve mihoskobik karaciger blligulan at,:lSlndan aynnlili ckgeriendirilmcsi yapllur.
Anahtar Ke,imeier : Kar",i,~a, paloloji, IU/l'mll, adli (!/Opsi.
4 S. KO<;:, E. ALBEK, C <;:AKALIR , A.S. <;:OLOGLU, E.N. GOK<;:EN, R.T. KESKiN
GiRiS VE AMA(:
istanbul'cia yllda 2500'c
yakla~ansaYlSI ilc adli otopsilcr zcngin bir
ara~t\J1namatcryali
olu~turmaktacllr.Bll
<;ah~mada,adli otopsi materyalincie karacigcrin lravmatik vc nontravmalik
makroskobik/mikroskobik lczyonlannm dcgcrlcndirilmcsi ama<;lancll.
GERE(,: VE YONTEM
istanbul Adli TIp Kurlll11U (ATK) Morg ihltsas Daircsi'ndc 1994 yillnda yapilan 2224 otopsiocn dele cdtlcll makroskobik ve mikroskobik karaciger bulgularI. travmatik vc llontr'lvmatlk Jczyonlar yiilllindcn dcgcrlcndirildi.
Travmatik vc nontravmatik blilgulan birliktc i~ercn I () (Jigu lie travmalik bll!gll i~enncycn 661 olgll (toplam 671 olgll) l11orfo1ojik olarak incelendi.
Bli 671 olgunun 41 ()'undan alman karacigcr dokuSlI brnekleri A TK Morg ihtisas Dalresl'nde rutin IIlcclemelerde klillanilan HIE tic boyanarak degerlel1diri1di.
BULGULAR
istanbul ATK Morg ihtisas Dairesi'nde 1994 ytllllda yapdan 2224 otopsi olgusu
iyindc karacigcrdc saplanan lravmatik lczyanlann saYlSI 180
(%8.(9)'dir. Bu olgulann
i.izclliklcri Tabla 1 'de giistcrildi.
Tablo I. Adli otopsilerdc karacigcrde travmatik bulgll saptanan 180 olgllda iillim nedeni
Olum Nedcni Erkek Kadm Toplam % (n=180) % (11=2224)
Klint yaralanma
gg
13 101 56.11 4.54Atqli silah yaralanmasl 34
3
37 20.55 1.66PatlaYlcl maclcle yaralanmasl 4 4 2.22 017
Kesici-clelici alet yaralallImlsl 34 4
3X
21.1 I l.70Toplam 160
20
180 100.00 8.092224 otopsinin 671 'indc
(%
30.17) makroskobik vc/veya mikroskobik nontravmatik
karacigcr lczyanu saptancb. Bulgular ve ijlUm ncdcnlcri Tablo 2, 3 ve 4'cie gijsterildi. 18
ya~m
allmda patolojik blligu g6stercn olgu saYIsI, 3'U kadm almak i.izcrc 19
(%
2.83)
bulundu.
Karaciger aglrlIgl 2224 algunun 1589'unda
(%
71.44)
<
1600 g, 164'i.inde
(%
7.37)
1601-1700 g, 16()'mda
(%
7.19) 1701-1800 g, 91'inde
(%
4.(9) 1801-1900 g, 82'sindc
(%
3.63) 1901-2000 g, 132'sindc
(%
5.93) 2001-3000 g ve 6'smda
(%
0.26)
>
3001 g
tartiidl.
Karacigerinde makroskobik ve mikroskobik patalajik lezy on saptanan 671 olgunun
JO'unda karacigcrdc bir hastallgm yal11SIra 4'Li
ate~lisilah, 4'U kcsici-delici alet ve 2'si
kUnt tiptc olmak i.izere yaw mcvcuttu.
Histopatolojik incclcmesi yapdan 410 algunun
(HIE
ile) 63'U
(%
15.36) nannal olup
olguda da kapslil Iczyonlan saptandl.
Nckroz hulgulml iyercll 8 ol,guc\an 5'jude mantar zdlirlenmcsine
ba,gl! dilh.lz nckmz
saplamh (Resim i
3 olguclakl nekroz
ISCkonjcsti
r
kalp yetmczlIgi sonUCll
geli~ensalltralllckrozlar seklilldc idi.
Krollik hepath tal1lS!
alml~
olan
olgu tekrar clcgcrlcndinldigindc 3
sistcmik granLilomat()z iltihap saptandl (Resim
3),
Digcr olgular klll1lk ve laboratuvar
vcrilcri
cldc edilemcdiginden sll1lflandIrllamadl.
GranUlomataz
hepatit olarak
Icndirdigimiz olgulanmlzdan birillde mikrobiyolojik tCl.kiklcrdc anti
HIV
1/2
ara~l!rmaslpozitif bulundu, Bu olgumuzda granlilomati)z iltihabm etkcni, ozel boyama
yijntcmleri ile verifiye edilemedi.
Blri
olmak lizerc 6 kronik
loksikolojik analizinde
opialmclabolitlcri saptanch.
Kronik hepalit olgulanmlzda, ijzcl
siSlcmi uygulanarnadl. HIE
loblder
bulunmadlgl portal inriltrasyon izlendi (Resim
4),
yapilamachgmdan skor
vc hcpaloselLilcr nekrozun
Tiimiiral killc s,lptanan
:1
2'sindc hcmangiom. 1 'indc sirozilc birlikte
karslI1om, kalan 2
adenokarsinom melastazl mevcut!u,
T~thlo 2. ><ontravHutik makrnskobik karaci,Ger Jezyonianl1ll1OllJm Ncdeni Dogal Tr;lvllla/asLk,; Tok,vik Belirsiz TlliJlam Tabln 3. Ozellik BUhlllmayan 56 ISS 35 ')
288
Yaolanma ( DiffITz!Lokai) Pasif 97 43 137 52 J 14 4300
incclclllcsi y~\pJ!;jn olgul:lrda notlttav111atik
nedcninc gore dai'!lIIl1!
Sinn Vcr Kaplayan 9 6 3 12 (llum Nedeni Ozcllik bul""mayan Postmortem dcgi~iklikler PelS;
r
i1ipcrell1i Yaj:I;\J1I11i.l Simz Nckroz Kronlk hepi.ll" Kolanjit kolanjiolit KivtYOl kllplaYiln lezyon
Kapslillezyollu
Dogal Travmal Asfiksi Toksik
34
83
9 9 2 10 38 13 14 6 () Bclirsiz Toplam IIno
6 86 3 11 S 3 3 Kapslil 2 12 14 % (410 olgu) 53,(,:' 20.97 10,24 2,68 1.95 2.4) 0.73on
073S. KO(. E. ALBEK. C. (AKALlR . A.S. (OLOGUJ. E.N. GOK(EN. R.T. KESKiN
Resin! I. DillLiz nckroz vc rcziulicl periportal hcpatositlcrde tubuler prolilera.syoJl (HEX I ()())
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Rcsim 3. I'un;" al;ll1larlia grallulull1alliz lczyoillar (HEX40)
