Postmortem Diagnosis of Anaphylactic Shock by Histopathological Examination of Mast Cell

Korean J Leg Med 2020;44:76-83

Department of Forensic Medicine, Yonsei University College of Medicine, Seoul, Korea,

Division of Forensic Medicine, National Forensic Service Daegu Institute, Chilgok, Korea,

Division of Forensic Medicine, National Forensic Service Daejeon Institute, Daejeon, Korea

E-mail: parkjp@yuhs.ac

An autopsy for a fatal anaphylactic shock (AS) is not rare; however, postmortem diagnosis of anaphylaxis can be very challenging due to nonspecific macroscopic findings and absence of diagnostic tests except serum mast cell tryptase analysis. We tried to review the usefulness of histopathologic examination as an alternative method for the postmortem diagnosis of AS in this study. Immunohistochemical staining was carried out for detection of mast cells in 27 autopsy cases, including 7 AS cases, 5 false-positive cases, and 15 control cases at the National Forensic Service from January 2013 to May 2015, and the differences of mast cell counts and staining pattern were analyzed. The results revealed no differences in the number of mast cells among the three groups; however, a characteristic mast cell degranulation staining pattern was observed in the AS group and false-positive group. It can be conclusively inferred that the histopathologic examination could prove helpful in the postmortem diagnosis of AS, but it should serve as an ancillary option.

Key Words: Anaphylaxis; Mast cells; Autopsy; Pathology