Histopathology in medico-legal autopsies: Clinical foundation, legal mandate, and judicial guarantee

Abstract

Histopathological examination remains a cornerstone of the medico-legal autopsy. It provides essential insights into the vitality and chronology of injuries, as well as the functional mechanisms of death—elements that cannot be reliably assessed through gross examination or postmortem imaging alone. Despite this, a growing number of forensic institutions are progressively excluding histological analysis from standard protocols, particularly in cases of violent death. This shift is often justified by operational, financial, or doctrinal arguments, but represents a methodological regression with serious implications for diagnostic accuracy and legal certainty.

This article reviews the clinical, technical, and normative foundations of histopathology in forensic practice, with particular emphasis on its role in trauma-related deaths. It addresses the limitations of relying solely on macroscopy or imaging, and underscores the value of microscopy in identifying vital tissue reactions, timing of lesions, and subtle mechanisms such as asphyxia, inhibition, or embolic phenomena. The discussion includes examples from the literature and institutional practice, as well as a critique of the current trend toward minimal or absent histological sampling.

Finally, the authors propose a minimum protocol for histological sampling in cases of violent or suspicious death, integrating this with scene analysis and targeted dissection. Histopathology is presented not as an optional complement, but as an integral part of the medico-legal diagnosis—both as a scientific tool and as a safeguard of forensic accountability.