Formalin pigment artifact deposition in autopsy tissue: predisposing factors, patterns of distribution and methods for r
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ORIGINAL ARTICLE
Formalin pigment artifact deposition in autopsy tissue: predisposing factors, patterns of distribution and methods for removal Kyriakos Chatzopoulos 1 & Benjamin Van Treeck 1 & Elise Venable 1 & Vishnu Serla 1 & Trenton Wirth 1 & Fazi Amirahmadi 1 & Alissa Peterson 1 & Peter T. Lin 1 Accepted: 20 February 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Formalin pigment deposition is a known artifact of autopsy histology, often anecdotally associated with decomposition of bodies. However, there is minimal data within the forensic literature demonstrating an association between formalin pigment deposition and length of postmortem interval. Furthermore, there is minimal data concerning other predisposing factors and patterns of distribution of formalin pigment deposition. In this study, we compare the amount and patterns of formalin deposition on histology slides from three categories of death: 1) decomposed bodies, 2) critically ill at time of death, and 3) sudden cardiac death. We also compare the effectiveness of two relatively simple histology laboratory methods to remove formalin pigment deposition from histology slides. Amongst the three categories of death, formalin deposition was highest in the decomposed category, second highest in the critically ill category, and lowest in the sudden cardiac death category. The organs most severely affected by formalin deposition were liver/ spleen/pancreas and kidneys, and the organs least affected were brain and lung. Formalin pigment deposition correlated with length of postmortem interval. Histologic patterns of formalin deposition included the endothelial lining of vessels, perinuclear compartment of neurons and myocytes, and the basal epithelial compartment of renal tubular epithelial cells. The alcoholic ammonium hydroxide method (AAH) was slightly more effective than the alkylphenol ethoxylate (APE) method for removing formalin pigment, though both methods were effective. Because formalin pigment is strongly refractile under polarized light, a polarization filter can also be useful for distinguishing formalin pigment from other pigments. Keywords Formalin pigment . Autopsy . Histology . Quality improvement
Introduction Formalin pigment is a polarizable byproduct of formaldehydeheme interaction. Formalin pigment deposition on histologic slides is a common histology artifact resulting from fixation of tissues in acidic solutions. Use of neutral buffered formalin can reduce the amount of formalin pigment artifact, but tissues which are excessively acidic may exhaust the buffer, thereby making formalin pigment deposition within tissue unavoidable [1]. The presence of formalin pigment artifact on histopathologic slides can obscure the identification of other pigments that may have clinical or forensic significance such as bile,
* Peter T. Lin [email protected] 1
Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
melanin or hemosiderin. Distinction of formalin pigment from hemosiderin is particularly r
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