The Histopathological Spectrum of Liver Diseases in Medico-Legal Autopsies: Findings From a Tertiary Care Center in Bangladesh

Background and objective Liver diseases often remain clinically silent until they reach advanced stages, and medico-legal autopsies can uncover previously undiagnosed pathologies. This study aimed to characterize the histopathological spectrum of liver diseases in medico-legal autopsies from a tertiary care center in Bangladesh. Methods This descriptive cross-sectional study was conducted in the Department of Pathology, Dhaka Medical College, Bangladesh, between September 1, 2021, and February 28, 2022. All adult (≥ 18 years) liver specimens obtained from medico-legal autopsies during the study period were consecutively included (n = 200). Demographic information and documented causes of death were collected using a structured form. Representative liver tissues were processed for routine histopathology and evaluated by light microscopy; lesions were categorized into steatosis, steatohepatitis, chronic hepatitis, cirrhosis, congestion, abscess, and malignant lesions. The data were analyzed using SPSS Statistics v22.0 (IBM Corp., Armonk, NY); Fisher's exact test was applied, and a p-value < 0.05 was considered significant. Results The mean age of the patients was 38.5 ± 11.05 years; the majority were male (96%), and most came from rural areas (61.5%). “Prisoners in cell” was recorded as the leading cause of death (32%). The liver weight distribution did not differ significantly by sex (p = 0.447). Histopathology revealed no significant abnormalities in 25% of patients. The most common lesions were steatohepatitis (20%) and cirrhosis (20%), followed by hepatic malignancies (17%), which included primary tumors (6%) and secondary tumors (11%). Other findings included steatosis (10%), chronic hepatitis (5%), congestion (2%), and hepatic abscess (1%). The sex distribution of major histopathological findings was also not statistically significant (p = 0.135). Conclusions Medico-legal autopsies revealed a substantial burden of previously undetected liver disease, dominated by steatohepatitis, cirrhosis, and malignancy. Routine histopathological evaluation via medico-legal autopsies may help identify concealed patterns of liver disease in Bangladesh.