Occult Hepatic Pathology in Medicolegal Autopsies: A Single-Center Histopathological Study From Jharkhand, India

Background The liver is a vital, highly vascular organ responsible for metabolism and is frequently affected by toxins, infections, circulatory disturbances, and systemic diseases. Medicolegal autopsies allow identification of both observable and clinically silent hepatic pathology, thereby aiding determination of the cause of death and characterization of local disease patterns. Objective To evaluate the histopathological spectrum of hepatic lesions in liver tissue obtained at medicolegal autopsy and to describe the frequency of clinically occult liver pathology within this autopsy series. Methods This was a retrospective observational study that included 196 liver tissue specimens received during medicolegal autopsies over a period of 18 months at a single tertiary care center in Jharkhand, India. All tissues were fixed in 10% neutral buffered formalin, processed, and stained with hematoxylin and eosin, and examined by light microscopy. Histopathological findings were recorded and analyzed using Jamovi 2.17.7 (The Jamovi Project, Sydney, Australia). The chi-square or Fisher's exact test was used for categorical data and Student's independent-samples t-test for continuous data, with p < 0.05 considered significant. Results Of 196 cases, 167 (85.2%) were male and 29 (14.8%) female. Mean liver weight was higher in males (1413.28 g) than in females (902.90 g). The most common gross findings were fatty change (92/196, 46.9%) followed by congestion (55/196, 28.1%). On histopathology, steatosis (98/196, 50.0%) and morphological chronic hepatitis (88/196, 44.9%) were the most frequent findings, followed by congestion (32/196, 16.3%) and necrosis (21/196, 10.7%). Granulomas and tumors were rare. Conclusion Medicolegal autopsy-based histopathological examination revealed a substantial burden of clinically silent hepatic lesions, particularly steatosis and chronic hepatitis, within this selected medicolegal cohort. These findings underscore the continuing value of autopsy histopathology, even in the era of advanced imaging and molecular diagnostics, for detecting occult liver disease. Given the selected, single-center and trauma-predominant nature of the cohort, the observed frequencies should be interpreted as hypothesis-generating rather than as population prevalence estimates.