A Comparative Analysis of the Efficacy of CD117 and Special Stains as Indicators of Mechanical Asphyxial Deaths

BACKGROUND: Determining the cause of death in suspected asphyxia is often difficult when external findings are absent. Mast cells (MCs) may provide objective histological evidence of hypoxia. OBJECTIVE: To compare the efficacy of immunohistochemistry (IHC) using CD117 with Toluidine Blue (TB) and Giemsa (GM) stains in detecting mast cells in asphyxial and non-asphyxial lung tissues. MATERIALS AND METHODS: Lung samples from 164 medicolegal autopsies at AIIMS Jodhpur were studied, 57 asphyxial and 107 non-asphyxial deaths. Peribronchial and perialveolar regions were examined using TB, GM, and IHC (CD117). Mean mast cell counts were compared using Mann-Whitney U and Kruskal-Wallis tests. RESULTS: Mast cell counts were significantly higher in asphyxial cases. Peribronchial counts: IHC 2.27 ± 1.02, TB 2.29 ± 1.19, GM 0.84 ± 0.59. Perialveolar counts: IHC 0.74 ± 0.12, TB 0.10 ± 0.19, GM 0.01 ± 0.51. IHC was more sensitive than GM (P < 0.001), while TB showed comparable efficacy to IHC. CONCLUSION: CD117-based IHC is the most sensitive method for identifying mast cells in asphyxial lungs, though TB remains a valuable low-cost option. Mast cell analysis can serve as an adjunct marker in diagnosing mechanical asphyxia.