Determination of Both Fetus’ and Mother's Blood Type from an Autopsy Case Immersed in Formalin for Over 50 Years

A female fetus which had been immersed in formalin for more than 50 years was found in Japan. Because no liquid blood could be obtained, we tried to use immunohistochemistry (IHC) methods to tissue samples obtained at autopsy to identify both the fetal and mother's blood type. We detected B antigens on endothelial cells in paraffin sections of the fetal organs. Furthermore, we observed both anti‐A‐ and anti‐B‐positive red blood cells in the intervillous space, which is indicative of the mother's blood type. To our knowledge, this is the first case report on determining the blood type of both the fetus and the mother from tissue immersed in formalin for such a long time. The results suggest that IHC is valuable for the determination of ABO blood type in circumstances of long postmortem duration and unfavorable storage conditions.     

Identification of gestational trophoblastic disease in a sexual assault case

In this study, gestational trophoblastic disease (GTD) was observed by short tandem repeat (STR) typing from the aborted tissues in a sexual assault case. By histological screening, the fetal tissue could not be distinguished from the maternal tissue in this case. Therefore, five specimens were collected randomly from the aborted tissues for DNA analysis. STR typing was performed by the commercial ABI Identifiler kit. The results showed that three specimens were of the maternal origin, one was a mixture of the mother and male fetus, and the other one was of male fetal origin with partial triploid. Three alleles were identified in each locus of D8S1179, D7S820 and VWA for the fetal specimen. For these three alleles, one matched the maternal origin and the others matched the putative paternal origin (suspect). Analysis of the Y-STR by using the commercial ABI Y-Filer kit, the fetal types matched the types of the suspect. We reported the case of partial mole on forensic evidence and gave the valuable information from its identification.     

Highly sensitive HLA-DNA typing from formalin-fixed and paraffin-embedded tissue samples

Nucleotide sequences have been determined for more than 1700 different alleles at the core of the human leukocyte antigen (HLA) system. The highly polymorphic character of these genes affects adaptive immune response and is also useful for forensic applications. HLA typing from formalin-fixed and paraffin-embedded tissue provides abundant useful information for both clinical settings and forensic investigations. This study, which investigated the potential use of DNA from formalin-fixed and paraffin-embedded tissue samples in an HLA PCR sequence-specific primer and probe (SPP) system, showed that tissue fixed in formalin for less than 3 days and embedded in paraffin can serve as a useful source of DNA for PCR-SPP typing kits.     

Multiple interchanging of tissue samples in cases of breast cancer

Due to the suspicion of a gynaecologist, a pathologist was suspected of incorrect diagnoses in cases of breast cancer and the interchanging of tissue samples. Many women applied to the attorney's bureau to clarify the reproaches. The privately owned laboratory for pathology was searched and 926 histological slides, roughly the same number of paraffin blocks and about 20 formalin fixed tissue samples were confiscated. Together with other confiscated material, at least 1236 histological slides and additional 249 paraffin blocks had to be sorted. Histological slides and paraffin blocks were matched with patients as far as possible following the laboratory book. Many of the warranted samples which were diagnosed as containing the carcinoma by the pathologist were missing. A total of 160 samples were chosen and rediagnosed by two independent pathologists. The formalin fixed tissue was negative for DNA most likely due to storage in formalin for years. Most of the histological slides were positive for DNA. On the whole, 18 expertises about histological findings and the DNA results were given. In some cases only DNA results could be presented, as previous experts had only performed DNA examinations without controlling the histological diagnosis. In six cases a carcinoma could be confirmed and the DNA profile matched with patient's DNA; in seven cases a carcinoma was confirmed without match with the patient; in two cases the carcinoma could not be confirmed in the presented samples. A jurisdictional solution was impossible because the accused pathologist died during the investigation. In conclusion, it must be stated that a DNA examination of histological slides should never be performed without a rediagnosis of an independent pathologist and photographic documentation of the findings. Whenever possible, material should be left on the slide.     

Analysis of DNA profiles extracted from degraded samples from archival of formalin fixed tissue included in paraffin (FFTIP) and hairs

The possibility of studying DNA extracted from archival of formalin fixed tissue included in paraffin (FFTIP) enables valuable retrospective investigations. However, according to some authors it is difficult to obtain genomic DNA of good quality, since the process of fixation often results in fragmentation of DNA. In order to evaluate the quality and quantity of DNA extracted, necropsy samples of FFTIP (spleen/lung) and hairs, with or without bulbs, were analyzed using three methods of extraction (QIAamp DNA mini, QIAamp DNA micro-kit and phenol–chloroform followed by microcon YM-30). The amount of DNA recovered was quantified by spectrophotometer. The β-actin, amelogenin gene and the profiles of STR were analyzed. Based on experimental results, a general guideline concerning the appropriate extraction method according to the tissue and the quantity of the starting material for the analysis of DNA from FFTIP and hairs could be suggested.     

Determination of paraquat in raw and formalin-fixed tissues by electron spin resonance (ESR) spectroscopy

ESR method was applied to determine paraquat levels in fresh and formalin-fixed tissues. Paraquat was converted to paraquat radical by adding sodium dithionite to tissue homogenates and detected by ESR. Paraquat levels of more than 0.2 micrograms/ml homogenate could be quantified with 0.1 ml of the homogenate. The use of manganese ions for standardization of paraquat signal enabled much more accurate ESR measurements because this ion was quite stable and its signal did not overlap that of paraquat. Even with tissues fixed in formalin, tissues paraquat levels were measureable after removing formalin from the tissue extract. This fact was verified by studying two cases; the tissues were kept in formalin for 1.5 years in case 1 and for 6.5 years in case 2. In both cases, the paraquat contents in tissues were 0.02-0.08 micrograms/g. In this way ESR is one of the most suitable methods in determining low levels of paraquat in tissues even after they were preserved in formalin for a long time.     

甲醛固定石蜡包埋组织STR分型检测

目的评估10%甲醛固定石蜡包埋组织STR分型结果的影响因素。方法采用QIAGEN法、IQ法、Chelex法对2具新鲜尸体在尸检时常规制备的心、脑、肝、脾、肾、肺、胃、肠石蜡包埋组织进行DNA提取,用AmpFlSTR Identifiler试剂盒进行PCR扩增,在3100-Avant上完成片段分析。另外对15个案例中室温保存1～5年的心、肝、肺、肠存档石蜡包埋组织共56份采用同样的方法进行STR分型。以STR基因座检出率评估分型有效性。结果各种组织DNA片段均随着保存时间延长而持续降解,其中心、肺组织STR基因座检出率与保存时间存在线性相关。相同保存时间时,各种组织基因座检出率差异有统计学意义。其中以肺组织在不同保存时间中基因座检出率最高。结论在甲醛固定时间一定的条件下,存放时间、组织类型、DNA提取方法和PCR模板质量浓度是影响石蜡包埋组织STR分型的重要因素。     

福尔马林固定石蜡包埋组织中DNA提取

由于甲醛介导的DNA损伤和石蜡对DNA提取的阻碍作用,使得常规DNA提取方法很难从福尔马林固定石蜡包埋组织(FFPET)中获取高质量的DNA。近年来,众多学者的研究表明,通过改良预处理方法,优化蛋白酶K消化作用,简化DNA提取步骤,纯化DNA提取物等,可以有效提高FFPET中提取的DNA质量,为FFPET的DNA分析奠定了基础。     

原发性脑干挫伤的HE染色观察

目的观察原发性脑干挫伤的形态学特点。方法从465例致死性颅脑损伤中,检出171例有脑干挫伤病变、均于伤后10min～7d死亡者。脑干标本经福尔马林固定后,以脑干各颅神经根水平面等处切取检材,每例共8块,HE染色,光镜观察。结果 171例中有24例颅底骨折致脑干挫伤者,脑干横切面见小灶出血,其余只有在镜下方可见有组织出血、挫碎或撕裂等脑挫伤改变,以及对损伤的应激反应现象。结论原发性脑干挫伤的形态学具有一定特点,故对鉴定脑干损伤有着重要的参考价值。     

人体组织在非缓冲福尔马林固定剂中的STR检测时限

目的评估经非缓冲福尔马林固定不同时间后的人体组织STR分型有效性,了解各种人体组织在非缓冲福尔马林固定剂中可获得完全STR分型位点的时限。方法市售40%福尔马林溶液经1∶9稀释后在室温(15～20℃)下固定人体组织,不同时间后取样。以QIAamp DNA法和IQTMDNA System法提取DNA,用quantifiler humanTaqman探针法进行DNA定量,用常规16 STR位点的AmpFSTR identifiler kit和短小片段9 STR位点的AmpFSTR Min-iFiler kit进行PCR扩增,在3100遗传分析仪进行扩增DNA片段长度检测,用GeneMapper ID v3.2对STR位点检出率进行分析。结果福尔马林固定时间、组织类型以及DNA提取方法、PCR的DNA模板终浓度均影响非缓冲福尔马林固定后人体组织STR分型效能。DNA提取用QIAgen法为优,DNA模板终浓度的最佳范围在1～3ng/μL。各类型组织在非缓冲福尔马林固定剂中的降解速率有差异,肺组织的降解速率最慢,肝、肠组织最快。固定时间在4d内的组织可以获得常规STR的完整位点数;固定时间在15d内的组织可以获得miniSTR的完整位点数。结论非缓冲福尔马林固定人体组织时间是影响STR分型的最主要因素,其次组织类型、提取方法、DNA模板浓度及STR基因座的选择也是此类降解样品成功检测的关键因素。     

Paternity-testing on paraffin-embedded abortion tissue: preparation of fetal cells may be indispensable

In a case of sexual abuse, a paternity test was performed on paraffin embedded abortion material. STR typing was successful only after isolating fetal tissue from the abortion-material and separately extracting DNA from the excised fetal cells. Examination with five STRs led to a paternity index of 332, confirming the abuse that had resulted in pregnancy.     

Elucidation of a poisoning case from the analysis of formalin in which brain tissue was preserved

The toxicological analysis of post-mortem materials often help determine the cause of death. When tissues have been fixed in formalin it may be possible to extract several drugs from the tissue and/or the preserving fluid. An unusual case of multiple poisoning is discussed from the aspect of laboratory analysis.     

利用RASSF1A位点检测母体血浆中胎儿SNP分型

目的探讨利用母体血浆中高甲基化RASSF1A位点进行胎儿SNP分型的应用价值。方法随机收集10个未孕健康妇女和45例不同孕期（早期5例、中期20例、晚期20例）孕妇的血样本及相应胎儿组织（绒毛组织、羊水、胎盘组织）;利用甲基化敏感限制性内切酶BstUI酶切后进行PCR,产物进行血细胞、血浆和胎儿组织（绒毛或胎盘）DNA RASSF1A序列的甲基化模式检测,并采用直接测序法对SNP rs4688725位点进行分型。结果经BstUI酶消化,RASSF1A序列在母体血细胞中均未检出,而在绒毛或胎盘组织中均能检出;在45名孕妇血浆中,RASSF1A序列均能被检出,且序列内的SNP分型与相应胎儿组织一致;在10名非孕妇女血浆中均未检出RASSF1A序列。结论母体和胎儿DNA中RASSF1A基因启动子区域的甲基化模式存在差异,可用于对母体血浆中的游离胎儿DNA进行SNP分型。     

Identification of N,N-dimethylamphetamine formed by methylation of methamphetamine in formalin-fixed liver tissue by multistage mass spectrometry

Methamphetamine is methylated in the presence of unbuffered formalin solutions within hours at room temperature. The product, N,N-dimethylamphetamine, is also found in human liver exposed to methamphetamine followed by incubation with formalin. In the present study, a direct mass spectrometric method was developed to identify N,N-dimethylamphetamine in human liver before and after treatment with formalin. Human liver samples were obtained from four deaths that were investigated by the West Virginia Office of Chief Medical Examiner. Full toxicological analysis was conducted on samples from the decedents and methamphetamine was among the positive findings in each case. The method used to expose liver tissue to formaldehyde involved treating a small piece of liver from each case with formalin solution (20% v/v) for 24 h at room temperature. The formalin treated tissues were homogenized and the resulting suspension was sonicated for 5 min, and then centrifuged. Supernatant aliquots were directly analyzed by electrospray ionization (ESI) mass spectrometry without chromatographic isolation. Positive ion multistage mass spectra recorded in MS, MS/MS and MS/MS/MS (MS3) modes were used to confirm the presence of N,N-dimethylamphetamine and methamphetamine in the mixture. Liver tissue not treated with formalin did not contain a detectable level of N,N-dimethylamphetamine. Decreases in methamphetamine concentrations in liver tissue resulting from treatment with formalin were measured using deuterium-labeled methamphetamine as internal standard. The method can be completed in less than 2 h on thawed tissue. The results suggest that the process of fixing tissues with formalin may lead to false negative findings for methamphetamine.     

Towards molecular autopsies: Development of a FFPE tissue DNA extraction workflow

Sudden unexpected death (SUD) is a devastating event and forms a substantial proportion of the cases investigated at forensic mortuaries each year. Despite post-mortem investigations, the cause of death may remain undetermined. There is potential for these unresolved cases to benefit from retrospective molecular autopsies for investigation into genetic mutations which may have contributed towards death. Often, formalin fixed paraffin embedded tissues (FFPET) are the only archival sources of DNA available for retrospective analyses. However, extracting usable DNA from FFPET is challenging as current methods yield poor quality and quantity DNA. Thus, this study aimed to optimise DNA recovery from FFPET by investigating several variables within the DNA extraction workflow, including the selection of tissue type, number and thickness of tissue sections, deparaffinisation method, and DNA extraction kit. The quantity and quality of DNA recovered were assessed using spectrophotometry, real time PCR, digital capillary electrophoresis and DNA profiling. This study was the first to implement a nuclei quantification using microscopy to guide the selection of the best tissue type to use for DNA analysis. The use of a greater number of thinner tissue sections (100 sections, each 1 μm) significantly improved DNA concentration, purity and fragment length. Additionally, the combination of Deparaffinization Solution with the QIAamp® DNA FFPE Tissue Kit proved most favourable with a median DNA yield of 320 ng and 55% of DNA fragments greater than 400 bp. Isolated DNA was of single source, indicating no contamination in the workflow, and FFPET blocks that were stored for up to 3.5 years did not significantly affect DNA degradation (p = 0.1764). These results are especially informative for designing library preparation and sequencing workflows for determining cause of death in unresolved SUD cases.     

Release of tissue paraquat into formalin solution during fixation

Formalin-fixed tissues and formalin solutions are among the most frequently found materials in pathology and forensic science laboratories. However, these materials are seldom used for the identification of poisons for forensic toxicology purposes. In this study, the possibility that paraquat may be released from formalin-fixed tissues during the fixation process was investigated. However, because of the interference of formaldehyde on the reduction of paraquat with dithionite reagent, paraquat in formalin solutions was treated with ion-pair column chromatography and then determined by measuring the derivative spectrum of reduced paraquat. The results show that the interference of formalin on paraquat determination has been eliminated by the proposed method. Furthermore, a study on the formalin solutions of fixed organs in cases with suspected paraquat intoxication revealed that portions of tissue paraquat had been released into formalin during the fixation process. Moreover, the paraquat levels in formalin increased with increased storage time. Therefore, these data suggest that the combined concentrations of paraquat in the formalin-fixed tissues and formalin solutions might reflect more reliably the total paraquat in the postmortem tissues. This investigation could be of value to the forensic toxicologist, especially in cases in which no fresh tissue samples are available for analysis.     

Postmortem DNA and RNA synthesis. Preliminary studies in human cadavers

Postmortem DNA and RNA synthesis was detected in tissue specimens harvested from two cadavers at different intervals between 2.5 and 32 h postmortem. Each tissue specimen was incubated for 1 h in a 3H-thymidine or 3H-cytidine solution. DNA- as well as RNA-synthesizing cells were found in skin tissue and bone marrow throughout the interval investigated. Cytidine incorporation decreased progressively during the course of the postmortem interval. DNA and RNA synthesis was also observed in cells of the testis, which were predominantly spermatogonia cells in the case of DNA. Low-grade RNA synthesis was detected in bowel epithelial cells up to 2.5 h postmortem; DNA synthesis was not present during the interval investigated. No supravital phenomena were observable in the splenic tissues examined.     

Immunohistochemical staining as a potential method for the identification of vaginal epithelial cells in forensic casework

There is currently no accurate method to identify vaginal epithelial cells uniquely. This study aimed to use a cell extraction procedure compatible with routine forensic sampling methods, and to investigate the expression of cytokeratin (CK), estrogen receptor-alpha (ERalpha), and phosphodiesterase 5 (PDE5) in order to distinguish between skin, buccal, vaginal, and external penile epithelial cells. Seminal fluid samples were also examined. Epithelial cell samples were fixed in formalin, embedded in agarose, and processed using histological methods. Antigen-antibody reactions were detected using the DAKO Envision+ detection system. CK was present in all cells from all five sources confirming the origin of cells as epithelial. Both ERalpha and PDE5 positively labeled vaginal, buccal, and skin epithelial cells. Although an antigen unique to vaginal epithelial cells was not identified, we have described a cell extraction procedure for use in the immunohistochemical detection of a wide range of antigens, an approach compatible with forensic diagnostics.     

福尔马林固定石蜡包埋组织3种DNA提取方法比较

目的探讨经福尔马林固定1d石蜡包埋组织(FFPET)提取DNA的简易有效方法。方法比较水浴加热、微波加热和二甲苯脱蜡的效果。组织脱蜡后分别采用Chelex-100+层析柱纯化法、DNA IQTM试剂盒磁珠提取法和Chelex-100+磁珠纯化法提取DNA;实时荧光定量PCR技术定量DNA;荧光标记毛细管电泳技术进行STR分型。结果二甲苯脱蜡的效果好于其他两种加热的脱蜡方法(P<0.05)。Chelex-100+层析柱纯化所获得的DNA量显著高于其他两种方法(P<0.05)。结论二甲苯脱蜡、Chelex-100+层析柱纯化法是一种简单、有效的FFPET处理方法。     

DNA genotyping of unbuffered formalin fixed paraffin embedded tissues

Formalin-induced DNA degradation was studied at different fixation times (3, 7, 16 and 32 days) each on 10 formalin fixed paraffin embedded tissues (FFPET) stored for 15 years at room temperature.The four different extraction protocols used in this study showed that Chelex100 extracts performed the best at 3 and 7 days of formalin fixation (DFF) (with regard to the quantity and the quality of the DNA). However, Qiamp extracts showed better results for long sized alleles, as well for single polymerase chain reaction (PCR) amplifications after 16 and 32 DFF, as for multiplex PCR at shorter fixation times. DNA degradation is expressed by the size of the amplified alleles, only 100 bp templates surviving after 32 DFF (AMG locus). Single locus amplifications (CD4 and FES/FPS alleles) performed better than multiplex PCR (ProfilerPlus), with nearly 100% positive results at 7 DFF. In both types of amplifications, the success rate decreased proportionally with the time of formalin fixation and, consequently, with the size of the required DNA template.