Pathological Study of the 2019 Novel Coronavirus Disease (COVID-19) through Post-Mortem Core Biopsies

Abstract

Data on pathologic changes of the 2019 novel coronavirus disease (COVID-19) are scarce. To gain knowledge about the pathology that may contribute to disease progression and fatality, we performed post-mortem needle core biopsies of lung, liver, and heart in four patients who died of COVID-19 pneumonia. The patients’ ages ranged from 59 to 81, including 3 males and 1 female. Each patient had at least one underlying disease, including immunocompromised status (chronic lymphocytic leukemia and renal transplantation) or other conditions (cirrhosis, hypertension, and diabetes). Time from disease onset to death ranged from 15 to 52 days. All patients had elevated white blood cell counts, with significant rise toward the end, and all had lymphocytopenia except for the patient with leukemia. Histologically, the main findings are in the lungs, including injury to the alveolar epithelial cells, hyaline membrane formation, and hyperplasia of type II pneumocytes, all components of diffuse alveolar damage. Consolidation by fibroblastic proliferation with extracellular matrix and fibrin forming clusters in airspaces is evident. In one patient, the consolidation consists of abundant intra-alveolar neutrophilic infiltration, consistent with superimposed bacterial bronchopneumonia. The liver exhibits mild lobular infiltration by small lymphocytes, and centrilobular sinusoidal dilation. Patchy necrosis is also seen. The heart shows only focal mild fibrosis and mild myocardial hypertrophy, changes likely related to the underlying conditions. In conclusion, the post-mortem examinations show advanced diffuse alveolar damage, as well as superimposed bacterial pneumonia in some patients. Changes in the liver and heart are likely secondary or related to the underlying diseases.

Pulmonary and systemic involvement in COVID‐19 patients assessed with ultrasound‐guided minimally invasive autopsy

“…9,32 Previous reports of autopsy series of COVID-19 patients have also shown that exudative DAD is a major finding. [10][11][12][13] A mixed pattern of exudative/proliferative DAD, observed in most of our patients and also by others, indicates the progression of the lung injury, probably related to both the temporal evolution of the injury and the effects of mechanical ventilation. 7,10 Three of our patients showed a mixed pattern of DAD, even with a short period from symptom onset to death.…”

“…[10][11][12][13] A mixed pattern of exudative/proliferative DAD, observed in most of our patients and also by others, indicates the progression of the lung injury, probably related to both the temporal evolution of the injury and the effects of mechanical ventilation. 7,10 Three of our patients showed a mixed pattern of DAD, even with a short period from symptom onset to death. Although there is a direct relationship between the duration of DAD and fibroproliferation, fibroproliferative changes may start early in the course of the disease.…”

“…Secondary bacterial pneumonia, which was a frequent finding in our series, has also been described in other reports. 7,10 The main extrapulmonary findings are related to comorbidities, such as diabetes mellitus and hypertension, and also reflect changes associated with septic shock (splenitis, neutrophilic infiltration in the hepatic sinusoids, and lymphoid hypoplasia). 2,6,33 However, it is likely that some changes in other organs can be attributed to viral disease-superficial perivascular dermatitis, myositis, orchitis, myocarditis, and alterations in the renal glomeruli, endothelium of small vessels, and cerebral cortex.…”

“…However, the number of autopsies reported up to now is small, and tissue sampling is often limited to a few organs, mostly the lungs, liver, and heart. [6][7][8][9][10][11][12][13] The scarce literature on COVID-19 autopsies markedly contrasts with the high number of deaths, probably because of the risk of contagion. In addition, strict protection procedures were recommended for autopsies of COVID-19 patients, restricting autopsies to a limited number of institutions.…”

COVID-19 Autopsies, Oklahoma, USA

“…11 Another recent report, an analysis of core biopsies obtained postmortem from four COVID-19 patients with a minimum of 15 days of symptoms, describes DAD in all biopsies, with superimposed bacterial pneumonia in one. 12 The aim of this report is to share our observations on the pathology of COVID-19 based on complete autopsies in two individuals who died in Oklahoma during the COVID-19 pandemic and were found to be positive for SARS-CoV-2 by postmortem testing. We also wish to share our experience regarding the precautions and personal protective equipment (PPE) used during these autopsies.…”