Postmortem Biopsies of the Lung, Heart, Liver, and Spleen of COVID-19 Patients

Abstract

Objective We aimed to evaluate histopathologic alterations in the lung, heart, liver, and spleen of coronavirus disease 2019 (COVID-19) decedents through postmortem core needle biopsies. Materials and methods Patients who died of reverse transcription-polymerase chain reaction-proven COVID-19 were included in this postmortem case series. Postmortem percutaneous ultrasound-guided biopsies of the lungs, heart, liver, and spleen were performed using 14- and 16-gauge needles. Biopsy samples were stained with hematoxylin-eosin and examined under a light microscope. Clinicodemographic characteristics, chest computed tomography (CT) images, and COVID-19-related treatments of the patients were also collected. Results Seven patients were included in this study. Liver and heart tissue samples were available from all patients, and lung and spleen tissue samples were available from five and three patients, respectively. Chest CT images predominantly revealed bibasilar ground-glass opacities. Lung biopsies showed diffuse alveolar damage in all biopsy specimens. Heart findings were nonspecific and largely compatible with the underlying disease. Patchy necrosis, steatosis, and mononuclear cell infiltration were the main findings in the liver biopsies. Splenic histopathological examination showed that splenic necrosis and neutrophil infiltration were common findings in all patients. Conclusion Tissue acquisition was complete for the heart and liver and acceptable for the lungs. The amount of tissue was sufficient for a proper histopathologic examination. Histopathological findings were generally in accordance with previous autopsy studies. Radiological findings of the lung were also correlated with the histopathologic findings. We consider that a postmortem biopsy is a feasible alternative for histopathological examinations in COVID-19 decedents.

Histopathological impact of SARS-CoV-2 on the liver: Cellular damage and long-term complications

“…Necrosis predominantly affects centrilobular areas, and occasionally midzonal areas with confluent necrosis have been reported[ 30 , 32 , 43 , 47 ]. Necrosis is a common finding, reported in as many as 86% of cases[ 43 , 48 ]. Within hepatic parenchyma, multiple foci of necroinflammatory activity have been observed[ 33 ], sometimes with extensive hepatocyte necrosis or patchy necrosis[ 33 , 48 - 50 ].…”

Non-metabolic causes of steatotic liver disease

“…Most samples are retrieved postmortem and reflect a very selected population, and furthermore, most studies are written on available data during autopsy; hence, clinical data are limited. Nevertheless, histological samples on approximately 270 patients who died secondary to COVID-19 can be found in the literature, of whom 57% have hepatic steatosis, often mild, and difficult to distinguish from, e.g., shock/SIRS, drug-induced liver injury, or metabolic syndrome [130,131,[134][135][136][137][138][139][140][141][142][143][144][145][146][147][148][149][150][151][152][153] .…”

Pulmonary Vascular Thrombosis in COVID-19: Clinical and Morphological Parallels

“…Следствием иммунотромбоза становится тромботическое поражение сосудов легочного русла, резистентное к антикоагулянтной терапии из-за неконтролируемой гиперкоагуляции [3,14,15,33,34]. Тромботическое поражение бассейна легочной артерии, в том числе, изолированное, охватывает крупные и мелкие ветви легочной артерии (долевые, сегментарные и субсегментарные), а также сосуды микроциркуляторного русла [35,36]. Результаты систематического обзора демонстрируют поражение главной ЛА у 13,5% пациентов, ветвей мелкого и среднего калибра -у 100% [29].…”