Pulmonary Pathology of Early Phase 2019 Novel Coronavirus (COVID-19) Pneumonia in Two Patients with Lung Cancer

Abstract

There is currently a lack of pathologic data on the novel coronavirus (SARS-CoV-2) pneumonia, or COVID-19, from autopsy or biopsy. Two patients who recently underwent lung lobectomies for adenocarcinoma were retrospectively found to have had COVID-19 at the time of surgery. These two cases thus provide important first opportunities to study the pathology of COVID-19. Pathologic examinations revealed that, apart from the tumors, the lungs of both patients exhibited edema, proteinaceous exudate, focal reactive hyperplasia of pneumocytes with patchy inflammatory cellular infiltration, and multinucleated giant cells. Hyaline membranes were not prominent.Since both patients did not exhibit symptoms of pneumonia at the time of surgery, these changes likely represent an early phase of the lung pathology of COVID-19 pneumonia.

Virologic and clinical characteristics for prognosis of severe COVID-19: a retrospective observational study in Wuhan, China

“…Currently, more than 823, 626 people have contracted the virus and more than 40, 598 have died worldwide. Robust research is ongoing to help better understand this novel virus [2][3][4][5][6][7] . However, we still understand little about the virologic characteristics of SARS-CoV-2, and scarce data are available in terms of the risk factors associated with refractory COVID-19.…”

Bioinformatic characterization of angiotensin-converting enzyme 2, the entry receptor for SARS-CoV-2

“…The dataset we studied included neither the AT2 nor secretory3 cells that have been recently shown positive for ACE2 (48). The results suggest that SARS-CoV infection may target the cell types that are important for the protection of airway mucosa and their damage may lead to deterioration of epithelial cell function, finally leading to a more severe lung disease with accumulation of alveolar exudate and inflammatory cells and lung edema, the signs of pneumonia recently described in the lung specimens of two patients with COVID-19 infection (60). Gene ontology analysis suggested that ACE2 is involved in angiogenesis/blood vessel morphogenesis processes in addition to its classical function in renin-angiotensin system.…”

Is there a role for tissue plasminogen activator as a novel treatment for refractory COVID-19 associated acute respiratory distress syndrome?

“…[3][4][5] Similar pathologic findings have now been observed in lung specimens from patients infected with COVID-19. 6 This physiologically destructive activation of the clotting system in ARDS results from enhanced activation and propagation of clot formation together with suppression of fibrinolysis, [7][8][9] and is thought to be mediated by dysfunction of the pulmonary endothelium in the case of influenza A. 10 Targeting the coagulation and fibrinolytic systems to improve the treatment of ARDS has been proposed since at least 2003.…”