Vascular/epithelial changes as late sequelae after recovery from SARS‐COV‐2 infection: an in‐vivo comparative study

Abstract

Aims While there is partial evidence of lung lesions in patients suffering from long COVID there are substantial concerns about lung remodelling sequelae after COVID‐19 pneumonia. The aim of the present retrospective comparative study was to ascertain morphological features in lung samples from patients undergoing tumour resection several months after SARS‐CoV‐2 infection. Methods and results The severity of several lesions with a major focus on the vascular bed was analysed in 2 tumour‐distant lung fragments of 41 cases: 21 SARS‐CoV‐2 (+) lung tumour (LT) patients and 20 SARS‐CoV‐2 (−) LT patients. A systematic evaluation of several lesions was carried out by combining their scores into a grade of I–III. Tissue SARS‐CoV‐2 genomic/subgenomic transcripts were also investigated. Morphological findings were compared with clinical, laboratory and radiological data. SARS‐CoV‐2 (+) LT patients with previous pneumonia showed more severe parenchymal and vascular lesions than those found in SARS‐CoV‐2 (+) LT patients without pneumonia and SARS‐CoV‐2 (−) LT patients, mainly when combined scores were used. SARS‐CoV‐2 viral transcripts were not detected in any sample. SARS‐CoV‐2 (+) LT patients with pneumonia showed a significantly higher radiological global injury score. No other associations were found between morphological lesions and clinical data. Conclusions To our knowledge, this is the first study that, after a granular evaluation of tissue parameters, detected several changes in lungs from patients undergoing tumour resection after SARS‐CoV‐2 infection. These lesions, in particular vascular remodelling, could have an important impact overall on the future management of these frail patients.