Pathological study of the 2019 novel coronavirus disease (COVID-19) through postmortem core biopsies

Abstract

Data on pathologic changes of the 2019 novel coronavirus disease are scarce. To gain knowledge about the pathology that may contribute to disease progression and fatality, we performed postmortem 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 three males and one 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 postmortem 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.

Analysis of Mortality in Patients With COVID-19: Clinical and Laboratory Parameters

“…The CBC profile from the first day postop showed high WBC counts and lymphocytopenia before the positive CT and nuclear acid test, suggesting that this CBC profile may serve as a good clue for early diagnosis in the future. Third, as seen in another study of ours [11], superimposed bacterial infection can be seen a portion of patients, which can lead to elevation of WBC.…”

SARS-CoV-2 Infection-Associated Hemophagocytic Lymphohistiocytosis: An autopsy series with clinical and laboratory correlation

“…Most have focused on pulmonary findings either from resections for lung cancer or post-mortem tissue biopsy of lung, heart, and liver. [9][10][11][12] Given the reports of a subset of patients exhibiting clinical features of cytokine storm 5 , we studied our first four autopsies of COVID-19 patients for histologic evidence of hemophagocytosis within the reticuloendothelial organs (lymph node, spleen, bone marrow, and liver) and correlate with clinical and laboratory parameters to detect the syndrome of HLH.…”

“…[6][7][8] Despite these clinical observations, there has been relatively little clinicopathologic correlation with the post-mortem findings in COVID-19 which to date have generally focused on the pulmonary histology of diffuse alveolar damage. [9][10][11][12] Herein we report the first cases of SARS-CoV-2 associated HLH diagnosed post-mortem using histologic, clinical and laboratory criteria.…”

The first, holistic immunological model of COVID‐19: Implications for prevention, diagnosis, and public health measures

“…Post-mortem analysis of lung diseases showed diffuse alveolar damage, including injury to the alveolar epithelial cells, hyaline membrane formation, fibrin deposition, and hyperplasia of type II pneumocytes. 109…”