Pulmonary histopathological findings in Covid-19 patients: based on minimally invasive autopsies

Hallazgos histopatológicos pulmonares en COVID-19. Experiencia de autopsias mínimamente invasivas

Introduction: COVID-19 is caused by the SARS-CoV-2 virus. Its clinical presentation varies from asymptomatic patients to severe manifestations. During the pandemic, autopsies have allowed the recognition of changes in different organs, with the lung being the main affected organ. The aim of this study is reporting our experience derived from pulmonary histopathological findings, based on the minimally invasive autopsy method. Methodology: samples were taken in the immediate postmortem (one hour) period from 8 patients who died with PCR-confirmed COVID-19, in the intensive care unit (ICU) of Hospital de San José, Bogotá, Colombia.  Tissue specimens were analyzed independently by two pathologists. Results: all specimens exhibited, diffuse alveolar damage (DAD) in exudative or proliferative phases, or both, in addition to bronchopneumonia and interstitial pneumonitis. Discussion: the lung is the main organ affected by SARS-CoV-2 and the most frequent histopathologic finding is exudative phase or various phases DAD. Alterations in different systems have also been described. Conclusions: the most frequent histopathological finding is DAD in any of its phases. Minimally invasive autopsy is considered a very useful alternative when conventional autopsy cannot be performed, since it does not have major restrictions and allows collecting viable samples.

1. Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review. JAMA. 2020;324(8):782–793. doi: 10.1001/jama.2020.12839
2. Xu H, Zhong L, Deng J, Peng J, Dan H, Zeng X, et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci. 2020;12(1):8. doi: 10.1038/s41368-020-0074-x
3. Tu H, Tu S, Gao S, Shao A, Sheng J. Current epidemiological and clinical features of COVID-19; a global perspective from China. J Infect. 2020;81(1):1-9. https://doi.org/10.1016/j.jinf.2020.04.011
4. Schwartz DA, Herman CJ. The importance of the autopsy in emerging and reemerging infectious diseases. Clin Infect Dis. 1996;23(2):248–54. doi: 10.1093/clinids/23.2.248
5. Polak SB, Van Gool IC, Cohen D, von der Thüsen JH, van Paassen J. A systematic review of pathological findings in COVID-19: a pathophysiological timeline and possible mechanisms of disease progression. Mod Pathol. 2020;33(11):2128-2138. doi: 10.1038/s41379-020-0603-3
6. Deshmukh V, Motwani R, Kumar A, Kumari C, Raza K. Histopathological observations in COVID-19: a systematic review. J Clin Pathol. J Clin Pathol. 2021;74(2):76-83. doi: 10.1136/jclinpath-2020-206995
7. Hanley B, Naresh KN, Roufosse C, Nicholson AG, Weir J, Cooke GS, et al. Histopathological findings and viral tropism in UK patients with severe fatal COVID-19: a post-mortem study. Lancet Microbe. 2020;1(6):e245–53. doi: 10.1016/S2666-5247(20)30115-4
8. Parra-Medina R, Herrera S, Mejia J. Systematic Review of Microthrombi in COVID-19 Autopsies. Acta Haematol. 2021;144(5):476-483. doi: 10.1159/000515104
9. Peiris S, Mesa H, Aysola A, Manivel J, Toledo J, Borges-Sa M, et al. Pathological findings in organs and tissues of patients with COVID-19: A systematic review. PLoS One. 2021;16(4):e0250708. doi: 10.1371/journal.pone.0250708
10. Duarte-Neto AN, da Silva LFF, Monteiro RAA, Theodoro-Filho J, et al. Ultrasound-Guided Minimally Invasive Tissue Sampling: A Minimally Invasive Autopsy Strategy During the COVID-19 Pandemic in Brazil, 2020. Clin Infect Dis. 2021;73(Suppl_5):S442-S453. doi: 10.1093/cid/ciab885
11. Li Y, Wu J, Wang S, Li X, Zhou J, Huang B, Luo D, Cao Q, Chen Y, Chen S, Ma L, Peng L, Pan H, Travis WD, Nie X. Progression to fibrosing diffuse alveolar damage in a series of 30 minimally invasive autopsies with COVID-19 pneumonia in Wuhan, China. Histopathology. 2021;78(4):542-555. doi: 10.1111/his.14249
12. Duarte-Neto AN, Monteiro RAA, da Silva LFF, Malheiros DMAC, de Oliveira EP, Theodoro-Filho J, et al. Pulmonary and systemic involvement in COVID-19 patients assessed with ultrasound-guided minimally invasive autopsy. Histopathology. 2020 Aug;77(2):186-197. doi: 10.1111/his.14160
13. Brook OR, Piper KG, Mercado NB, Gebre MS, Barouch DH, Busman-Sahay K, Starke CE, Estes JD, Martinot AJ, Wrijil L, Ducat S, Hecht JL. Feasibility and safety of ultrasound-guided minimally invasive autopsy in COVID-19 patients. Abdom Radiol (NY). 2021;46(3):1263-1271. doi: 10.1007/s00261-020-02753-7