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Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study
BACKGROUND: COVID-19 is characterised by respiratory symptoms, which deteriorate into respiratory failure in a substantial proportion of cases, requiring intensive care in up to a third of patients admitted to hospital. Analysis of the pathological features in the lung tissues of patients who have d...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier Ltd.
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7279758/ https://www.ncbi.nlm.nih.gov/pubmed/32526193 http://dx.doi.org/10.1016/S1473-3099(20)30434-5 |
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author | Carsana, Luca Sonzogni, Aurelio Nasr, Ahmed Rossi, Roberta Simona Pellegrinelli, Alessandro Zerbi, Pietro Rech, Roberto Colombo, Riccardo Antinori, Spinello Corbellino, Mario Galli, Massimo Catena, Emanuele Tosoni, Antonella Gianatti, Andrea Nebuloni, Manuela |
author_facet | Carsana, Luca Sonzogni, Aurelio Nasr, Ahmed Rossi, Roberta Simona Pellegrinelli, Alessandro Zerbi, Pietro Rech, Roberto Colombo, Riccardo Antinori, Spinello Corbellino, Mario Galli, Massimo Catena, Emanuele Tosoni, Antonella Gianatti, Andrea Nebuloni, Manuela |
author_sort | Carsana, Luca |
collection | PubMed |
description | BACKGROUND: COVID-19 is characterised by respiratory symptoms, which deteriorate into respiratory failure in a substantial proportion of cases, requiring intensive care in up to a third of patients admitted to hospital. Analysis of the pathological features in the lung tissues of patients who have died with COVID-19 could help us to understand the disease pathogenesis and clinical outcomes. METHODS: We systematically analysed lung tissue samples from 38 patients who died from COVID-19 in two hospitals in northern Italy between Feb 29 and March 24, 2020. The most representative areas identified at macroscopic examination were selected, and tissue blocks (median seven, range five to nine) were taken from each lung and fixed in 10% buffered formalin for at least 48 h. Tissues were assessed with use of haematoxylin and eosin staining, immunohistochemical staining for inflammatory infiltrate and cellular components (including staining with antibodies against CD68, CD3, CD45, CD61, TTF1, p40, and Ki-67), and electron microscopy to identify virion localisation. FINDINGS: All cases showed features of the exudative and proliferative phases of diffuse alveolar damage, which included capillary congestion (in all cases), necrosis of pneumocytes (in all cases), hyaline membranes (in 33 cases), interstitial and intra-alveolar oedema (in 37 cases), type 2 pneumocyte hyperplasia (in all cases), squamous metaplasia with atypia (in 21 cases), and platelet–fibrin thrombi (in 33 cases). The inflammatory infiltrate, observed in all cases, was largely composed of macrophages in the alveolar lumina (in 24 cases) and lymphocytes in the interstitium (in 31 cases). Electron microscopy revealed that viral particles were predominantly located in the pneumocytes. INTERPRETATION: The predominant pattern of lung lesions in patients with COVID-19 patients is diffuse alveolar damage, as described in patients infected with severe acute respiratory syndrome and Middle East respiratory syndrome coronaviruses. Hyaline membrane formation and pneumocyte atypical hyperplasia are frequent. Importantly, the presence of platelet–fibrin thrombi in small arterial vessels is consistent with coagulopathy, which appears to be common in patients with COVID-19 and should be one of the main targets of therapy. FUNDING: None. |
format | Online Article Text |
id | pubmed-7279758 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Elsevier Ltd. |
record_format | MEDLINE/PubMed |
spelling | pubmed-72797582020-06-09 Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study Carsana, Luca Sonzogni, Aurelio Nasr, Ahmed Rossi, Roberta Simona Pellegrinelli, Alessandro Zerbi, Pietro Rech, Roberto Colombo, Riccardo Antinori, Spinello Corbellino, Mario Galli, Massimo Catena, Emanuele Tosoni, Antonella Gianatti, Andrea Nebuloni, Manuela Lancet Infect Dis Articles BACKGROUND: COVID-19 is characterised by respiratory symptoms, which deteriorate into respiratory failure in a substantial proportion of cases, requiring intensive care in up to a third of patients admitted to hospital. Analysis of the pathological features in the lung tissues of patients who have died with COVID-19 could help us to understand the disease pathogenesis and clinical outcomes. METHODS: We systematically analysed lung tissue samples from 38 patients who died from COVID-19 in two hospitals in northern Italy between Feb 29 and March 24, 2020. The most representative areas identified at macroscopic examination were selected, and tissue blocks (median seven, range five to nine) were taken from each lung and fixed in 10% buffered formalin for at least 48 h. Tissues were assessed with use of haematoxylin and eosin staining, immunohistochemical staining for inflammatory infiltrate and cellular components (including staining with antibodies against CD68, CD3, CD45, CD61, TTF1, p40, and Ki-67), and electron microscopy to identify virion localisation. FINDINGS: All cases showed features of the exudative and proliferative phases of diffuse alveolar damage, which included capillary congestion (in all cases), necrosis of pneumocytes (in all cases), hyaline membranes (in 33 cases), interstitial and intra-alveolar oedema (in 37 cases), type 2 pneumocyte hyperplasia (in all cases), squamous metaplasia with atypia (in 21 cases), and platelet–fibrin thrombi (in 33 cases). The inflammatory infiltrate, observed in all cases, was largely composed of macrophages in the alveolar lumina (in 24 cases) and lymphocytes in the interstitium (in 31 cases). Electron microscopy revealed that viral particles were predominantly located in the pneumocytes. INTERPRETATION: The predominant pattern of lung lesions in patients with COVID-19 patients is diffuse alveolar damage, as described in patients infected with severe acute respiratory syndrome and Middle East respiratory syndrome coronaviruses. Hyaline membrane formation and pneumocyte atypical hyperplasia are frequent. Importantly, the presence of platelet–fibrin thrombi in small arterial vessels is consistent with coagulopathy, which appears to be common in patients with COVID-19 and should be one of the main targets of therapy. FUNDING: None. Elsevier Ltd. 2020-10 2020-06-08 /pmc/articles/PMC7279758/ /pubmed/32526193 http://dx.doi.org/10.1016/S1473-3099(20)30434-5 Text en © 2020 Elsevier Ltd. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Articles Carsana, Luca Sonzogni, Aurelio Nasr, Ahmed Rossi, Roberta Simona Pellegrinelli, Alessandro Zerbi, Pietro Rech, Roberto Colombo, Riccardo Antinori, Spinello Corbellino, Mario Galli, Massimo Catena, Emanuele Tosoni, Antonella Gianatti, Andrea Nebuloni, Manuela Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study |
title | Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study |
title_full | Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study |
title_fullStr | Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study |
title_full_unstemmed | Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study |
title_short | Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study |
title_sort | pulmonary post-mortem findings in a series of covid-19 cases from northern italy: a two-centre descriptive study |
topic | Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7279758/ https://www.ncbi.nlm.nih.gov/pubmed/32526193 http://dx.doi.org/10.1016/S1473-3099(20)30434-5 |
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