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Now published in The Lancet

Pulmonary Post-Mortem Findings in a Large Series of COVID-19 Cases from Northern Italy

15 Pages Posted: 11 Jun 2020

See all articles by Luca Carsana

Luca Carsana

Sacco Hospital-ASST Fatebenefratelli-Sacco Milan - Pathology Unit

Aurelio Sonzogni

Papa Giovanni XXIII Hospital - Department of Pathology

Ahmed Nasr

Papa Giovanni XXIII Hospital - Department of Pathology

Roberta Simona Rossi

Sacco Hospital-ASST Fatebenefratelli-Sacco Milan - Pathology Unit

Alessandro Pellegrinelli

Sacco Hospital-ASST Fatebenefratelli-Sacco Milan - Pathology Unit

Pietro Zerbi

Sacco Hospital-ASST Fatebenefratelli-Sacco Milan - Pathology Unit

Roberto Rech

Sacco Hospital-ASST Fatebenefratelli-Sacco Milan - Department of Anesthesiology and Intensive Care Unit

Riccardo Colombo

Sacco Hospital-ASST Fatebenefratelli-Sacco Milan - Department of Anesthesiology and Intensive Care Unit

Spinello Antinori

Università degli Studi di Milano - Dipartimento di Scienze Biomediche e Cliniche “Luigi Sacco”

Mario Corbellino

Sacco Hospital-ASST Fatebenefratelli-Sacco Milan - Department of Infectious Diseases

Massimo Galli

University of Milan

Emanuele Catena

Sacco Hospital-ASST Fatebenefratelli-Sacco Milan - Department of Anesthesiology and Intensive Care Unit

Antonella Tosoni

Sacco Hospital-ASST Fatebenefratelli-Sacco Milan - Pathology Unit

Andrea Gianatti

Papa Giovanni XXIII Hospital - Department of Pathology and Laboratory Medicine

Manuela Nebuloni

University of Milan - Luigi Sacco Department of Biomedical and Clinical Science

More...

Abstract

Importance: The analysis of lung tissues of patients with COVID-19 may help understand pathogenesis and clinical outcomes in this life-threatening respiratory illness.

Objective: To determine the histological patterns in lung tissue of patients with severe COVID-19.

Design and Participants: Lungs tissues of 38 cases who died for COVID-19 in two hospital of Northern Italy were systematically analysed. Hematoxylin-eosin staining, immunohistochemistry for the inflammatory infiltrate and cellular components, electron microscopy were performed.

Results: The features of the exudative and proliferative phases of Diffuse Alveolar Disease (DAD) were found: capillary congestion, necrosis of pneumocytes, hyaline membrane, interstitial oedema, pneumocyte hyperplasia and reactive atypia, platelet-fibrin thrombi. The inflammatory infiltrate was composed by macrophages in alveolar lumens and lymphocytes mainly in the interstitium. Electron microscopy revealed viral particles within cytoplasmic vacuoles of pneumocytes.

Conclusions and Relevance: The predominant pattern of lung lesions in COVID-19 patients is DAD, as described for the other two coronavirus that infect humans, SARS-CoV and MERS-CoV. Hyaline membrane formation and pneumocyte atypical hyperplasia are frequently found. The main relevant finding is the presence of platelet-fibrin thrombi in small arterial vessels; this important observation fits into the clinical context of coagulopathy which dominates in these patients and which is one of the main targets of therapy.

Funding Statement: No Funding

Declaration of Interests: No Conflict of Interest

Ethics Approval Statement: Tissue samples were taken as part of routine autopsies

Keywords: Lung histopathology in COVID 19 infection

Suggested Citation

Carsana, Luca and Sonzogni, Aurelio and Nasr, Ahmed and Rossi, Roberta Simona and Pellegrinelli, Alessandro and Zerbi, Pietro and Rech, Roberto and Colombo, Riccardo and Antinori, Spinello and Corbellino, Mario and Galli, Massimo and Catena, Emanuele and Tosoni, Antonella and Gianatti, Andrea and Nebuloni, Manuela, Pulmonary Post-Mortem Findings in a Large Series of COVID-19 Cases from Northern Italy (April 8, 2020). Available at SSRN: https://ssrn.com/abstract=3572890 or http://dx.doi.org/10.2139/ssrn.3572890

Luca Carsana

Sacco Hospital-ASST Fatebenefratelli-Sacco Milan - Pathology Unit

Milan
Italy

Aurelio Sonzogni

Papa Giovanni XXIII Hospital - Department of Pathology ( email )

Bergamo
Italy

Ahmed Nasr

Papa Giovanni XXIII Hospital - Department of Pathology

Bergamo
Italy

Roberta Simona Rossi

Sacco Hospital-ASST Fatebenefratelli-Sacco Milan - Pathology Unit

Milan
Italy

Alessandro Pellegrinelli

Sacco Hospital-ASST Fatebenefratelli-Sacco Milan - Pathology Unit

Milan
Italy

Pietro Zerbi

Sacco Hospital-ASST Fatebenefratelli-Sacco Milan - Pathology Unit

Milan
Italy

Roberto Rech

Sacco Hospital-ASST Fatebenefratelli-Sacco Milan - Department of Anesthesiology and Intensive Care Unit

Milan
Italy

Riccardo Colombo

Sacco Hospital-ASST Fatebenefratelli-Sacco Milan - Department of Anesthesiology and Intensive Care Unit

Milan
Italy

Spinello Antinori

Università degli Studi di Milano - Dipartimento di Scienze Biomediche e Cliniche “Luigi Sacco” ( email )

Milan
Italy

Mario Corbellino

Sacco Hospital-ASST Fatebenefratelli-Sacco Milan - Department of Infectious Diseases

Milan
Italy

Massimo Galli

University of Milan

Via Festa del Perdono, 7
Milan, 20122
Italy

Emanuele Catena

Sacco Hospital-ASST Fatebenefratelli-Sacco Milan - Department of Anesthesiology and Intensive Care Unit

Milan
Italy

Antonella Tosoni

Sacco Hospital-ASST Fatebenefratelli-Sacco Milan - Pathology Unit

Milan
Italy

Andrea Gianatti

Papa Giovanni XXIII Hospital - Department of Pathology and Laboratory Medicine

Bergamo
Italy

Manuela Nebuloni (Contact Author)

University of Milan - Luigi Sacco Department of Biomedical and Clinical Science ( email )

Via Festa del Perdono, 7
Milan, 20122
Italy

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