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Published on: June 5, 2021
Postmortem examination of three SARS-CoV-2-positive autopsies including histopathologic and immunohistochemical
George-Călin Oprinca1,2, Lilioara-Alexandra Muja3,4
1Department of Anatomical Pathology, County Clinical Emergency Hospital of Sibiu, Corneliu Coposu Boulevard 2-4, 550245, Sibiu, Romania. george_oprinca@yahoo.com.
Abstract:
This paper describes three autopsy cases with postmortem diagnosis of SARS-CoV-2 infection, with detailed macroscopic examination as well as advanced microscopic studies of organ tissues collected using hematoxylin-eosin stains and immunohistochemical markers. Two of the cases were admitted briefly in the County Clinical Emergency Hospital of Sibiu, and one was found deceased at his home address. All three autopsies were completed at the County morgue, in the COVID-19 restricted area, using complete protective equipment. The lungs of the patients seemed to be the center organ of invasion and pathogenesis of the novel coronavirus with diffuse areas of condensation, subpleural retraction zones but with different aspect of the classic bacterial bronchopneumonia. Microscopic evaluation revealed viral cytopathic effect of type II pneumocytes with a couple of cells that presented cytoplasmic and nuclear inclusions and who tend to form clusters mimicking multinucleated giant cells. Hyaline membranes and destruction of the alveolar wall as well as microthrombi formation within the small blood vessels were constantly found in almost all our three cases. The spleen had sustained white pulp atrophy with absence of lymphoid follicles. There were no microscopic signs of viral infection on the myocardium or the other organs.
Insights
Autopsy findings reveal severe lung damage in three SARS-CoV-2 (COVID-19) cases, including viral effects on pneumocytes and microthrombi. Spleen atrophy was also observed, indicating systemic impact.
Area of Science:
- Pathology
- Virology
- Pulmonology
Background:
- Investigating the postmortem pathological changes associated with SARS-CoV-2 (COVID-19) infection.
- Examining three autopsy cases to understand the organ-specific impact of the novel coronavirus.
Observation:
- Macroscopic examination revealed diffuse lung condensation and subpleural retraction zones, distinct from typical bacterial bronchopneumonia.
- Microscopic analysis showed viral cytopathic effects on type II pneumocytes, including cytoplasmic/nuclear inclusions and multinucleated giant cell formation.
- Constant findings included hyaline membranes, alveolar wall destruction, and microthrombi in small lung vessels across all cases.
Findings:
- The lungs were the primary organ affected, demonstrating significant pathological changes indicative of severe viral pneumonia.
- Microscopic evidence of viral cytopathic effects and microthrombi formation highlights the lung's central role in SARS-CoV-2 pathogenesis.
- Sustained white pulp atrophy with lymphoid follicle absence was noted in the spleen, suggesting broader systemic immune response or impact.
Implications:
- These findings underscore the severe pulmonary pathology caused by SARS-CoV-2 and its potential to induce microvascular thrombosis.
- The observed splenic changes suggest a potential impact on the immune system beyond the respiratory tract.
- Detailed autopsy studies are crucial for fully understanding the multi-organ effects and pathogenesis of novel viral infections like COVID-19.
