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COVID-19 pulmonary pathology: a multi-institutional autopsy cohort from Italy and New York City.
Mod Pathol. 2020 11; 33(11):2156-2168.MP

Abstract

SARS-CoV-2, the etiologic agent of COVID-19, is a global pandemic with substantial mortality dominated by acute respiratory distress syndrome. We systematically evaluated lungs of 68 autopsies from 3 institutions in heavily hit areas (2 USA, 1 Italy). Detailed evaluation of several compartments (airways, alveolar walls, airspaces, and vasculature) was performed to determine the range of histologic features. The cohort consisted of 47 males and 21 females with a median age of 73 years (range 30-96). Co-morbidities were present in most patients with 60% reporting at least three conditions. Tracheobronchitis was frequently present, independent from intubation or superimposed pneumonia. Diffuse alveolar damage (DAD) was seen in 87% of cases. Later phases of DAD were less frequent and correlated with longer duration of disease. Large vessel thrombi were seen in 42% of cases but platelet (CD61 positive) and/or fibrin microthrombi were present at least focally in 84%. Ultrastructurally, small vessels showed basal membrane reduplication and significant endothelial swelling with cytoplasmic vacuolization. In a subset of cases, virus was detected using different tools (immunohistochemistry for SARS-CoV-2 viral spike protein, RNA in situ hybridization, lung viral culture, and electron microscopy). Virus was seen in airway epithelium and type 2 pneumocytes. IHC or in situ detection, as well as viable form (lung culture positive) was associated with the presence of hyaline membranes, usually within 2 weeks but up to 4 weeks after initial diagnosis. COVID-19 pneumonia is a heterogeneous disease (tracheobronchitis, DAD, and vascular injury), but with consistent features in three centers. The pulmonary vasculature, with capillary microthrombi and inflammation, as well as macrothrombi, is commonly involved. Viral infection in areas of ongoing active injury contributes to persistent and temporally heterogeneous lung damage.

Authors+Show Affiliations

Department of Pathology and Laboratory Medicine, New-York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA. alb9003@med.cornell.edu.Department of Pathology and Laboratory Medicine, New-York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.Department of Pathology and Laboratory Medicine, New-York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.Department of Pathology and Laboratory Medicine, New-York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.Department of Pediatrics, New-York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.Department of Pathology and Laboratory Medicine, New-York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.Department of Pathology and Laboratory Medicine, New-York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.Department of Pathology and Laboratory Medicine, New-York Presbyterian Hospital-Weill Cornell Medicine, New York, NY, USA.Department of Molecular Medicine, Padua University Hospital, Padua, Italy.Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, Padua, Italy.Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, Padua, Italy.Department of Medicine, Padua University Hospital, Padua, Italy.Department of Molecular Medicine, Padua University Hospital, Padua, Italy.Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University Hospital, Padua, Italy.Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

32879413

Citation

Borczuk, Alain C., et al. "COVID-19 Pulmonary Pathology: a Multi-institutional Autopsy Cohort From Italy and New York City." Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc, vol. 33, no. 11, 2020, pp. 2156-2168.
Borczuk AC, Salvatore SP, Seshan SV, et al. COVID-19 pulmonary pathology: a multi-institutional autopsy cohort from Italy and New York City. Mod Pathol. 2020;33(11):2156-2168.
Borczuk, A. C., Salvatore, S. P., Seshan, S. V., Patel, S. S., Bussel, J. B., Mostyka, M., Elsoukkary, S., He, B., Del Vecchio, C., Fortarezza, F., Pezzuto, F., Navalesi, P., Crisanti, A., Fowkes, M. E., Bryce, C. H., Calabrese, F., & Beasley, M. B. (2020). COVID-19 pulmonary pathology: a multi-institutional autopsy cohort from Italy and New York City. Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc, 33(11), 2156-2168. https://doi.org/10.1038/s41379-020-00661-1
Borczuk AC, et al. COVID-19 Pulmonary Pathology: a Multi-institutional Autopsy Cohort From Italy and New York City. Mod Pathol. 2020;33(11):2156-2168. PubMed PMID: 32879413.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - COVID-19 pulmonary pathology: a multi-institutional autopsy cohort from Italy and New York City. AU - Borczuk,Alain C, AU - Salvatore,Steven P, AU - Seshan,Surya V, AU - Patel,Sanjay S, AU - Bussel,James B, AU - Mostyka,Maria, AU - Elsoukkary,Sarah, AU - He,Bing, AU - Del Vecchio,Claudia, AU - Fortarezza,Francesco, AU - Pezzuto,Federica, AU - Navalesi,Paolo, AU - Crisanti,Andrea, AU - Fowkes,Mary E, AU - Bryce,Clare H, AU - Calabrese,Fiorella, AU - Beasley,Mary Beth, Y1 - 2020/09/02/ PY - 2020/07/06/received PY - 2020/08/10/accepted PY - 2020/08/10/revised PY - 2020/9/4/pubmed PY - 2020/10/30/medline PY - 2020/9/4/entrez SP - 2156 EP - 2168 JF - Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc JO - Mod Pathol VL - 33 IS - 11 N2 - SARS-CoV-2, the etiologic agent of COVID-19, is a global pandemic with substantial mortality dominated by acute respiratory distress syndrome. We systematically evaluated lungs of 68 autopsies from 3 institutions in heavily hit areas (2 USA, 1 Italy). Detailed evaluation of several compartments (airways, alveolar walls, airspaces, and vasculature) was performed to determine the range of histologic features. The cohort consisted of 47 males and 21 females with a median age of 73 years (range 30-96). Co-morbidities were present in most patients with 60% reporting at least three conditions. Tracheobronchitis was frequently present, independent from intubation or superimposed pneumonia. Diffuse alveolar damage (DAD) was seen in 87% of cases. Later phases of DAD were less frequent and correlated with longer duration of disease. Large vessel thrombi were seen in 42% of cases but platelet (CD61 positive) and/or fibrin microthrombi were present at least focally in 84%. Ultrastructurally, small vessels showed basal membrane reduplication and significant endothelial swelling with cytoplasmic vacuolization. In a subset of cases, virus was detected using different tools (immunohistochemistry for SARS-CoV-2 viral spike protein, RNA in situ hybridization, lung viral culture, and electron microscopy). Virus was seen in airway epithelium and type 2 pneumocytes. IHC or in situ detection, as well as viable form (lung culture positive) was associated with the presence of hyaline membranes, usually within 2 weeks but up to 4 weeks after initial diagnosis. COVID-19 pneumonia is a heterogeneous disease (tracheobronchitis, DAD, and vascular injury), but with consistent features in three centers. The pulmonary vasculature, with capillary microthrombi and inflammation, as well as macrothrombi, is commonly involved. Viral infection in areas of ongoing active injury contributes to persistent and temporally heterogeneous lung damage. SN - 1530-0285 UR - https://www.unboundmedicine.com/medline/citation/32879413/COVID_19_pulmonary_pathology:_a_multi_institutional_autopsy_cohort_from_Italy_and_New_York_City_ L2 - https://doi.org/10.1038/s41379-020-00661-1 DB - PRIME DP - Unbound Medicine ER -