X H Yao1, T Y Li2, Z C He1, Y F Ping1, H W Liu3, S C Yu1, H M Mou3, L H Wang4, H R Zhang1, W J Fu1, T Luo1, F Liu1, Q N Guo5, C Chen1, H L Xiao6, H T Guo1, S Lin1, D F Xiang1, Y Shi1, G Q Pan5, Q R Li1, X Huang7, Y Cui7, X Z Liu8, W Tang3, P F Pan7, X Q Huang2, Y Q Ding9, X W Bian1. 1. Institute of Pathology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China. 2. Department of Vascular Surgery, Southwest Hospital, Third Military MedicalUniversity (Army Medical University), Chongqing 400038, China. 3. Chongqing Three-Gorges Central Hospital, Chongqing 404000, China. 4. Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China. 5. Institute of Pathology, Xinqiao Hosital, Third Military Medical University (Army Medical University),Chongqing 400037, China. 6. Department of Pathology, Daping Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China. 7. Department of Intensive Care Medicine, Chongqing Three-Gorges Central Hospital, Chongqing 404000, China. 8. Infection Management Department, Chongqing Three-Gorges Central Hospital, Chongqing 404000, China. 9. Department of Pathology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Abstract
Objective: To investigate the pathological characteristics and the clinical significance of novel coronavirus (2019-nCoV)-infected pneumonia (termed by WHO as coronavirus disease 2019, COVID-19). Methods: Minimally invasive autopsies from lung, heart, kidney, spleen, bone marrow, liver, pancreas, stomach, intestine, thyroid and skin were performed on three patients died of novel coronavirus pneumonia in Chongqing, China. Hematoxylin and eosin staining (HE), transmission electron microcopy, and histochemical staining were performed to investigate the pathological changes of indicated organs or tissues. Immunohistochemical staining was conducted to evaluate the infiltration of immune cells as well as the expression of 2019-nCoV proteins. Real time PCR was carried out to detect the RNA of 2019-nCoV. Results: Various damages were observed in the alveolar structure, with minor serous exudation and fibrin exudation. Hyaline membrane formation was observed in some alveoli. The infiltrated immune cells in alveoli were majorly macrophages and monocytes. Moderate multinucleated giant cells, minimal lymphocytes, eosinophils and neutrophils were also observed. Most of infiltrated lymphocytes were CD4-positive T cells. Significant proliferation of type Ⅱ alveolar epithelia and focal desquamation of alveolar epithelia were also indicated. The blood vessels of alveolar septum were congested, edematous and widened, with modest infiltration of monocytes and lymphocytes. Hyaline thrombi were found in a minority of microvessels. Focal hemorrhage in lung tissue, organization of exudates in some alveolar cavities, and pulmonary interstitial fibrosis were observed. Part of the bronchial epithelia were exfoliated. Coronavirus particles in bronchial mucosal epithelia and type Ⅱ alveolar epithelia were observed under electron microscope. Immunohistochemical staining showed that part of the alveolar epithelia and macrophages were positive for 2019-nCoV antigen. Real time PCR analyses identified positive signals for 2019-nCoV nucleic acid. Decreased numbers of lymphocyte, cell degeneration and necrosis were observed in spleen. Furthermore, degeneration and necrosis of parenchymal cells, formation of hyaline thrombus in small vessels, and pathological changes of chronic diseases were observed in other organs and tissues, while no evidence of coronavirus infection was observed in these organs. Conclusions: The lungs from novel coronavirus pneumonia patients manifest significant pathological lesions, including the alveolar exudative inflammation and interstitial inflammation, alveolar epithelium proliferation and hyaline membrane formation. While the 2019-nCoV is mainly distributed in lung, the infection also involves in the damages of heart, vessels, liver, kidney and other organs. Further studies are warranted to investigate the mechanism underlying pathological changes of this disease.
Objective: To investigate the pathological characteristics and the clinical significance of novel coronavirus (2019-nCoV)-infected pneumonia (termed by WHO as coronavirus disease 2019, COVID-19). Methods: Minimally invasive autopsies from lung, heart, kidney, spleen, bone marrow, liver, pancreas, stomach, intestine, thyroid and skin were performed on three patients died of novel coronavirus pneumonia in Chongqing, China. Hematoxylin and eosin staining (HE), transmission electron microcopy, and histochemical staining were performed to investigate the pathological changes of indicated organs or tissues. Immunohistochemical staining was conducted to evaluate the infiltration of immune cells as well as the expression of 2019-nCoV proteins. Real time PCR was carried out to detect the RNA of 2019-nCoV. Results: Various damages were observed in the alveolar structure, with minor serous exudation and fibrin exudation. Hyaline membrane formation was observed in some alveoli. The infiltrated immune cells in alveoli were majorly macrophages and monocytes. Moderate multinucleated giant cells, minimal lymphocytes, eosinophils and neutrophils were also observed. Most of infiltrated lymphocytes were CD4-positive T cells. Significant proliferation of type Ⅱ alveolar epithelia and focal desquamation of alveolar epithelia were also indicated. The blood vessels of alveolar septum were congested, edematous and widened, with modest infiltration of monocytes and lymphocytes. Hyaline thrombi were found in a minority of microvessels. Focal hemorrhage in lung tissue, organization of exudates in some alveolar cavities, and pulmonary interstitial fibrosis were observed. Part of the bronchial epithelia were exfoliated. Coronavirus particles in bronchial mucosal epithelia and type Ⅱ alveolar epithelia were observed under electron microscope. Immunohistochemical staining showed that part of the alveolar epithelia and macrophages were positive for 2019-nCoV antigen. Real time PCR analyses identified positive signals for 2019-nCoV nucleic acid. Decreased numbers of lymphocyte, cell degeneration and necrosis were observed in spleen. Furthermore, degeneration and necrosis of parenchymal cells, formation of hyaline thrombus in small vessels, and pathological changes of chronic diseases were observed in other organs and tissues, while no evidence of coronavirus infection was observed in these organs. Conclusions: The lungs from novel coronavirus pneumoniapatients manifest significant pathological lesions, including the alveolar exudative inflammation and interstitial inflammation, alveolar epithelium proliferation and hyaline membrane formation. While the 2019-nCoV is mainly distributed in lung, the infection also involves in the damages of heart, vessels, liver, kidney and other organs. Further studies are warranted to investigate the mechanism underlying pathological changes of this disease.
Authors: R Hanafi; P-A Roger; B Perin; G Kuchcinski; N Deleval; F Dallery; D Michel; L Hacein-Bey; J-P Pruvo; O Outteryck; J-M Constans Journal: AJNR Am J Neuroradiol Date: 2020-06-18 Impact factor: 3.825
Authors: Jason Pik Eu Chang; Yu Jun Wong; Wei Lyn Yang; Kieron Boon Leng Lim; Poh Seng Tan; Gim Hin Ho; Benjamin Cherng Hann Yip; James Weiquan Li; Chern Hao Chong; David Eng Hui Ong; Tju Siang Chua; Charles Kien Fong Vu; Kok Ann Gwee; Tiing Leong Ang; Chee Kiat Tan Journal: Singapore Med J Date: 2020-04-29 Impact factor: 1.858
Authors: Eleni E Ladikou; Helena Sivaloganathan; Kate M Milne; William E Arter; Roshan Ramasamy; Ramy Saad; Simon M Stoneham; Barbara Philips; Alice C Eziefula; Timothy Chevassut Journal: Clin Med (Lond) Date: 2020-07-21 Impact factor: 2.659