Department of Pathology and Laboratory Medicine, NewYork-Presbyterian Hospital, New York, New York, USA.
Weill Cornell Medicine, New York, New York, USA.
Pathobiology. 2021;88(1):56-68. doi: 10.1159/000511325. Epub 2020 Sep 17.
A novel coronavirus, SARS-CoV-2, was identified in Wuhan, China in late 2019. This virus rapidly spread around the world causing disease ranging from minimal symptoms to severe pneumonia, which was termed coronavirus disease (i.e., COVID). Postmortem examination is a valuable tool for studying the pathobiology of this new infection.
We report the clinicopathologic findings from 32 autopsy studies conducted on patients who died of COVID-19 including routine gross and microscopic examination with applicable special and immunohistochemical staining techniques.
SARS-CoV-2 infection was confirmed by nasopharyngeal RT-PCR in 31 cases (97%) and by immunohistochemical staining for SARS-CoV-2 spike-protein in the lung in the remaining 1 case (3%). The ethnically diverse cohort consisted of 22 males and 10 females with a mean age of 68 years (range: 30-100). Patients most commonly presented with cough (17 [55%]), shortness of breath (26 [81%]), and a low-grade fever (17 [55%]). Thirty-one (97%) of the patients had at least 1 comorbidity (mean = 4). Twenty-eight patients (88%) had widespread thromboembolic disease, as well as diffuse alveolar damage (30 [94%]), diabetic nephropathy (17 [57%]) and acute tubular injury. Patterns of liver injury were heterogeneous, featuring 10 (36%) with frequent large basophilic structures in sinusoidal endothelium, and increased immunoblast-like cells in lymph nodes.
This series of autopsies from patients with COVID-19 confirms the observation that the majority of severely affected patients have significant pulmonary pathology. However, many patients also have widespread microscopic thromboses, as well as characteristic findings in the liver and lymph nodes.
一种新型冠状病毒，即 SARS-CoV-2，于 2019 年底在中国武汉被发现。该病毒迅速在全球范围内传播，导致从轻微症状到严重肺炎等各种疾病，被称为冠状病毒病（即 COVID）。尸检是研究这种新感染的病理生物学的一种有价值的工具。
我们报告了对 32 例死于 COVID-19 的患者进行的 32 项尸检研究的临床病理发现，包括常规的大体和显微镜检查，并应用了适用的特殊和免疫组织化学染色技术。
SARS-CoV-2 感染通过鼻咽 RT-PCR 在 31 例（97%）中得到确认，通过肺内 SARS-CoV-2 刺突蛋白的免疫组织化学染色在 1 例（3%）中得到确认。该种族多样化的队列包括 22 名男性和 10 名女性，平均年龄为 68 岁（范围：30-100）。患者最常见的表现为咳嗽（17 [55%]）、呼吸急促（26 [81%]）和低热（17 [55%]）。31 例（97%）患者至少有 1 种合并症（平均=4）。28 例（88%）患者有广泛的血栓栓塞性疾病，以及弥漫性肺泡损伤（30 [94%]）、糖尿病肾病（17 [57%]）和急性肾小管损伤。肝损伤模式具有异质性，10 例（36%）肝窦内皮常有大量嗜碱性结构，淋巴结中免疫母细胞样细胞增多。
本系列来自 COVID-19 患者的尸检证实了大多数严重受影响的患者都有明显的肺部病理表现的观察结果。然而，许多患者也有广泛的显微镜下血栓形成，以及肝脏和淋巴结的特征性发现。
