Department of Pathology, University of Michigan-Michigan Medicine, Ann Arbor, Michigan.
Department of Pathology, University of Michigan-Michigan Medicine, Ann Arbor, Michigan.
J Am Soc Cytopathol. 2021 May-Jun;10(3):261-269. doi: 10.1016/j.jasc.2021.01.003. Epub 2021 Jan 22.
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with "flu-like" upper respiratory tract symptoms and pneumonia. Body cavity effusions develop in a subset of patients with advanced disease. Although SARS-CoV-2 is known to be present in certain body fluids (eg, blood) of COVID patients, it remains unclear if body cavity fluids are sites of infection. Our aim was to characterize the cytologic and clinical findings in COVID-19 patients with effusions.
A record search for all cases of body cavity effusion cytology in SARS-CoV-2 positive patients from March 1, 2020, to September 1, 2020, was performed. Clinical history, fluid chemical analysis, cytologic findings, and patient outcomes were recorded. All cytology slides were reviewed. In situ hybridization (ISH) targeting SARS-CoV-2 spike protein transcript (V-nCoV2019-S) was performed on cell block material in all cases.
A total of 17 effusion cytology cases were identified among 15 COVID patients, including 13 pleural, 2 pericardial, and 2 peritoneal. Most (13 of 15) patients were hospitalized for COVID complications. Eight patients died during hospitalization, 7 from COVID complications. All fluids were transudative by protein criteria. Lymphocytic or histiocytic inflammation predominated in 12 of 17 cases. Five exhibited hemophagocytosis. No viral cytopathic changes or extra-medullary megakaryocytes were seen. Viral RNA was not detected in any case by ISH.
Body cavity effusion is an ominous finding in patients with advanced COVID-19 disease. Such effusions tend to be transudative with lymphohistiocytic inflammation, and commonly exhibit hemophagocytosis, an otherwise rare finding in effusion cytologies. No direct infection of cellular elements by SARS-CoV-2 was identified by ISH.
由严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）引起的 2019 年冠状病毒病（COVID-19）与“流感样”上呼吸道症状和肺炎有关。在疾病进展的患者中，会出现体腔积液。虽然已知 SARS-CoV-2 存在于 COVID 患者的某些体液（例如血液）中，但尚不清楚体腔液是否为感染部位。我们的目的是描述 COVID-19 伴有胸腔积液患者的细胞学和临床特征。
对 2020 年 3 月 1 日至 2020 年 9 月 1 日期间 SARS-CoV-2 阳性患者的所有体腔积液细胞学检查病例进行了记录搜索。记录了临床病史、液体化学分析、细胞学发现和患者结局。所有细胞学切片均进行了复查。对所有病例的细胞块材料均进行了针对 SARS-CoV-2 刺突蛋白转录本（V-nCoV2019-S）的原位杂交（ISH）。
在 15 名 COVID 患者中，共发现 17 例胸腔积液细胞学检查病例，包括 13 例胸腔积液、2 例心包积液和 2 例腹腔积液。大多数（15 例中的 13 例）患者因 COVID 并发症住院。8 例患者在住院期间死亡，其中 7 例死于 COVID 并发症。所有液体均根据蛋白标准为渗出液。17 例中有 12 例以淋巴细胞或组织细胞炎症为主。5 例出现噬血细胞现象。未见病毒细胞病变或骨髓外巨核细胞。ISH 未检测到任何病例的病毒 RNA。
在患有晚期 COVID-19 疾病的患者中，体腔积液是一种严重的发现。这种积液倾向于表现为淋巴细胞性或组织细胞性炎症的渗出液，并且常表现为噬血细胞现象，这在胸腔积液细胞学检查中是一种罕见的发现。ISH 未发现 SARS-CoV-2 直接感染细胞成分。
