Kashif A W, Paliwal Gourang, Kinra Prateek, Sharma Manish, Boruah Dibyajyoti, Toor Sharanjeet, Patrikar Seema
Professor, Department of Pathology, Armed Forces Medical College, Pune, India.
Assistant Professor (Pathology), 7 AFH, Kanpur, India.
Med J Armed Forces India. 2025 May-Jun;81(3):328-336. doi: 10.1016/j.mjafi.2024.08.006. Epub 2024 Sep 19.
COVID 19 infection is a multi-systemic disease with the lungs bearing the maximum brunt. Very few autopsy studies have been done on the deceased patients. The present study aimed to study the clinical spectrum and lab parameters of COVID-19 patients along with the morphological spectrum of the lung changes in these patients by histology, Immunohistochemistry and Electron microscopy. We also compared the Clinical severity and Lab parameters with the histopathological phase of the lung involvement.
We conducted a cross sectional observational study between Jun 2021 to Dec 2022 where in needle necropsy of lung tissue of COVID 19 confirmed fatal cases were studied by histopathology, immunohistochemistry (using CD3, CD4, CD8, CD19, CD20, CD68 and Pan CK markers) and Electron microscopy. Various hematological, histopathological and ultrastructural parameters were studied. The results were analyzed using SPSS 25.0 software.
A total of 24 cases were studied. The mean age was 65.9 yrs, male: female ratio was 2:1. Five had moderately severe COVID while 19 had severe COVID infection. Diffuse alveolar damage (DAD) was seen in 83% of all the cases. On the basis of clinical severity and histopathological staging, broadly two histopathological groups were made (Proliferative and Organizing). Difference between TLC, N/L ratio and L/Platelet ratio in two histopathological groups was assessed using unpaired t test, however no significant difference was noted. We did not find any correlation between clinical severity and histopathological groups though severe cases of COVID-19 were found to have a shorter time between admission to the hospital and death. All the biopsies were subjected to electron microscopy and in two of the cases we could demonstrate corona virus particles.
Our study has shown that severe cases of COVID 19 are associated with a shorter time between admission to hospital and death. While the histopathology of the lung showed diffuse alveolar damage as the most common finding; the Transmission Electron Microscopy (TEM) played an important role in characterizing the ultrastructure of these cells and demonstrating corona virus particles.
新型冠状病毒肺炎（COVID-19）感染是一种多系统疾病，肺部受影响最为严重。对死亡患者进行的尸检研究非常少。本研究旨在通过组织学、免疫组织化学和电子显微镜研究COVID-19患者的临床谱和实验室参数，以及这些患者肺部变化的形态学谱。我们还比较了临床严重程度和实验室参数与肺部受累的组织病理学阶段。
我们在2021年6月至2022年12月期间进行了一项横断面观察性研究，对COVID-19确诊死亡病例的肺组织进行针吸尸检，采用组织病理学、免疫组织化学（使用CD3、CD4、CD8、CD19、CD20、CD68和Pan CK标记物）和电子显微镜进行研究。研究了各种血液学、组织病理学和超微结构参数。使用SPSS 25.0软件分析结果。
共研究了24例病例。平均年龄为65.9岁，男女比例为2:1。5例为中度重症COVID，19例为重症COVID感染。83%的病例出现弥漫性肺泡损伤（DAD）。根据临床严重程度和组织病理学分期，大致分为两个组织病理学组（增殖期和机化期）。使用非配对t检验评估两个组织病理学组之间的总淋巴细胞计数（TLC）、中性粒细胞/淋巴细胞比值（N/L）和淋巴细胞/血小板比值（L/血小板）的差异，但未发现显著差异。尽管发现COVID-19重症病例入院至死亡的时间较短，但我们未发现临床严重程度与组织病理学组之间存在任何相关性。所有活检均进行了电子显微镜检查，在其中两例病例中我们能够观察到冠状病毒颗粒。
我们的研究表明，COVID-19重症病例入院至死亡的时间较短。虽然肺部组织病理学显示弥漫性肺泡损伤是最常见的发现；但透射电子显微镜（TEM）在表征这些细胞的超微结构和显示冠状病毒颗粒方面发挥了重要作用。
