Fibrotic progression and radiologic correlation in matched lung samples from COVID-19 post-mortems

Emanuela Barisione, Federica Grillo, Lorenzo Ball, Rita Bianchi, Marco Grosso, Patrizia Morbini, Paolo Pelosi, Nicolò Antonino Patroniti, Arduino De Lucia, Giovanni Orengo, Angelo Gratarola, Marta Verda, Giuseppe Cittadini, Luca Mastracci, Roberto Fiocca

Research output: Contribution to journalArticlepeer-review

Abstract

Data on the pathology of COVID-19 are scarce; available studies show diffuse alveolar damage; however, there is scarce information on the chronologic evolution of COVID-19 lung lesions. The primary aim of the study is to describe the chronology of lung pathologic changes in COVID-19 by using a post-mortem transbronchial lung cryobiopsy approach. Our secondary aim is to correlate the histologic findings with computed tomography patterns. SARS-CoV-2-positive patients, who died while intubated and mechanically ventilated, were enrolled. The procedure was performed 30 min after death, and all lung lobes sampled. Histopathologic analysis was performed on thirty-nine adequate samples from eight patients: two patients (illness duration < 14 days) showed early/exudative phase diffuse alveolar damage, while the remaining 6 patients (median illness duration—32 days) showed progressive histologic patterns (3 with mid/proliferative phase; 3 with late/fibrotic phase diffuse alveolar damage, one of which with honeycombing). Immunohistochemistry for SARS-CoV-2 nucleocapsid protein was positive predominantly in early-phase lesions. Histologic patterns and tomography categories were correlated: early/exudative phase was associated with ground-glass opacity, mid/proliferative lesions with crazy paving, while late/fibrous phase correlated with the consolidation pattern, more frequently seen in the lower/middle lobes. This study uses an innovative cryobiopsy approach for the post-mortem sampling of lung tissues from COVID-19 patients demonstrating the progression of fibrosis in time and correlation with computed tomography features. These findings may prove to be useful in the correct staging of disease, and this could have implications for treatment and patient follow-up.

Original languageEnglish
JournalVirchows Archiv
DOIs
Publication statusAccepted/In press - 2020

Keywords

  • COVID-19
  • Diffuse alveolar damage
  • Lung fibrosis
  • Radiologic patterns
  • Transbronchial lung cryobiopsy

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Molecular Biology
  • Cell Biology

Fingerprint

Dive into the research topics of 'Fibrotic progression and radiologic correlation in matched lung samples from COVID-19 post-mortems'. Together they form a unique fingerprint.

Cite this