Postmortem Biopsies of the Lung, Heart, Liver, and Spleen of COVID-19 Patients.

Isil Yurdaisik,Mustafa Akker,Aysegul Agirman,Suleyman Hilmi Aksoy,Aysim B Oz,Fuad Nurili,Ahu S Demiroz

doi:10.7759/cureus.20734

Abstract

ObjectiveWe aimed to evaluate histopathologic alterations in the lung, heart, liver, and spleen of coronavirus disease 2019 (COVID-19) decedents through postmortem core needle biopsies.Materials and methodsPatients who died of reverse transcription-polymerase chain reaction-proven COVID-19 were included in this postmortem case series. Postmortem percutaneous ultrasound-guided biopsies of the lungs, heart, liver, and spleen were performed using 14- and 16-gauge needles. Biopsy samples were stained with hematoxylin-eosin and examined under a light microscope. Clinicodemographic characteristics, chest computed tomography (CT) images, and COVID-19-related treatments of the patients were also collected.ResultsSeven patients were included in this study. Liver and heart tissue samples were available from all patients, and lung and spleen tissue samples were available from five and three patients, respectively. Chest CT images predominantly revealed bibasilar ground-glass opacities. Lung biopsies showed diffuse alveolar damage in all biopsy specimens. Heart findings were nonspecific and largely compatible with the underlying disease. Patchy necrosis, steatosis, and mononuclear cell infiltration were the main findings in the liver biopsies. Splenic histopathological examination showed that splenic necrosis and neutrophil infiltration were common findings in all patients.ConclusionTissue acquisition was complete for the heart and liver and acceptable for the lungs. The amount of tissue was sufficient for a proper histopathologic examination. Histopathological findings were generally in accordance with previous autopsy studies. Radiological findings of the lung were also correlated with the histopathologic findings. We consider that a postmortem biopsy is a feasible alternative for histopathological examinations in COVID-19 decedents.

Highlights

A novel virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first appeared in China through rapidly progressing pneumonia cases and gave rise to a pandemic
We aimed to evaluate histopathologic alterations in the lung, heart, liver, and spleen of coronavirus disease 2019 (COVID-19) decedents through postmortem core needle biopsies
Patients who died of reverse transcription-polymerase chain reaction-proven COVID-19 were included in this postmortem case series

Summary

Introduction

A novel virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first appeared in China through rapidly progressing pneumonia cases and gave rise to a pandemic. The virus enters the cells via angiotensin-converting enzyme 2 (ACE2) cell surface receptors [2,3]. As these receptors are abundant in lung tissue, the disease affects the lungs more severely than other parts of the body. With the fear of spreading the disease, the autopsy of COVID19 victims is prohibited or advised against, even in developed countries [4]. This reluctance to perform autopsies translates to the relative scarcity of autopsy studies, which are not commensurate with the commonality of COVID-19.

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