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Case Reports
. 2020 Nov;477(5):743-748.
doi: 10.1007/s00428-020-02829-1. Epub 2020 Apr 30.

Early histologic findings of pulmonary SARS-CoV-2 infection detected in a surgical specimen

Angelina Pernazza  1 , Massimiliano Mancini  2 , Emma Rullo  3 , Massimiliano Bassi  4 , Tiziano De Giacomo  4 , Carlo Della Rocca  1 , Giulia d'Amati  5
Affiliations
Case Reports

Early histologic findings of pulmonary SARS-CoV-2 infection detected in a surgical specimen

Angelina Pernazza et al. Virchows Arch. 2020 Nov.

Abstract

Despite the current pandemic season, reports on pathologic features of coronavirus disease 19 (Covid-19) are exceedingly rare at the present time. Here we describe the pathologic features of early lung involvement by Covid-19 in a surgical sample resected for carcinoma from a patient who developed SARS-CoV-2 infection soon after surgery. The main histologic findings observed were pneumocyte damage, alveolar hemorrhages with clustering of macrophages, prominent and diffuse neutrophilic margination within septal vessels, and interstitial inflammatory infiltrates, mainly represented by CD8+ T lymphocytes. These features are similar to those previously described in SARS-CoV-1 infection. Subtle histologic changes suggestive pulmonary involvement by Covid-19 may be accidentally encountered in routine pathology practice, especially when extensive sampling is performed for histology. These findings should be carefully interpreted in light of the clinical context of the patient and could prompt a pharyngeal swab PCR test to rule out the possibility of SARS-CoV-2 infection in asymptomatic patients.

Keywords: Covid-19; Lung histology; Pathology; SARS-CoV-2.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
High-resolution CT scans performed one (a) and two (b) weeks after surgery, respectively show ground glass bilateral opacities, enlarging with time, with the additional finding of areas of consolidation
Fig. 2
Fig. 2
a (× 20) Alveolar hemorrhages and clusters of macrophages with occasional giant cells (arrow). b (× 10) The alveolar septa show mild fibrous thickening limited to the subpleural area. c (× 10) Fibrin deposits admixed with red blood cells and inflammatory infiltrates (H&E)
Fig. 3
Fig. 3
a (× 40) Pneumocyte desquamation (arrow) and reactive hyperplasia with focal nuclear inclusion (asterisk). Abundant hemosiderin pigment is present within alveolar macrophages. b (× 40) Diffuse pneumocyte loss (arrows) and alveolar septal thickening. c (× 40) Inflammatory infiltrates and fibrous plugs as those observed in organizing pneumonia (arrow). d (× 40) Neutrophilic vascular margination and edema of the alveolar wall. e Diffuse interstitial lymphocyte infiltrate and intra-alveolar macrophages (H&E). f (× 20) CD8 immunostaining shows a prevalence of cytotoxic T lymphocytes (immunoperoxidase stain)
See this image and copyright information in PMC

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