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Comment
. 2021 Oct;76(10):1044-1046.
doi: 10.1136/thoraxjnl-2020-216714. Epub 2021 Mar 23.

Pulmonary vascular proliferation in patients with severe COVID-19: an autopsy study

Belén Pérez-Mies  1   2   3   4 , María Gómez-Rojo  5 , Irene Carretero-Barrio  1 , Tommaso Bardi  5 , Amparo Benito  1   4 , Mónica García-Cosío  1   4 , Álvaro Caballero  6 , Raul de Pablo  2   4   6 , Juan Carlos Galán  2   7   8 , David Pestaña  4   5 , Jose Palacios  9   2   3   4
Affiliations
Comment

Pulmonary vascular proliferation in patients with severe COVID-19: an autopsy study

Belén Pérez-Mies et al. Thorax. 2021 Oct.

Abstract

Diffuse alveolar damage and thrombi are the most common lung histopathological lesions reported in patients with severe COVID-19. Although some studies have suggested increased pulmonary angiogenesis, the presence of vascular proliferation in COVID-19 lungs has not been well characterised. Glomeruloid-like microscopic foci and/or coalescent vascular proliferations measuring up to 2 cm were present in the lung of 14 out of 16 autopsied patients. These lesions expressed CD31, CD34 and vascular endothelial cadherin. Platelet-derived growth factor receptor-β immunohistochemistry and dual immunostaining for CD34/smooth muscle actin demonstrated the presence of pericytes. These vascular alterations may contribute to the severe and refractory hypoxaemia that is common in patients with severe COVID-19.

Keywords: ARDS; COVID-19; histology/cytology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Vascular patterns in patients with COVID-19. (A) Normal lung H&E. (B) CD34 expression in normal lung. (C) Dual staining for CD34 (brown) and CK18 (pink) in normal lung. (D) ‘Glomerular-like’ vascular tufting>150 μm, protruding into the alveolar lumen or enlarging the alveolar walls (VS 1). (E) CD34 staining. (F) Dual staining for CD34/CK18 with some epithelial cells in alveolar spaces. (G) Confluent capillaries arranged perpendicularly to each other occupying at least one high-power field (VS 2) (H) CD34 staining. (I) Dual staining for CD34/CK18 with scarce residual epithelial cells in alveolar spaces not entrapped in the vascular proliferation. VS, vascular score.
Figure 2
Figure 2
Case with vascular score 3. (A) Complex mesh-like vascular framework of 1.7 cm of diameter with no or minimal residual alveolar spaces (area within lines), panoramic view. (B) CD34 staining, panoramic view. (C) Mesh-like framework capillaries replacing normal lung. Detail of area within lines is shown (A). (D) CD34 staining. (E) Dual staining for CD34/CK18 with scarce epithelial cells in residual small-size alveolar spaces.
Figure 3
Figure 3
Vascular markers. Positive vascular endothelial cadherin staining in a glomeruloid-like structure (A). Single immunostaining with platelet-derived growth factor receptor-β (B) and dual staining for CD34 (pink) and smooth muscle actin (brown) (C), demonstrating the presence of pericytes.
See this image and copyright information in PMC

Comment on

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