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Review
. 2021 May 17;16(1):34.
doi: 10.1186/s13027-021-00369-0.

Lung histopathological findings in COVID-19 disease - a systematic review

Giuseppe Pannone #  1 , Vito Carlo Alberto Caponio #  2 , Ilenia Sara De Stefano  1 , Maria Antonietta Ramunno  1 , Mario Meccariello  1 , Alessio Agostinone  1 , Maria Carmela Pedicillo  1 , Giuseppe Troiano  3 , Khrystyna Zhurakivska  3 , Tommaso Cassano  3 , Maria Eleonora Bizzoca  3 , Silvana Papagerakis  4 , Franco Maria Buonaguro  5 , Shailesh Advani  6 , Lorenzo Lo Muzio  3
Affiliations
Review

Lung histopathological findings in COVID-19 disease - a systematic review

Giuseppe Pannone et al. Infect Agent Cancer. .

Abstract

Since December 2019, the global burden of the COVID-19 pandemic has increased rapidly and has impacted nearly every country in the world, affecting those who are elderly or with underlying comorbidities or immunocompromised states. Aim of this systematic review is to summarize lung histopathological characteristics of COVID-19, not only for diagnostic purpose but also to evaluate changes that can reflect pathophysiological pathways that can inform clinicians of useful treatment strategies. We identified following histopathological changes among our patients:: hyaline membranes; endothelial cells/ interstitial cells involvement; alveolar cells, type I pneumocytes/ type II pneumocytes involvement; interstitial and/ or alveolar edema; evidence of hemorrhage, of inflammatory cells, evidence of microthrombi; evidence of fibrin deposition and of viral infection in the tissue samples.The scenario with proliferative cell desquamation is typical of Acute Respiratory Distress Syndrome (ARDS) that can be classified as diffuse alveolar damage (DAD) and not DAD-ARDS. The proposed pathological mechanism concerns the role of both innate and adaptive components of the immune system. COVID-19 lethal cases present themselves as a heterogeneous disease, characterized by the different simultaneous presence of different histological findings, which reflect histological phases with corresponding different pathological pathways (epithelial, vascular and fibrotic changes), in the same patient.

Keywords: COVID-19; Histopathology; Lung; Systematic review; Therapy.

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Conflict of interest statement

Authors declare no interests.

Figures

Fig. 1
Fig. 1
PRISMA Flowchart of selection process
Fig. 2
Fig. 2
Summary of histopathological features occurring in fatal cases of COVID-19 lung injury. Findings of epithelial, vascular and fibrotic pattern are represented. Note that epithelial damage like viral cytopathic changes, desquamation and reactive hyperplasia of type II pneumocytes, hyaline membrane formation and interstitial inflammatory response have been frequently observed together with findings of vascular damage like capillary congestion, intracapillary microthombosis, alveolar hemorrhage, interstitial and intra-alveolar edema. Furthermore, interstitial fibrous changes, occurring separately or in combination with epithelial and/or vascular injury in a subgroup of patients, are shown. For further details see descriptive text
See this image and copyright information in PMC

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