key: cord-0833671-hvs6kvf1
authors: Bian, Xiu-Wu
title: Autopsy of COVID-19 victims in China
date: 2020-06-06
journal: Natl Sci Rev
DOI: 10.1093/nsr/nwaa123
sha: 3966f1126a6bfb88937a35d25e56ce8d7171a2fe
doc_id: 833671
cord_uid: hvs6kvf1

Distribution of SARS-CoV-2 virus and pathological features of multiple organs in COVID-19 patients remains unclear, which interferes with the improvement of COVID-19 diagnosis and treatment. In this article, we summarize the pathological findings obtained from systematic autopsy (37 cases) and percutaneous multiple organ biopsy (“minimally invasive autopsy”, 54 cases). These findings should shed light on better understanding of the progression of COVID-19 infection and the means of more effective intervention.

completed two cases. Altogether, a total of 91 COVID-19 victims were pathologically inspected and diagnosed. This may represent the largest number of autopsy cases with the most comprehensive examination in the world thus far. Furthermore, our systematic autopsy has established a basis of collaboration among a number of pathological institutions during the COVID-19 pandemic in China. During the process, anatomic pathologists and technicians also collaborated with engineers to establish the biosafety platforms for autopsy of COVID-19 victims. Governmental laws and regulations played an important role in mobilizing rapid response to this major public health emergency.

The Pathology Team has performed intensive pathological diagnosis and research at organ, tissue, cell, ultrastructural and molecular levels. We discovered that SARS-CoV-2-infection causes injuries in multiple organs and tissues with prominent and extensive pulmonary lesions.

The pathological characteristics of pulmonary lesions caused by SARS-CoV-2 infection were similar to those from SARS infection but differences have been noticed. Intensive spatial and temporal heterogeneity of pulmonary lesions was observed in individual patient. Pathological changes in the respiratory system were most significant. Trachea and bronchus manifested mucosa congestion, increased secretion, and focal epithelial exfoliation. Changes in pulmonary parenchyma presented with differences in extent and distribution. Under light microscopy, the parenchymal areas contained diffuse alveolar damage and exudative inflammation. Serous and fibrin exudate filled alveolar spaces, and hyaline membrane formation could be seen. The infiltrating leukocytes in the alveoli were mainly monocytes and macrophages. Type II pneumocyte hyperplasia and focal pneumocyte exfoliation were clearly observed. Some areas of bronchial mucosa manifested epithelia exfoliation, mucin accumulation and mucin plug formation. A few alveoli showed excessive inflation, septal rupture or cystic cavity formation. Focal pulmonary hemorrhage and consequential hemorrhagic infarction or necrosis were observed. Pulmonary vessels showed vasculitis, thrombosis (mixed thrombi and hyaline thrombi), and thromboembolism. Exudate organization (also termed as pulmonary carnification) and pulmonary interstitial fibrosis were observed in cases with long disease duration (see pulmonary complications in Table 1) .

Under electron microscopy, coronavirus particles were observed in the cytoplasm of tracheal and bronchial mucosa epithelia and alveolar type II pneumocytes. Immunohistochemical staining demonstrated that some tracheal and bronchial mucosa epithelia and type II alveolar epithelial cells and the infiltrating macrophages, which express angiotensin converting enzyme 2 (ACE2), were positive for SARS-CoV-2 protein. The trachea and pulmonary tissues (except some lung lobes) were positive for SARS-CoV-2 nuclear acid. Functionally, alveolar damage, exudation, interstitial inflammation, and extensive thrombosis constituted cause for ventilatory disorder. Airway epithelial hyperplasia, exfoliation, and mucus congestion increased ventilation obstruction, especially in the small airway. Altogether, these changes were considered as pathological basis for lethal respiratory failure. 

A novel coronavirus from patients with pneumonia in China

Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan

Pathological evidence for residual SARS-CoV-2 in pulmonary tissues of a ready-for-discharge patient

We thank the patients and their families for their dedication. We also thank clinical staff and