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CC BY-NC-ND 4.0 · J Lab Physicians 2021; 13(02): 097-106
DOI: 10.1055/s-0041-1730750
Original Article

Evaluation of Pathological Findings of COVID-19 by Minimally Invasive Autopsies: A Single Tertiary Care Center Experience from India

Vikarn Vishwajeet
1   Department of Pathology and Lab Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
,
Abhishek Purohit
1   Department of Pathology and Lab Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
,
Deepak Kumar
2   Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
,
Vijay Parag
2   Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
,
Swapnil Tripathi
2   Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
,
Tanuj Kanchan
3   Department of Forensic Medical and Toxicology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
,
Nikhil Kothari
4   Department of Anaesthesia, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
,
Naveen Dutt
5   Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
,
Poonam Abhay Elhence
1   Department of Pathology and Lab Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
,
Pradeep Kumar Bhatia
4   Department of Anaesthesia, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
,
Vijaya Lakshmi Nag
6   Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
,
Mahendra Kumar Garg
2   Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
,
Sanjeev Misra
7   Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
› Author Affiliations Funding None.
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Abstract

Objectives The 2019 novel coronavirus (2019-nCoV) has spread across the globe with more than 6 lakh deaths. Clinical autopsies are important to understand the pathobiology of the disease.

Materials and Methods Autopsy techniques have been modified to be minimally invasive autopsies in all COVID-19 positive cases, and tissue biopsies were sampled from lungs, liver, and bone marrow within an hour after death. Detailed histological analysis was performed in the sampled tissues, along with immunohistochemistry. Patients’ clinical records were collected.

Statistical Analysis Descriptive statistics were used to summarize data.

Results Of the 21 cases studied, 76.2% patients were ≥ 60 years of age, 80.9% were males, and 85.7% had co-morbidities. Histopathological analysis revealed diffuse alveolar damage (including exudative and organizing phase) in 88.9% cases. Microthrombi were seen in 44.4% cases. Additional findings include viral cytopathic changes, metaplastic change in the epithelium, intra-alveolar hemorrhage, and pulmonary edema. Liver showed centrizonal congestion with hepatocytic loss, lobular inflammation, steatosis, Kupffer cell hypertrophy, and sinusoidal neutrophilic infiltration, while significant portal infiltrate and cholestasis were absent to minimal. Bone marrow revealed hemophagocytosis in 60% cases.

Conclusion Incorporation of minimally invasive autopsies provides an effective method to study the pathological findings in COVID-19 deaths in resource-constrained settings. Presence of pulmonary microthrombi in a significant number of cases supports the vascular events, apart from the characteristic diffuse alveolar damage, as an important pathogenic mechanism for lung injury in COVID-19 infections. Histopathological findings in the liver and bone marrow suggest indirect insult to these organs, related to circulatory and/or hyperinflammatory response to viral infections.

Keywords

autopsy - COVID-19 - pathology - SARS-CoV-2


Publication History

Article published online:
28 June 2021

© 2021. The Indian Association of Laboratory Physicians. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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