Pulmonary pathology and COVID-19: lessons from autopsy. The experience of European Pulmonary Pathologists
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REVIEW AND PERSPECTIVES
Pulmonary pathology and COVID-19: lessons from autopsy. The experience of European Pulmonary Pathologists Fiorella Calabrese 1 & Federica Pezzuto 1 & Francesco Fortarezza 1 & Paul Hofman 2 & Izidor Kern 3 & Angel Panizo 4 & Jan von der Thüsen 5 & Sergei Timofeev 6 & Gregor Gorkiewicz 7 & Francesca Lunardi 1 Received: 4 June 2020 / Revised: 25 June 2020 / Accepted: 28 June 2020 # The Author(s) 2020
Abstract Since its initial recognition in December 2019, Coronavirus disease 19 (COVID-19) has quickly spread to a pandemic infectious disease. The causative agent has been recognized as a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), primarily affecting the respiratory tract. To date, no vaccines are available nor any specific treatment. To limit the number of infections, strict directives have been issued by governments that have been translated into equally rigorous guidelines notably for post-mortem examinations by international and national scientific societies. The recommendations for biosafety control required during specimen collection and handling have strongly limited the practice of autopsies of the COVID-19 patients to a few adequate laboratories. A full pathological examination has always been considered an important tool to better understand the pathophysiology of diseases, especially when the knowledge of an emerging disorder is limited and the impact on the healthcare system is significant. The first evidence of diffuse alveolar damage in the context of an acute respiratory distress syndrome has now been joined by the latest findings that report a more complex scenario in COVID-19, including a vascular involvement and a wide spectrum of associated pathologies. Ancillary tools such as electron microscopy and molecular biology used on autoptic tissue samples from autopsy are also significantly contributing to confirm and/or identify new aspects useful for a deeper knowledge of the pathogenetic mechanisms. This article will review and summarize the pathological findings described in COVID-19 until now, chiefly focusing on the respiratory tract, highlighting the importance of autopsy towards a better knowledge of this disease. Keywords COVID-19 . SARS-CoV-2 . Autopsy . Lung . Pandemic
Introduction * Fiorella Calabrese [email protected] 1
Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, Via A. Gabelli 61, 35121 Padova, Italy
2
Laboratory of Clinical and Experimental Pathology, FHU OncoAge, Biobank BB-0033-00025, University Côte d’Azur, Nice, France
3
University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
4
Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
5
Department of Pathology, Erasmus MC, Rotterdam, The Netherlands
6
Moscow City Hospital #40, Moscow, Russia
7
Institute of Pathology, Medical University of Graz, Graz, Austria
The viral family Coronaviridae are enveloped, positive-sense, single-stranded RNA viruses, and typically cause mild
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