Pathomorphological changes in lungs in case of COVID-19: clinical and therapeutic parallels


DOI: https://dx.doi.org/10.18565/therapy.2020.5.35-46

Zayratyants O.V., Malyavin A.G., Samsonova M.V., Chernyaev A.L., Mishnev O.D., Mikhaleva L.M., Krupnov N.M., Kalinin D.V.

1) A.I. Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of Russia; 2) Scientific research institute of pulmonology FMBA of Russia, Moscow; 3) N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia, Moscow; 4) Research Institute of Human Morphology, Moscow; 5) State clinical hospital No. 31 of the Moscow City Health Department; 6) D.I. Mastbaum Bureau of forensic medicine, Ryazan; 7) A.V. Vishnevsky National Medical Research Center of Surgery of the Ministry of Healthcare of Russia, Moscow; 8) I.V. Davydovsky state clinical hospital of Healthcare Department of Moscow
The aim of the study is examination of the morphology of pulmonary damage in COVID-19 based on the analysis of autopsy data.
Material and methods. We studied the results of 2000 autopsies (1212 deceased men and 788 women; average age 68.5 ± 15.63 years), a unique number of autopsies for COVID-19, performed in Moscow from March 20 to May 22, 2020. Histological and histochemical methods of autopsy material examination were used, as well as an immunohistochemical method.
Results. Pathological changes in pulmonary characteristic of COVID-19, differing in their prevalence, were identified in all the deceased and had the form of diffuse alveolar damage (DAD) development in combination with vascular bed damage of the lungs (microangiopathy, thrombosis, in some cases, destructive-productive vasculitis) and alveolar-hemorrhagic syndrome, mainly in the first, exudative phase of DAD. This viral interstitial pneumonia with a vascular and hemorrhagic component was the morphological substrate of ARDS. The article describes in details and illustrates the features of the upper respiratory tract lesions in patients with COVID-19, identified during autopsies.
Conclusion. The revealed pathomorphological features of the inflammatory process in COVID-19 (priority of endothelial damage with micro- and macrothrombus formation, relatively late development of the exudative phase of inflammation and a tendency to pneumofibrosis developing) predetermine the long duration of therapy and the need in respiratory rehabilitation, which is mainly aimed at pulmonary recruitment. At the same time, the obtained results raise a number of actual questions concerning the expediency and duration of the use of several drugs.
Keywords: COVID-19, autopsy, pathomorphological changes in lungs, diffuse alveolar injury, pneumocirrhosis
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About the Autors

Oleg V. Zayratyants, MD, professor, head of the Department of pathological anatomy of A.I. Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of Russia. Address: 127473, Moscow, 20/1 Delegatskaya Str. E-mail: ovzair@mail.ru. Tel.: +7 (903) 184-92-17. SPIN code: 4817-1084. ORCID: 0000-0003- 3606-3823
Andrey G. Malyavin, MD, professor of the Department of phthisiology and pulmonology of A.I. Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of Russia. Address: 127473, Moscow, 20/1 Delegatskaya Str. Tel.: +7 (916) 547-83-73. E-mail: maliavin@mail.ru
Maria V. Samsonova, MD, head of the laboratory of pathological anatomy of Scientific research Institute of pulmonology of FMBA of Russia. Address: 115682, Moscow, 28 Orekhovy Boulevard Str. Tel: +7 (495) 465-58-59. E-mail: samary@mail.ru. SPIN code: 9525-9085. ORCID: 0000-0001- 8170-1260
Andrey L. Chernyaev, MD, professor, head of the Department of fundamental pulmonology of Scientific research Institute of pulmonology of FMBA of Russia, leading researcher at N.I. Pirogov research institute of human morphology of the Ministry of Healthcare of Russia. Address: 115682, Moscow, 28 Orekhovy Boulevard Str. Tel.: +7 (495) 465-58-59. E-mail: cheral12@gmail.com. ORCID: 0000-0003-0973-9250
Oleko D. Mishnev, MD, professor, head of the Department of pathological anatomy, faculty of general medicine of N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 117997, Moscow, 1 Ostrovityanova Str.Tel.: +7 (905) 513-97-07. E-mail: mishnevod@gmail.com. ORCID: 0000-0002-5466-9147
Lyudmila M. Mikhaleva, MD, professor, director of Research institute of human morphology. Address: 117418, Moscow, 3 Tsyurupy Str. head of the pathologoanatomical department of State clinical hospital No. 31 of the Moscow City health Department. Address: 101000, Moscow, 42/5 Lobachevsky Str. Tel.: +7 (499) 120-80-65. E-mail: mikhalevalm@yandex.ru. SPIN code: 2086-7513. ORCID: 0000-0003-2052-914X
Nikolay M. Krupnov, PhD, head of the state of the D.I. Mastbaum Bureau of forensic medicine. Address: 390047 Ryazan, 18 Vostochny promuzel raion Str. Tel.: +7 (4912) 24-34-23. E-mail: Krupatan@yandex.ru. SPIN code: 4814-3226. ORCID: 0000-0002-5162-1662
Dmitry V. Kalinin, PhD, head of the pathologoanathomical Departments of A.V. Vishnevsky National Medical Research Center of Surgery of the Ministry of Healthcare of Russia and I.V. Davydovsky state clinical hospital of Healthcare Department of Moscow. Address: 117997, Moscow, 27 B. Serpukhovskaya Str. Tel.: +7 (964) 774-67-48.
E-mail: dmitry.v.kalinin@gmail.com. ORCID: 0000-0001-6247-9481

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