期刊
HUMAN PATHOLOGY
卷 116, 期 -, 页码 49-62出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.humpath.2021.06.008
关键词
SARS-CoV-2; Autopsy; COVID-19; Histiocyte; Multiplex immunohistochemistry
类别
资金
- Boston University Mallory Pathology Associates, Inc.
- Boston Medical Center
Comparison of lung tissue immunopathology in patients with severe COVID-19 and those with DAD before the COVID-19 pandemic revealed a distinctive pattern of pseudopalisaded histiocytic hyperplasia in COVID-19 associated DAD. This inflammatory pattern may represent the unique immunopathology associated with the dexamethasone responsive form of DAD in severe COVID-19.
Severe COVID-19 results in a glucocorticoid responsive form of acute respiratory distress (ARDS)/diffuse alveolar damage (DAD). Herein we compare the immunopathology of lung tissue procured at autopsy in patients dying of SARS-CoV-2 with those dying of DAD prior to the COVID-19 pandemic. Autopsy gross and microscopic features stratified by duration of illness in twelve patients who tested positive for SARS-CoV-2 viral RNA, as well as seven patients dying of DAD prior to the COVID-19 pandemic were evaluated with multiplex (5-plex: CD4, CD8, CD68, CD20, AE1/AE3) and SARS-CoV immunohistochemistry to characterize the immunopathologic stages of DAD. We observed a distinctive pseudopalisaded histiocytic hyperplasia interposed between the exudative and proliferative phase of COVID-19 associated DAD, which was most pronounced at the fourth week from symptom onset. Pulmonary macrothrombi were seen predominantly in cases with pseudopalisaded histiocytic hyperplasia and/or proliferative phase DAD. Neither pseudopalisaded histiocytic hyperplasia nor pulmonary macrothrombi was seen in non-COVID-19 DAD cases, whereas microthrombi were common in DAD regardless of etiology. The inflammatory pattern of pseudopalisaded histiocytic hyperplasia may represent the distinctive immunopathology associated with the dexamethasone responsive form of DAD seen in severe COVID-19. (C) 2021 Elsevier Inc. All rights reserved.
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