Objectives: To observe the pulmonary changes with coronavirus disease 2019 (COVID-19) in postmortem needle specimens, to detect the presence of 2019 novel coronavirus(2019-nCoV) in the lung tissues, and to analyze the clinicopathological characteristics. Methods: For 10 decedents with 2019-nCoV infection in Wuhan, bilateral lungs underwent ultrasound-guided percutaneous multi-point puncture autopsy, and pulmonary pathological changes were described in routine hematoxylin-eosin staining (HE) slides. Electron microscopy was also performed. The reverse transcription polymerase chain reaction (RT-PCR) was employed to detect 2019-nCoV nucleic acid in lung tissue, and the pathological characteristics were demonstrated in combination with clinical data analysis. Results: Of the 10 deaths associated with COVID-19, 7 were male and 3 were female. The average age was 70 (39-87) years. Medical record showed that 7 patients had underlying diseases. The average course of disease was 30 (16-36) days. Nine cases showed fibrinous and suppurative exudation in the alveolar cavity accompanied by the formation of hyaline membrane, and fibroblastic proliferation of alveolar septum. Type Ⅱ alveolar epithelial cells showed reactive hyperplasia and desquamation. Many macrophages accumulated in the alveolar cavity. Capillary hyaline thrombus and intravascular mixed thrombus were noted. In some cases, acute bronchiolitis with mucous membrane exfoliation, accumulation of bronchiolar secretions, and bronchiolar epithelial metaplasia occurred. In the cohort, a large number of bacteria (cocci) were detected in 1 case and a large number of fungi (yeast type) were detected in 1 case. Nine cases were positive for the nucleic acids of 2019-nCoV while one case remained negative by RT-PCR. Coronavirus particles were detected in the cytoplasm of type Ⅱ alveolar epithelium. Conclusions: The pulmonary pathological changes of fatal COVID-19 are diffuse alveolar damage (DAD), mainly in the acute exudative stage and the organic proliferative stage. There are fibrinous exudate aggregation in alveolar cavity with hyaline membrane formation, fibroblastic proliferation in alveolar septum, and alveolar epithelial cell injuries with reactive hyperplasia and desquamation of type Ⅱ alveolar epithelial cells. A large amount of neutrophils and monocytes infiltration is present in most cases and bacteria and fungi are detected in some cases, suggesting a serious bacterial or fungal infection secondary to the DAD.
目的： 观察新型冠状病毒感染疾病（COVID-19）死亡患者肺组织穿刺标本的病理变化，检测肺组织内是否存在新型冠状病毒（2019-nCoV），结合临床表现进行分析。 方法： 对武汉地区10例COVID-19死亡病例双侧肺脏行B超引导下经皮多点穿刺尸检，常规HE染色制片后观察肺组织的病理改变，行电镜检查，并运用逆转录-聚合酶链反应（RT-PCR）方法检测肺组织内2019-nCoV核酸，结合临床资料进行临床病理分析。 结果： 10例死亡患者中7例男性，3例女性。平均年龄70（39~87）岁。7例合并基础疾病。平均病程30（16~36）d。9例肺组织肺泡腔内检出程度不一的纤维素性及化脓性炎性渗出物，肺泡腔内透明膜形成。肺泡隔纤维母细胞增生。Ⅱ型肺泡上皮细胞反应性增生和脱落。肺泡腔内见多少不等的巨噬细胞。可见毛细血管透明血栓和血管内混合血栓。部分病例检出急性细支气管炎伴黏膜剥脱及腔内分泌物增多和细支气管上皮化生。该组病例中1例肺泡腔内检出大量细菌（球菌），1例检出大量真菌（酵母型菌体）。9例肺组织2019-nCoV核酸检测阳性，1例阴性。电镜下，Ⅱ型肺泡上皮细胞胞质内检出冠状病毒颗粒。 结论： 该组2019-nCoV感染死亡病例肺部病理学改变表现为弥漫性肺泡损伤（DAD），以急性渗出期和机化增生期为主，有肺泡腔内纤维素性渗出物聚集伴透明膜形成，肺泡隔纤维母细胞增生，肺泡上皮细胞损伤伴Ⅱ型肺泡上皮细胞反应性增生和脱落。大部分病例伴多量中性粒细胞和单核细胞浸润，部分病例检出大量细菌及真菌，提示在DAD基础上继发了严重的细菌或真菌感染。.
Keywords: Autopsy; Coronavirus infections; Lung diseases; Lung injury; Minimally invasive autopsy; Pathological conditions, anatomical.