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SARS-CoV-2 Pozitif Olgularda Dalak ve Bölgesel Lenf Düğümlerinde Ölüm Sonrası Histopatolojik Bulgular

Year 2022, Volume: 36 Issue: 3, 119 - 126, 14.12.2022

Abstract

Amaç: SARS-CoV-2 virüsü dalak ve lenf düğümlerini etkileyebilir. Bu çalışmada bölgesel lenf nodları ve dalakta histomorfolojik değişiklikleri, immünohistokimyasal bulguları ve gerçek zamanlı polimeraz zincir reaksiyonu testi (rt-PCR) sonuçlarını değerlendirmeyi amaçladık. Yöntemler: SARS-Cov-2 pozitif olan 12 postmortem nazofaringeal sürüntü vakasının bölgesel lenf düğümleri ve dalak örnekleri değerlendirildi. Üst paratrakeal, alt paratrakeal ve hiler lenf nodları ve dalak örnekleri ışık mikroskobu altında H&E boyalı kesitler ve immünohistokimyasal olarak boyanmış kesitler ile incelendi.
Bulgular: Dokuz olguda yaygın alveoler hasar görüldü. Konjesyon, immünoblastik ve plazmablastik hücrelerin varlığı, subkapsüler sinüslerin genişlemesi, apoptotik hücrelerin varlığı ve sinüs histiositozu en sık görülen değişikliklerdi. Dört olguda üst paratrakeal lenf düğümlerinde, yedi olguda alt paratrakeal lenf düğümlerinde ve beş olguda hiler lenf düğümlerinde SARS-CoV-2 rt-PCR testi pozitifti. Beyaz pulpa atrofisi ve kırmızı pulpa kanaması dalakta en sık görülen bulgulardı. Dalakta dört vakada SARS-CoV-2 rt-PCR testi pozitifti.
Sonuç: SARS-CoV-2 virüsü lenf düğümlerine ve dalağa yayılarak dokuları tahrip edebilir.

References

  • Elsoukkary SS, Mostyka M, Dillard A, Berman DR, Ma LX, Chadburn A, et al. Autopsy Findings in 32 Patients with COVID-19: A Single-Institution Experience. Pathobiology. 2021; 88(1):56-68.
  • WHO Coronavirus Disease Dashboard. https://covid19.who.int/. Accessed December 31, 2021.
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  • Tian S, Hu W, Niu L, Liu H, Xu H, Xiao SY. Pulmonary pathology of early phase 2019 novel coronavirus (COVID-19) pneumonia in two patients with lung cancer. J Thorac Oncol 2020;15:700-704.
  • Satturwar S, Fowkes M, Farver C, Wilson AM, Eccher A, Girolami I, et al. Postmortem Findings Associated With SARS-CoV-2: Systematic Review and Meta-analysis. Am J Surg Pathol. 2021;45(5):587-603.
  • Bugra A, Das T, Arslan MN, Ziyade N, Buyuk Y. Postmortem pathological changes in extrapulmonary organs in SARS-CoV-2 rt-PCR-positive cases: a single-center experience. Ir J Med Sci 2022;191(1):81-91.
  • Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N. Engl. J. Med 2020;382(18):1708-1720.
  • Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical Features of Patients Infected with 2019 Novel Coronavirus in Wuhan, China. Lancet 2020;395(10223):497-506.
  • Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al.Clinical Characteristics of 138 Hospitalized PatientsWith 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020;323(11):1061-1069.
  • Huang I, Pranata R. Lymphopenia in Severe Coronavirus Disease-2019 (COVID-19): Systematic Review and Meta-Analysis. J. Intensive Care 2020;8:36.
  • Jafarzadeh A, Jafarzadeh S, Nozari P, Mokhtari P, Nemati M. Lymphopenia an Important Immunological Abnormality in Patients with COVID-19: Possible Mechanisms. Scand. J. Immunol 2021;93(2):e12967.
  • Xiang Q, Feng Z, Diao B, Tu C, Qiao Q, Yang H, et al. SARS-CoV-2 Induces Lymphocytopenia by Promoting Inflammation and Decimates Secondary Lymphoid Organs. Front. Immunol 2021;12:661052.
  • Daş T, Buğra A, Arslan MN, Ziyade N, Buyuk Y. Evaluation of postmortem pathological changes in the lung in SARS-CoV-2 RT-PCR positive cases. J Surg Med 2021;5(11): 1113-1120.
  • Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China JAMA Intern Med 2020;180(7):934-943.
  • Peiris JS, Chu CM, Cheng VC, Chan KS, Hung IF, Poon LL, Law KI, et al. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study, Lancet 2003;361(9371):1767-1772.
  • Nassar MS, Bakhrebah MA, Meo SA, Alsuabeyl MS, Zaher WA. Middle east respiratory syndrome coronavirus (MERS-CoV) infection: epidemiology, pathogenesis and clinical characteristics Eur Rev Med Pharmacol Sci 2018;22(15):4956-4961.
  • Song P, Li W, Xie J, Hou Y, You C. Cytokine storm induced by SARS-CoV-2. Clin Chim Acta, 2020;509:280-287.
  • Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol 2020;146(1):110-118.
  • Haslbauer JD, Matter MS, Stalder AK, Tzankov A. Histomorphological patterns of regional lymph nodes in COVID-19 lungs. Pathologe. 2021;42(Suppl 1):89-97.
  • Abdullaev A, Odilov A, Ershler M, Volkov A, Lipina T, Gasanova T, et al. Viral Load and Patterns of SARS-CoV-2 Dissemination to the Lungs, Mediastinal Lymph Nodes, and Spleen of Patients with COVID-19 Associated Lymphopenia. Viruses 2021;13(7):1410.
  • Menter T, Haslbauer JD, Nienhold R, Savic S, Hopfer H, Deigendesch N, et al. Postmortem examination of COVID-19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings in lungs and other organs suggesting vascular dysfunction. Histopathology 2020;77(2): 198–209.
  • Iwasaki A, Yang Y. The potential danger of suboptimal antibody responses in COVID-19. Nat Rev Immunol 2020;20(6):339–341.
  • Bergsten E, Horne A, Aricó M, Astigarraga I, Egeler RM, Filipovich AH, et al. Confirmed efficacy of etoposide and dexamethasone in HLH treatment: longterm results of the cooperative HLH-2004 study. Blood 2017;130(25):2728-2738.
  • Risdall RJ, McKenna RW, Nesbit ME, Krivit W, Balfour HH Jr, Simmons RL, et al. Virus-associated hemophagocytic syndrome: a benign histiocytic proliferation distinct from malignant histiocytosis. Cancer 1979;44(3):993- 1002.
  • Ramos-Casals M, Brito-Zerón P, López-Guillermo A, Khamashta MA, Bosch X. Adult haemophagocytic syndrome. Lancet 2014;383:1503-1516.
  • Prilutskiy A, Kritselis M, Shevtsov A, Yambayev I, Vadlamudi C, Zhao Q, et al. SARS-CoV-2 Infection-Associated Hemophagocytic Lymphohistiocytosis. Am J Clin Pathol 2020;154(4):466-474.
  • Diao B, Wang C, Tan Y, Chen X, Liu Y, Ning L, et al. Reduction and functional exhaustion of T cells in patients with coronavirus disease 2019 (COVID-19). Front immunol 2020;11:827.
  • Gupta S. Tumor necrosis factor-alpha-induced apoptosis in T cells from aged humans: a role of TNFR-I and downstream signaling molecules. Exp Gerontol 2002;37(2-3):293-299.
  • Channappanavar R, Perlman S. Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology. Semin Immunopathol 2017;39 (5):529-539.
  • Xiong Y, Liu Y, Cao L, Wang D, Guo M, Jiang A et al. Transcriptomic characteristics of bronchoalveolar lavage fluid and peripheral blood mononuclear cells in COVID-19 patients. Emerg Microbes Infect 2020;9(1):761-770.
  • Kaneko N, Kuo HH, Boucau J, Farmer JR, Allard-Chamard H, Mahajan VS, et al. Loss of Bcl-6-Expressing T Follicular Helper Cells and Germinal Centers in COVID-19. Cell 2020;183(1):143-157.e13.
  • Feng Z, Diao B, Wang R, Wang G, Wang C, Tan Yet al. The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) directly decimates human spleens and lymph nodes. medRxiv. 2020. https://doi.org/10.1101/2020.03.27.20045427.

Postmortem histopathological findings in the spleen and the regional lymph nodes in SARS-Cov-2 positive cases

Year 2022, Volume: 36 Issue: 3, 119 - 126, 14.12.2022

Abstract

Objective: SARS-CoV-2 virus can affect the spleen and lymph nodes. In this study, we aimed to evaluate the histomorphological changes, immunohistochemical findings and real-time polymerase chain reaction test (rt-PCR) results in regional lymph nodes and spleen. Methods: The regional lymph nodes and spleen samples of 12 cases of postmortem nasopharyngeal swabs that were positive for SARS-Cov-2 were evaluated. Upper paratracheal, lower paratracheal, and hilar lymph nodes and spleen samples were examined under a light microscope with H&E stained sections and immunohistochemically stained sections.
Results: Diffuse alveolar damage was seen in nine cases. Congestion, presence of immunoblastic and plasmablastic cells, expansion of subcapsular sinuses, presence of apoptotic cells, and sinus histiocytosis were the most common changes. The SARS-CoV-2 rt-PCR test was positive in four cases in the upper paratracheal lymph nodes, in seven cases in the lower paratracheal lymph nodes, and in five cases in the hilar lymph nodes. White pulp atrophy and red pulp hemorrhage were the most common findings in the spleen. The SARS-CoV-2 rt-PCR test was positive in four cases in the spleen.
Conclusion: SARS-CoV-2 virus can spread to the lymph nodes and spleen and destroy the tissues.

References

  • Elsoukkary SS, Mostyka M, Dillard A, Berman DR, Ma LX, Chadburn A, et al. Autopsy Findings in 32 Patients with COVID-19: A Single-Institution Experience. Pathobiology. 2021; 88(1):56-68.
  • WHO Coronavirus Disease Dashboard. https://covid19.who.int/. Accessed December 31, 2021.
  • Carsana L, Sonzogni A, Nasr A, Rossi RS, Pellegrinelli A, Zerbi P, et al. Pulmonary post-mortem findings in a large series of COVID-19 cases from Northern Italy. Infect Dis 2020;20(10):1135-1140.
  • Tian S, Hu W, Niu L, Liu H, Xu H, Xiao SY. Pulmonary pathology of early phase 2019 novel coronavirus (COVID-19) pneumonia in two patients with lung cancer. J Thorac Oncol 2020;15:700-704.
  • Satturwar S, Fowkes M, Farver C, Wilson AM, Eccher A, Girolami I, et al. Postmortem Findings Associated With SARS-CoV-2: Systematic Review and Meta-analysis. Am J Surg Pathol. 2021;45(5):587-603.
  • Bugra A, Das T, Arslan MN, Ziyade N, Buyuk Y. Postmortem pathological changes in extrapulmonary organs in SARS-CoV-2 rt-PCR-positive cases: a single-center experience. Ir J Med Sci 2022;191(1):81-91.
  • Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N. Engl. J. Med 2020;382(18):1708-1720.
  • Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical Features of Patients Infected with 2019 Novel Coronavirus in Wuhan, China. Lancet 2020;395(10223):497-506.
  • Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al.Clinical Characteristics of 138 Hospitalized PatientsWith 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020;323(11):1061-1069.
  • Huang I, Pranata R. Lymphopenia in Severe Coronavirus Disease-2019 (COVID-19): Systematic Review and Meta-Analysis. J. Intensive Care 2020;8:36.
  • Jafarzadeh A, Jafarzadeh S, Nozari P, Mokhtari P, Nemati M. Lymphopenia an Important Immunological Abnormality in Patients with COVID-19: Possible Mechanisms. Scand. J. Immunol 2021;93(2):e12967.
  • Xiang Q, Feng Z, Diao B, Tu C, Qiao Q, Yang H, et al. SARS-CoV-2 Induces Lymphocytopenia by Promoting Inflammation and Decimates Secondary Lymphoid Organs. Front. Immunol 2021;12:661052.
  • Daş T, Buğra A, Arslan MN, Ziyade N, Buyuk Y. Evaluation of postmortem pathological changes in the lung in SARS-CoV-2 RT-PCR positive cases. J Surg Med 2021;5(11): 1113-1120.
  • Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China JAMA Intern Med 2020;180(7):934-943.
  • Peiris JS, Chu CM, Cheng VC, Chan KS, Hung IF, Poon LL, Law KI, et al. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study, Lancet 2003;361(9371):1767-1772.
  • Nassar MS, Bakhrebah MA, Meo SA, Alsuabeyl MS, Zaher WA. Middle east respiratory syndrome coronavirus (MERS-CoV) infection: epidemiology, pathogenesis and clinical characteristics Eur Rev Med Pharmacol Sci 2018;22(15):4956-4961.
  • Song P, Li W, Xie J, Hou Y, You C. Cytokine storm induced by SARS-CoV-2. Clin Chim Acta, 2020;509:280-287.
  • Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol 2020;146(1):110-118.
  • Haslbauer JD, Matter MS, Stalder AK, Tzankov A. Histomorphological patterns of regional lymph nodes in COVID-19 lungs. Pathologe. 2021;42(Suppl 1):89-97.
  • Abdullaev A, Odilov A, Ershler M, Volkov A, Lipina T, Gasanova T, et al. Viral Load and Patterns of SARS-CoV-2 Dissemination to the Lungs, Mediastinal Lymph Nodes, and Spleen of Patients with COVID-19 Associated Lymphopenia. Viruses 2021;13(7):1410.
  • Menter T, Haslbauer JD, Nienhold R, Savic S, Hopfer H, Deigendesch N, et al. Postmortem examination of COVID-19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings in lungs and other organs suggesting vascular dysfunction. Histopathology 2020;77(2): 198–209.
  • Iwasaki A, Yang Y. The potential danger of suboptimal antibody responses in COVID-19. Nat Rev Immunol 2020;20(6):339–341.
  • Bergsten E, Horne A, Aricó M, Astigarraga I, Egeler RM, Filipovich AH, et al. Confirmed efficacy of etoposide and dexamethasone in HLH treatment: longterm results of the cooperative HLH-2004 study. Blood 2017;130(25):2728-2738.
  • Risdall RJ, McKenna RW, Nesbit ME, Krivit W, Balfour HH Jr, Simmons RL, et al. Virus-associated hemophagocytic syndrome: a benign histiocytic proliferation distinct from malignant histiocytosis. Cancer 1979;44(3):993- 1002.
  • Ramos-Casals M, Brito-Zerón P, López-Guillermo A, Khamashta MA, Bosch X. Adult haemophagocytic syndrome. Lancet 2014;383:1503-1516.
  • Prilutskiy A, Kritselis M, Shevtsov A, Yambayev I, Vadlamudi C, Zhao Q, et al. SARS-CoV-2 Infection-Associated Hemophagocytic Lymphohistiocytosis. Am J Clin Pathol 2020;154(4):466-474.
  • Diao B, Wang C, Tan Y, Chen X, Liu Y, Ning L, et al. Reduction and functional exhaustion of T cells in patients with coronavirus disease 2019 (COVID-19). Front immunol 2020;11:827.
  • Gupta S. Tumor necrosis factor-alpha-induced apoptosis in T cells from aged humans: a role of TNFR-I and downstream signaling molecules. Exp Gerontol 2002;37(2-3):293-299.
  • Channappanavar R, Perlman S. Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology. Semin Immunopathol 2017;39 (5):529-539.
  • Xiong Y, Liu Y, Cao L, Wang D, Guo M, Jiang A et al. Transcriptomic characteristics of bronchoalveolar lavage fluid and peripheral blood mononuclear cells in COVID-19 patients. Emerg Microbes Infect 2020;9(1):761-770.
  • Kaneko N, Kuo HH, Boucau J, Farmer JR, Allard-Chamard H, Mahajan VS, et al. Loss of Bcl-6-Expressing T Follicular Helper Cells and Germinal Centers in COVID-19. Cell 2020;183(1):143-157.e13.
  • Feng Z, Diao B, Wang R, Wang G, Wang C, Tan Yet al. The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) directly decimates human spleens and lymph nodes. medRxiv. 2020. https://doi.org/10.1101/2020.03.27.20045427.
There are 32 citations in total.

Details

Primary Language English
Subjects Forensic Medicine
Journal Section Research Articles
Authors

Aytül Buğra 0000-0001-5640-8329

Taner Daş 0000-0002-1216-186X

Erdoğan Kara 0000-0002-5695-5709

Nihan Ziyade 0000-0002-3606-0756

Yalcin Buyuk 0000-0002-2270-5568

Publication Date December 14, 2022
Submission Date September 19, 2022
Published in Issue Year 2022 Volume: 36 Issue: 3

Cite

Vancouver Buğra A, Daş T, Kara E, Ziyade N, Buyuk Y. Postmortem histopathological findings in the spleen and the regional lymph nodes in SARS-Cov-2 positive cases. J For Med. 2022;36(3):119-26.
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