Professionals Analyze Pathology Following lung Lobectomies for Adenocarcinoma

Two patients who underwent lung lobectomies for adenocarcinoma were found to have COVID-19 at the time of operations, enabling professionals to conduct COVID-19 pathological examinations, according to a recent study published in the Journal of Thoracic Oncology.

The pathological examinations found that the lungs of both patients exhibited “edema, proteinaceous exudate, focal reactive hyperplasia of pneumocytes with patchy inflammatory cellular infiltration, and multinucleated giant cells.” The patients did not exhibit these symptoms of pneumonia during the time of the initial operation, meaning these changes were likely representative of an early phase of the COVID-19 pathology.

“The 2 cases reported here represent ‘accidental’ sampling of COVID-19, in which surgeries were performed for tumors in the lungs at a time when the superimposed infections were not recognized,” wrote the researchers. “These provided the first opportunities for studying the pathology of COVID-19.”

The first of the 2 cases was a female aged 84 years who went for treatment evaluation of a tumor in the right middle lobe of her lung. On day 12 of hospitalization, she underwent a thoracoscopic resection of the right middle lobe.

On day 16, she experienced symptoms of COVID-19, including difficulty in breathing, chest tightness, wheezing, and dry cough. A test result revealed a positive case of COVID-19 on day 24, with her death coming on day 29 of hospitalization.

The second case was a male aged 73 years who presented for elective surgery for lung cancer. A nodule was discovered on the right lower lobe of the lung nine months earlier, with an adenocarcinoma diagnosis coming in a later needle biopsy. Three days after admission, the male patient underwent a right lower lobe lung resection with lymph node dissection.

A fever, dry cough, chest tightness, and muscle pain were reported 9 days after the operation. He was treated for COVID-19 after influenza and other infectious disease tests returned negative. After 20 days of treatment in the infectious ward, the male patient gradually recovered and was discharged.

“The two cases presented here also exhibited exudative and proliferative phases of acute lung injury, such as edema, inflammatory infiltrate, type II pneumocyte hyperplasia, and organization, but without obvious hyaline membrane formation and other long-term processes, such as squamous metaplasia,” wrote the researchers. “Of note, the pathologic changes seen in our two cases preceded the development of clinical symptoms and likely represent an earlier phase of the disease.”

There have been several studies previously examining clinical features and radiological findings, but no pathological studies have been conducted on the “basis of autopsies or biopsies.” Because of the suddenness of the COVID-19 outbreak, large patient volumes in hospitals, shortage of healthcare professionals, and high rates of transmissions, autopsies and biopsies have been lacking.

The two patients featured in this study had operations which overlapped with the infection, allowing the researchers to obtain and examine the proper specimens of the histopathology of the COVID-19 pneumonia.

“There is currently a lack of pathologic data on the novel coronavirus (severe acute respiratory syndrome coronavirus 2) pneumonia, or COVID-19, from autopsy or biopsy,” wrote the researchers. “These two cases thus provide important first opportunities to study the pathology of COVID-19.”

Reference:

Tian S, Hu W, Niu L, et al. Pulmonary Pathology of Early-Phase 2019 Novel Coronavirus (COVID-19) Pneumonia in Two Patients with Lung Cancer. Journal of Thoracic Oncology. https://doi.org/10.1016/j.jtho.2020.02.010.