Pathological Features in 100 Deceased Patients With COVID-19 in Correlation With Clinical and Laboratory Data.

Background: Autopsies on COVID-19 deceased patients have many limitations due to necessary epidemiologic and preventative measures. The ongoing pandemic has caused a significant strain on healthcare systems and is being extensively studied around the world. Clinical data does not always corelate with post-mortem findings. The goal of our study was to find pathognomonic factors associated with COVID-19 mortality in 100 post-mortem full body autopsies. Materials and Methods: Following necessary safety protocol, we performed 100 autopsies on patients who were diagnosed with COVID-19 related death. The macroscopic and microscopic pathologies were evaluated along with clinical and laboratory findings. Results: Extensive coagulopathic changes are seen throughout the bodies of diseased patients. Diffuse alveolar damage is pathognomonic of COVID-19 viral pneumonia, and is the leading cause of lethal outcome in younger patients. Extrapulmonary pathology is predominantly seen in the liver and spleen. Intravascular thrombosis is often widespread and signs of septic shock are often present. Conclusion: The described pathological manifestations of COVID-19 in deceased patients are an insight into the main mechanisms of SARS-CoV-2 associated lethal outcome. The disease bears no obvious bias in severity, but seems to be more severe in some patients, hinting at genetic or epigenetic factors at play.

[Pathomorphological features of pulmonary Langerhans cell histiocytosis].

The paper provides the clinical and X-ray characteristics of pulmonary Langerhans cell histiocytosis (PLCH). It describes pulmonary pathohistological changes in this disease, characterizes the cellular composition of granuloma, and gives methods that can verify the diagnosis of PLCH. A case of PLCH with severe respiratory failure, for which bilateral lung transplantation and histological examination of removed lungs have been made, is described.

[The present views of chronic obstructive pulmonary disease and the senile lung].

The gross postmortem diagnosis of chronic obstructive pulmonary disease (COPD) and its differential diagnosis with senile lungs on autopsy specimens are much difficult if clinical, X-ray, and functional findings are absent. The diagnosis of COPD is now possible only if medical history and clinical data, external respiratory function, and disease severity are considered and compared with the gross and microscopic autopsy pattern, by obligatorily evaluating the state of collagen and elastic fibers. Taking into account the current definition and essence of COPD, it is expedient to reconsider existing stereotypes in the postmortem diagnosis of this disease, by focusing our efforts on the study of its morphologic substrate, patho-, and morphogenesis.

[A diagnosis of Wegener's granulomatosis in a 14-year-old patient].

The paper describes a case of Wegener's granulomatosis with upper airway and lung involvements in a 14-year-old patient. Cavernous pulmonary tuberculosis was presumptively diagnosed during planned examination. The diagnosis of Wegener's granulomatosis was established by examining the materials obtained during marginal resection of the lung. The clinical and laboratory indices and histological findings of the biopsy specimens taken during open lung biopsy were considered.

[Biochemical diagnostics of fatal opium intoxication].

Biochemical diagnostics of fatal opium intoxication remains a topical problem in forensic medical science and practice. We investigated materials obtained in the course of forensic medical expertise of the cases of fatal opium intoxication. The study revealed significant differences between myoglobin levels in blood, urine, myocardium, and skeletal muscles. The proposed approach to biochemical diagnostics of fatal opium intoxication enhances the accuracy and the level of evidence of expert conclusions.

[Pneumocystic pneumonia].

The article is devoted to short description of epidemiology, clinical and radiologic demonstration of pneumocystic pneumonia. The features of pathologicoanatomic changes at pneumocystic pneumonia are described. Own observation about combination of classic and scarce histological changes at this disease is in the article.

[Calcification and ossification of lungs].

The different types of lung calcification and ossification including idiopathic and developing after various diseases are in the article. We have described rare lung pathology - pulmonary alveolar microlithiasis. We have drawn attention to the possible mechanisms of lung calcification and ossification development.

[Pathological anatomy in A/H1N1 influenza].

Forty autopsy cases died from A/H1N1 influenza in Moscow, the Moscow Region, and Chita were analyzed. Major changes were found to develop in the trachea and lung. The lung showed the pattern of exudative and proliferative stages of diffuse alveolar lesion. In addition, the signs of viremia-associated infectious-toxic shock, as suggested by pronounced changes in the brain, kidneys, liver, spleen, adrenals, and lymph nodes were revealed. Bacterial bronchopneumonia was detected only in 20% of cases.

[Pathomorphology of the lung in severe influenza A/H1N1].

Thirty-five autopsy cases of influenza A/HIN1 in Moscow were analyzed. Primary pathological changes were found in the trachea and lung. The lung showed a pattern of the exudative and proliferative stages of diffuse alveolar damage. In addition, there were signs of infectious-toxic shock associated with viremia, as suggested by pronounced changes in the brain, kidneys, liver, spleen, adrenals, and lymph nodes. Bacterial bronchopneumonia was detected in only 20% of cases.

[Morphofunctional characteristics of pulmonary and bronchial arteries in bronchial asthma, chronic obstructive lung disease, idiopathic fibrosing alveolitis].

Morphological and morphometric studies have shown that secondary pulmonary hypertension is characterized by more pronounced pathological changes in the pulmonary arterial branches in severe chronic obstructive lung disease (COLD) than in idiopathic fibrosing alveolitis. Secondary pulmonary hypertension does develop in atopic bronchial asthma. Moreover, there are more significant pathological changes in the pulmonary arteries than in the bronchial ones. In severe COLD, the development of emphysema affects that of pulmonary arterial hypertension.

[Idiopathic and secondary pulmonary hypertension].

In the available literature, there are single papers on the association of the values of external respiratory function and the EchoCG sings of pulmonary hypertension with the morphological parameters of pulmonary arterial branches in idiopathic pulmonary hypertension (IPH) and secondary pulmonary hypertension (SPH). The present investigation comprised a comprehensive study of life-time functional changes in the cardiopulmonary system and postmortem morphometric changes in the heart and pulmonary vessels in idiopathic pulmonary fibrosis (IPF)-induced SPH and IPH. The investigation has indicated that PPH and SPH are characterized by the same-type rearrangement of pulmonary arterial branches as intimal hyperplasia and medial hypertrophy; however, IPH, as compared with SPH, induces a more significant cor pulmonale. The magnitude of right and left ventricular dysfunction corresponds to the degree of pulmonary hypertension (PH) and cor pulmonale. In IPF, the decreases in tidal volumes and pulmonary diffusion capacity favor PH progression.

[Morphological characteristics of stenosis of the major duodenal papilla].

The study demonstrates a broad spectrum of pathological processes (of inflammatory, tumorous, and tumor-like genesis) of the major duodenal papilla, which result in its stenosis. It should be stressed that only a comprehensive clinical and morphological approach to diagnosing diseases of the major duodenal papilla and accordingly to choosing an adequate treatment may be a success. The morphological studies are currently prominent.

[Morphofunctional characteristics of microvessels in serous tumors of the ovaries].

High vascularization is noted in serous papillary ovarian tumors of a low malignancy grade, particularly in malignant serous ovarian tumors with low vascularization in benign neoplasms. Pronounced morphological changes in the vascular wall are found mainly in malignant tumors and tumors of a low malignancy grade where primitive blood vessels of a sinusoid type with a thin muscle wall prevail. Types of vascularization in the tumors studied are variable and this correlates with results of color doppler mapping.

[Morphological characteristics of cell populations in bronchial biopsy from mining-chemical factory workers]. / Morfologicheskie osobennosti kletochnykh populiatsii bronkhobioptatov u rabotnikov gornokhimicheskogo predpriiatiia.

A clinicomorphological examination of bronchial and transbronchial biopsies from the workers of a mining and chemical enterprise in Zheleznogorsk has demonstrated that long-term exposure to low-dose radionuclide radiation induces essential inflammatory and scleroticatrophic changes in the bronchopulmonary tissue. All the cell populations of the bronchial epithelium and stroma as well as a respiratory part of the lungs are involved into the pathological process. Squamous metaplasia of the bronchial epithelium is observed in 50% cases, in half of them various dysplastic processes occur. The complex of the above morphological alterations evidences for an oncological trend in pathological processes in the lungs of workers exposed to radionuclides.

[Effect of halogen aerosol therapy on resistance parameters of the respiratory tract]. / Vliianie galoaérozol'noi terapii na zashchitnye svoistva respiratornogo trakta.

AIM: Assessment of the efficacy of dry high-dispersive aerosol of sodium chloride--the main acting factor of haloaerosol therapy--on defense system of the respiratory tract. MATERIAL AND METHODS: 188 patients with respiratory disease and at risk of pulmonary pathology received course of haloaerosol therapy. 49 matched patients were given placebo. The effect of the treatment was assessed by clinicoendoscopic picture, cytomorphological and bacteriological characteristics of the bronchoalveolar lavage, contamination activity of the microflora, activity of local humoral immunity in pharyngeal brush-biopsies and saliva, rheological indices of the sputum. RESULTS: Dry aerosol of sodium chloride demonstrated antiinflammatory activity in the respiratory tract, mucoregulating action. It enhances drainage of the bronchi, activates alveolar macrophages, improves biocenosis and local humoral immunity. CONCLUSION: Haloaerosol therapy has positive effect on the defense system, improves function of the respiratory tracts.

[Concentration of heavy elements and their compounds in the cells from BALF and pulmonary tumors in radiation-exposed subjects]. / Soderzhanie tiazhelykh élementov i ikh soedinenii v kletkakh bronkhoaal'veoliarnykh smyvov i v tkaniakh opukholei legkikh u lits, podvergavshikhsia radiatsionnomu vozdeistviiu.

AIM: Measurement of heavy elements in alveolar macrophages (AM) of bronchoalveolar lavage (BAL) and pulmonary tumor tissue (PTT); investigation of spacial distribution of the heavy particles in the tissues. MATERIALS AND METHODS: Laser mass-spectrometry estimated quantitative and qualitative characteristics of heavy elements (Mn, Fe, Co, Cu, Zr, etc.) in diagnostic and therapeutic BAL of 6 patients exposed to radiation after the Chernobyl accident and in pulmonary tumor tissue of patients operated for central small-cell and peripheral bronchoalveolar cancer who also had been exposed to radiation after the Chernobyl. RESULTS: Heavy elements concentration in the secondary BAL was less than in the primary one. This shows effectiveness of the procedures aimed at removal of heavy particles from the respiratory organs. Heavy elements content was quite different in two histologically different tumors. CONCLUSION: Laser mass-spectrometry proved its usefulness in simultaneous study of the quantity and quality of heavy elements in AM of BAL and tumors in radiation-exposed subjects, in investigation of the elements distribution in the pulmonary tissues and changes of elements composition in the tissues in the course of tumors development.

[Morphologic and molecular-genetic characterization of lung cancer developing in people who have worked at nuclear facilities and who have lived in Russian territories polluted after the accident at the Chernobyl power plant]. / Morfologicheskie i molekuliarno-geneticheskie osobennosti raka legkogo, razvivshegosia u lits, rabotavshikh na radiatsionnykh proizvodstvakh i prozhivavshikh na zagriaznennykh posle avarii na Chernobyl'skoi AES territoriiakh Rossii.

Clinicomorphological analysis of 15 lung carcinomas of patients who had been exposed for a long time to the radiation after the Chernobyl accident was performed. The material consisted of 10 surgical and 5 autopsy cases and was studied at the light, electron microscopic and immunohistochemical level. There were 6 peripheral, 8 central carcinomas and one massive tumor. Fibrous areas with many dust particles were found in peripheral carcinomas. In central tumors chronic obstructive bronchitis with epithelial dysplasia and metaplasia was observed. Carcinoma was represented by various histologic types: small cell (4 cases), combined small cell with squamous differentiation (5 cases), adenocarcinoma (5 cases), adenosquamous type (1 case). Peculiar calcium deposits in both stroma and parenchyma were found in tumors with glandular differentiation. Morphogenesis of calcium microdeposits may be connected with dust radioactive particles elimination. Central carcinoma had, in the majority of cases, a neuroendocrine differentiation and can be related to some types of small cell carcinoma. Peripheral cancer was mostly of a glandular differentiation and was, as a rule, carcinoma in the scar. Lung carcinomas studied had peculiar molecular-genetic features: lack or low bcl-2 expression, low Ki-67 expression and a high degree of c-myc expression. Tumors were characterized by a low apoptosis index independently of a histologic type. Apoptosis was not complete: lack of apoptotic bodies phagocytosis this resulting in postapoptotic detritus formation.

[Cytological characteristics, elemental composition of alveolar macrophages from bronchoalveolar lavage, lung pathology in liquidators of the consequences of the accident at the Chernobyl power plant]. / Tsitologicheskie osobennosti, élementnyi sostav al'veoliarnykh makrofagov bronkhoal'veoliarnykh smyvov, patomorfologiia legkikh u likvidatorob posledstvii avarii na Chernobyl'skoi AES.

Bronchoalveolar lavage fluid (BALF), broncho- and transbronchial biopsies were examined in Chernobyl wreckers eleven years after the accident. Cytologically and electron-microscopically, there was predominance of alveolar macrophages (AM) with many cytoplasmic foreign bodies containing clear needle-like crystals. Roentgenospectral analysis and laser mass-spectrometry revealed chemical elements which are part of non-active "hot particles" (Al, Si, Ca, Fe) as well as reactor fuel elements and the station constructive materials which are the active part of "hot particles". Programmed BALF allowed to decrease cytosis and the amount of AM containing foreign-body particles as well as concentration of the majority of chemical elements in AM.

[Cystic fibrosis in adolescent patients]. / Mukovistsidoz v iunosheskom vozraste.

Summary--An autopsy observation of mucoviscydosis in a female who died at the age of 17 with a prevalent affection of the bronchopulmonary system is reported. Pronounced cystic fibrosis with atrophy and lipomatosis of the pancreas was found. The cause of death was respiratory failure in spite of intensive antibacterial therapy. Bullous emphysema with frequent pneumothorax in adults with this disease considerably worsens the prognosis and requires urgent therapy which in this case was not conducted because of late hospitalization.