Working Paper Case Report Version 3 This version is not peer-reviewed

Clinical Pathology of Critical Patient with Novel Coronavirus Pneumonia (COVID-19)

Version 1 : Received: 26 February 2020 / Approved: 27 February 2020 / Online: 27 February 2020 (12:30:45 CET)
Version 2 : Received: 27 February 2020 / Approved: 27 February 2020 / Online: 27 February 2020 (16:06:23 CET)
Version 3 : Received: 29 February 2020 / Approved: 2 March 2020 / Online: 2 March 2020 (15:32:55 CET)
Version 4 : Received: 9 March 2020 / Approved: 9 March 2020 / Online: 9 March 2020 (10:31:10 CET)

A peer-reviewed article of this Preprint also exists.


Background Novel coronavirus pneumonia ( COVID-19) have emerged as major global health threats since December, 2019. Up to now, the histopathology of critical patient with COVID-19 remains largely undisclosed. Methods We here performed the whole lung biopsy, and described the pathological changes of one COVID-19 critical patient done with transplant by HE staining, immunohistochemistry and special staining including Masson staining, PAS staining and silver methenamin staining. Findings The whole lung tissue displayed diffuse congestive appearance or partly haemorrhagic necrosis on gross examination. The haemorrhagic necrosis was prominently present in outer edge of the right lobe of the right lung. The cut surfaces of the lung displayed severe congestive and haemorrhagic changes. The main pathological lung changes showed bronchiolitis and alveolitis with proliferation, atrophy, desquamation and squamous metaplasia of epithelial cells. Massive pulmonary interstitial fibrosis, and partly hyaline degeneration, variable degrees of hemorrhagic pulmonary infarction. Small vessels hyperplasia, vessel wall thickening, lumen stenosis, occlusion and microthrombosis formation. Focal monocytes, lymphocytes and plasma cells infiltrating into pulmonary interstitium. Atrophy, vacuolar degeneration, proliferation, desquamation and squamous metaplasia in alveolar epithelial cells. Alveolar cavity congestion was prominent, and contained mucus, edema fluid, desquamated epithelial cells, and inflammatory cells. We can also found several multinucleate giant cells and intracytoplasmic viral inclusion bodies. Masson staining indicated massive pulmonary interstitial fibrosis. Immunohistochemistry results showed positive for immunity cells including CD3, CD4, CD8, CD20, CD79a, CD5, CD38 and CD68. Interpretation We show clinical pathology biopsy of critical patient with COVID-19, which might provide a deep insight of the pathogenesis and the severity of this disease.


Novel coronavirus pneumonia; COVID-19; SARS-CoV-2; Pathology; Critical patient


Medicine and Pharmacology, Pathology and Pathobiology

Comments (1)

Comment 1
Received: 2 March 2020
Commenter: Weiren Luo
Commenter's Conflict of Interests: Author
Comment: Main changes
1)In Induction section, the last sentence has been changed as “Different from lung needle biopsy taken from the died patient recently reported by Wang FS research group,6 we here performed the whole lung biopsy of the surgical patient, and for the first time, describe the main pathological changes of critical patient with COVID-19.”
2)In discussion section the sentence “Additionally, immunologic cells focally infiltrated into lung interstitium.” has been added as “On the other side, cytokine storm links to an excessively exaggerated immune response, and uncontrolled proinflammatory responses, which causes severe organ diseases including lung damages.14-16 Several representative cytokines have been identified including IL-1β, IL-18, TNF-α, IL-6, IL-8 and IL-10, which are produced and regulated by various immunological cells including CD8 and CD4 T cells.17 Interestingly, we observed that lymphocytes, monocytes and plasma cells infiltrating into pulmonary interstitium, and these types of inflammatory cells were confirmed by immunohistological method. ”
3)In Acknowledge section, “We thank Marge limited company for providing ultrasonic rapid tissue dehydrator and finished the electronic version and paper version of pathological report in time on February 17 and 18, 2020, respectively. We thank 3DHISTECH, and for the first time, we launched and completed digital pathology of COVID-19 through WSI scanning on February 22-24, 2020 (;”
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