Pulmonary Pathology of Early COVID-19 Pneumonia Identified Retrospectively in Two Patients With Lung Cancer

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An international team of clinicians and researchers have described the pathology of the novel coronavirus, or COVID-19, for the first time. Their findings were published by Tian et al in the Journal of Thoracic Oncology.

The article’s senior author, Shu-Yuan Xiao, MD, from the University of Chicago Medicine in Chicago, teamed up with a small group of clinicians from the Zhongnan Hospital of Wuhan University, in Wuhan, China.

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The article describes two patients who recently underwent lung lobectomies for adenocarcinoma and were retrospectively found to have had COVID-19 at the time of surgery. Pathologic examinations revealed that, apart from the tumors, the lungs of both patients exhibited edema, proteinaceous exudate, focal reactive hyperplasia of pneumocytes with patchy inflammatory cellular infiltration, and multinucleated giant cells. Fibroblastic plugs were noted in airspaces.

“This is the first study to describe the pathology of disease caused by...COVID-19 pneumonia, since no autopsy or biopsies had been performed thus far. This would be the only description of early-phase pathology of the disease due to this rare coincidence...Since both patients did not exhibit symptoms of pneumonia at the time of surgery, these changes likely represent an early-phase of the lung pathology of COVID-19 pneumonia," Dr. Xiao said.

Two Cases

The first case was an 84-year-old female patient who was admitted for treatment evaluation of a tumor measuring 1.5 cm in the right middle lobe of the lung. The tumor was discovered on chest computed tomography scan at an outside hospital. She had a past medical history of hypertension for 30 years, as well as type 2 diabetes. Despite comprehensive treatment, assisted oxygenation, and other supportive care, the patient’s condition deteriorated, and she died. Subsequent clinical information confirmed that she was exposed to another patient in the same room who was subsequently found to be infected with the 2019 novel coronavirus.

The second case was a 73-year-old male patient who presented for elective surgery for lung cancer, which presented as a small mass in the right lower lobe of the lung. He had a past medical history of hypertension for 20 years, which had been adequately managed. Nine days after lung surgery, he developed a fever with dry cough, chest tightness, and muscle pain. A nucleic acid test for COVID-19 came back as positive. He gradually recovered and was discharged after 20 days of treatment in the infectious disease unit.

Common Scenario

According to the study, these two incidences also typify a common scenario during the earlier phase of the COVID-19 outbreak, during which a significant number of health-care providers became infected in hospitals in Wuhan, and patients in the same hospital room were cross-infected as they were exposed to unknown infectious sources. The presence of early lung lesions days before the patients developed symptoms corresponds to the long incubation period (usually 3 to 14 days) of COVID-19.

The long incubation period made it difficult to prevent transmission during the early days of this outbreak, as many health-care workers in Wuhan became infected when they were seeing patients without sufficient protection, according to Dr. Xiao. As of today, more than 15 doctors in Wuhan have died of COVID-19.

“We believe it is imperative to report the findings of routine histopathology for better understanding of the mechanism by which [COVID-19] causes lung injury in the unfortunate tens and thousands of patients in Wuhan and worldwide,” said Dr. Xiao.

Further studies by Dr. Xiao’s team and collaborators on COVID-19 pathology through postmortem biopsies are ongoing, which should provide data on the late changes of this disease.

Disclosure: For full disclosures of the study authors, visit