New Insights into COVID-19: Findings from Pathological Anatomy

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6 2 月, 2026

On 6 2 月, 2026

Introduction:

Half a year into the COVID-19 pandemic, various studies on the disease have been progressing simultaneously. Although pathological anatomy started relatively late, it has also achieved many accomplishments. Particularly, autopsy studies have identified some pathological features, elucidated certain pathogenic mechanisms, answered some clinical questions, and adjusted some treatment measures, once again confirming the importance of pathological anatomy in the diagnosis and treatment of emerging infectious diseases.

Regarding COVID-19, the cause has been identified as a novel coronavirus, known as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The main clinical manifestation is pneumonia, commonly referred to as novel coronavirus pneumonia (COVID-19) in China, while the World Health Organization (WHO) has named it Coronavirus Disease 2019 (COVID-19).

Regarding the pathological changes of COVID-19, the author has previously summarized them twice, roughly reflecting the pathological characteristics of the disease. Recently, more reports on pathological studies have been seen, providing some new insights or reinforcing certain existing understandings. Now, let’s summarize again for colleagues’ reference.

First, the disease caused by SARS-CoV-2 is not limited to the lungs but involves multiple organ damage, with lung lesions being predominant. However, lymphoid tissue, brain tissue, heart, liver, kidneys, and even testes can be affected. Testicular tissue contains ACE2 receptors, and viral nucleic acid can be detected in semen. Particularly notable are the lesions in lymph nodes and spleen, manifesting as lymphocytopenia and cellular immune damage. Therefore, the name COVID-19 better reflects the essence of the disease.

Second, in European autopsies of COVID-19, thrombosis and related hemorrhage, embolism, and infarction are found to be relatively common, significantly more than reported in China so far. Although microthrombosis, pulmonary hemorrhage, and infarction have been observed in domestic cases, they have not been emphasized or explained in detail. According to Italian autopsy reports, the main cause of death in COVID-19 is venous thrombosis. Germany also found that some patients died due to thrombosis leading to pulmonary embolism. Studies in France and the Netherlands found that about 30% of patients developed disseminated intravascular coagulation (DIC). Therefore, they advocate anticoagulant therapy.

Third, regarding the cause of death from SARS-CoV-2 infection, it is often attributed to pneumonia in China. However, in a large autopsy study in Germany, it was suggested that patients’ underlying diseases such as cardiovascular, liver, or kidney diseases are important causes of death, with SARS-CoV-2 infection merely triggering or exacerbating the condition, and lung lesions are not the direct cause of death. Some European patients died due to venous thrombosis leading to pulmonary or cerebral embolism.

Finally, regarding the characteristics of lung lesions, both domestic and international descriptions almost unanimously refer to diffuse alveolar damage (DAD), though there may be variations or emphasis in different cases. One set of autopsy data from Italy emphasizes DIC as the main lesion. As for its pathogenic mechanism, two domestic papers first proposed the concept of a cytokine storm, which has also received support internationally. Regarding the target cells and virus-related receptors of SARS-CoV-2, besides bronchiolar alveolar epithelial cells carrying ACE2 receptors, there are also speculations about other receptors and target cells, such as lymphocytes, vascular endothelial cells, intestinal epithelium, renal tubular epithelium, and seminiferous tubules, which require further in-depth research for confirmation.

It was initially thought that China was at the forefront of COVID-19 autopsies worldwide. However, it now appears that China only led in terms of timing, as the number of autopsy cases has long been surpassed by other countries. For example, Germany has already conducted 192 cases, and Italy has 70. In China, systematic autopsies do not exceed 50 cases, and so far, no comprehensive analysis or in-depth research papers on large case series have been published. Perhaps there will be a surge in pathological publications soon, showcasing the characteristics and patterns of Chinese pathology and highlighting the wisdom and depth of Chinese pathologists. Stay tuned.

Source: Huaxia Pathology Network

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