Histopathological assessment of biopsies and surgical resections of the colon in patients with COVID-19 (SARS-CoV-2)

Aim. Histopathological evaluation of biopsies and surgical resections of the large intestine in patients with COVID-19 (SARS-CoV-2). We conducted a retrospective analysis of colon biopsies/resections of 116 patients with a positive nasopharyngeal smear PCR test for SARS-CoV-2, obtained within 12 weeks prior to the biopsy/resection without a history of gastrointestinal disease.

Methods. Tissue sections were evaluated using standard light microscopy, and biopsy/resection tissues were stained with hematoxylin and eosin according to a standard protocol. When assessing the histomorphology of sections, five categories were evaluated reflecting the severity of histopathological damage: 1) histoarchitectonics of the mucous membrane, 2) epithelial changes, 3) composition and size of inflammatory cell infiltrates, 4) number of eosinophils, 5) microvascular changes. For each histological feature, the presence or absence of a feature or the severity of damage was additionally noted. The cases were grouped according to the totality of histological signs belonging to morphological patterns: 1) acute inflammatory pattern, 2) ischemic pattern, 3) IBD-like pattern.

Results and discussion. Of the 116 patients, 10 (8.6%) revealed a pattern of acute inflammatory damage: erosions and ulcers, crypt abscesses, epithelial hyperplasia, focal and diffuse clusters of polymorphonuclear granulocytes. In 62 (53.4%) cases, histological signs of an ischemic pattern were revealed: histoarchitectonic distortions, crypt atrophy and superficial necrosis/regeneration of the mucous membrane with the formation of granulation tissue, microvascular changes. In 17 (14.7%) cases, a pattern of damage associated with the IBD spectrum was found, characterized by changes/deformations of histoarchitectonics, metaplasia/hyperplasia of Paneth cells, destructive epithelial damage with mixed polymorphonuclear granulocytic and transmural lymphoplasmocytic infiltration with lymphoid clusters in the thickness of the entire intestinal wall and basal plasmocytosis.

Conclusion. This study revealed a high incidence of ischemic pattern of colon damage in patients within 12 weeks of COVID-19 and a number of cases of IBD-like pattern of intestinal damage. The data obtained can help in stratifying groups of patients with histopathological signs of intestinal damage after COVID-19 and show the relevance of conducting expanded prospective studies.

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