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Case Report: Lung Cancer and SARS-CoV-2–Related Microthrombi

By: Kelly M. Hennessey, PhD
Posted: Monday, November 9, 2020

Infection with SARS-CoV-2 is associated with a broad range and variable severity of clinical respiratory symptoms. In a case study, Paolo Navalesi, MD, of the University of Padova, Italy, and colleagues described the clinical course of a man admitted to the intensive care unit for pneumonia and severe respiratory failure. The patient tested positive for COVID-19 and received supportive ventilation and anticoagulant therapies. Vascular damage and a solid tumor with nonkeratinizing squamous cell carcinoma features were found postmortem. They published their report in the Journal of Thoracic Oncology.

This case involved a 77-year-old man with a persistent cough, difficulty breathing, and shortness of breath. Prior to hospital admission, a CT scan of the lungs and subsequent laboratory results revealed several abnormal findings in his lungs and blood. He was given mechanical ventilation to treat severe hypoxemia and dyspnea. Despite supportive and anticoagulant therapies, his respiratory rate decreased below 20 breaths per minute, and arterial oxygen pressure remained under 80%. After 25 days in the hospital, the patient died.

Postmortem examination revealed nonkeratinizing squamous cell carcinoma along with neoplastic microthrombi, fibrin clots in both small- and medium-sized vessels, and evidence of severe endothelial injury. The final diagnosis was nonkeratinizing squamous cell carcinoma with neoplastic thrombi associated with pneumonia with SARS-CoV-2–related vessel injury.

The researchers noted that the presence of illnesses such as lung cancer is necessary for understanding COVID-19 epidemiology. "A careful investigation and report of all lesions detected in COVID-19 lungs of deceased patients is mandatory to consistently prove the microvascular impairment," concluded the researchers.

Disclosure: The study authors reported no conflicts of interest.



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