Postmortem Findings in Italian Patients With COVID-19: A Descriptive Full Autopsy Study of Cases With and Without Comorbidities

Abstract Background Descriptions of the pathological features of coronavirus disease-2019 (COVID-19) caused by the novel zoonotic pathogen severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) emanate from tissue biopsies, case reports, and small postmortem studies restricted to the lung and specific organs. Whole-body autopsy studies of COVID-19 patients have been sparse. Methods To further define the pathology caused by SARS-CoV-2 across all body organs, we performed autopsies on 22 patients with COVID-19 (18 with comorbidities and 4 without comorbidities) who died at the National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS Hospital, Rome, Italy. Tissues from the lung, heart, liver, kidney, spleen, and bone marrow (but not the brain) were examined. Only lung tissues were subject to transmission electron microscopy. Results COVID-19 caused multisystem pathology. Pulmonary and cardiovascular involvement were dominant pathological features. Extrapulmonary manifestations included hepatic, kidney, splenic, and bone marrow involvement, and microvascular injury and thrombosis were also detected. These findings were similar in patients with or without preexisting medical comorbidities. Conclusions SARS-CoV-2 infection causes multisystem disease and significant pathology in most organs in patients with and without comorbidities.

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Whole-Body Functional MRI and PET/MRI in Multiple Myeloma

Cancers ◽

10.3390/cancers12113155 ◽

2020 ◽

Vol 12 (11) ◽

pp. 3155

Author(s):

Sébastien Mulé ◽

Edouard Reizine ◽

Paul Blanc-Durand ◽

Laurence Baranes ◽

Pierre Zerbib ◽

...

Keyword(s):

Multiple Myeloma ◽

Bone Marrow ◽

Functional Mri ◽

Bone Marrow Involvement ◽

High Sensitivity ◽

Response To Treatment ◽

Whole Body ◽

Response Evaluation ◽

Whole Body Mri ◽

Dce Mri

Bone disease is one of the major features of multiple myeloma (MM), and imaging has a pivotal role in both diagnosis and follow-up. Whole-body magnetic resonance imaging (MRI) is recognized as the gold standard for the detection of bone marrow involvement, owing to its high sensitivity. The use of functional MRI sequences further improved the performances of whole-body MRI in the setting of MM. Whole-body diffusion-weighted (DW) MRI is the most attractive functional technique and its systematic implementation in general clinical practice is now recommended by the International Myeloma Working Group. Whole-body dynamic contrast-enhanced (DCE) MRI might provide further information on lesions vascularity and help evaluate response to treatment. Whole Body PET/MRI is an emerging hybrid imaging technique that offers the opportunity to combine information on morphology, fat content of bone marrow, bone marrow cellularity and vascularization, and metabolic activity. Whole-body PET/MRI allows a one-stop-shop examination, including the most sensitive technique for detecting bone marrow involvement, and the most recognized technique for treatment response evaluation. This review aims at providing an overview on the value of whole-body MRI, including DW and DCE MRI, and combined whole-body 18F-FDG PET/MRI in diagnosis, staging, and response evaluation in patients with MM.

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Application value of diffusion weighted whole body imaging with background body signal suppression in monitoring the response to treatment of bone marrow involvement in lymphoma

Journal of Magnetic Resonance Imaging ◽

10.1002/jmri.25300 ◽

2016 ◽

Vol 44 (6) ◽

pp. 1522-1529 ◽

Cited By ~ 8

Author(s):

Mengtian Sun ◽

Jingliang Cheng ◽

Yong Zhang ◽

Feifei Wang ◽

Yun Meng ◽

...

Keyword(s):

Bone Marrow ◽

Bone Marrow Involvement ◽

Response To Treatment ◽

Whole Body ◽

Whole Body Imaging ◽

Body Imaging ◽

Diffusion Weighted ◽

Signal Suppression

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Diagnostic accuracy of pelvic magnetic resonance imaging for the assessment of bone marrow involvement in diffuse large B-cell lymphoma

PLoS ONE ◽

10.1371/journal.pone.0252226 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0252226

Author(s):

Qing Ke ◽

Cheng-Cheng Liao ◽

Xiao-Hong Tan ◽

Bao-Ping Guo ◽

Hong Cen ◽

...

Keyword(s):

Bone Marrow ◽

Cell Lymphoma ◽

Bone Marrow Involvement ◽

B Cell Lymphoma ◽

Diagnostic Value ◽

Whole Body ◽

Pelvic Mri ◽

Pelvic Magnetic Resonance Imaging ◽

Large B Cell Lymphoma ◽

Pet Ct

Purpose We investigated the efficacy of pelvic magnetic resonance imaging (MRI) in the diagnosis of bone marrow involvement (BMinv) in diffuse large B-cell lymphoma (DLBCL) patients. Patients and methods This was a retrospective study of data from a previous study (NCT02733887). We included 171 patients who underwent bone marrow biopsy (BMB) and bone marrow smear (BMS), pelvic MRI, and whole-body positron emission tomography-computed tomography (PET/CT) from January 2016 to December 2019 at a single center. BMB/BMS and whole-body PET/CT results were used as reference standards against which we calculated the diagnostic value of pelvic MRI for BMinv in DLBCL patients. A chi-square test was used to compare detection rates, and a receiver operating characteristic curve was used to evaluate diagnostic value of pelvic MRI. Propensity-score matching was performed according to clinical information, and Kaplan-Meier curves were constructed to compare progression-free survival (PFS) and overall survival (OS) of patients. Results The BMinv detection rate of pelvic MRI (42/171) was higher (P = 0.029) than that of BMB/BMS (25/171), and similar to that of PET/CT (44/171; P = 0.901). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of pelvic MRI were 83.33%, 98.37%, 94.15%, 95.24%, and 93.80%, respectively. Median PFS values were as follows: BMB/BMS-positive, 17.8 months vs. BMB/BMS-negative, 26.9 months (P = 0.092); PET/CT-positive, 24.8 months vs. PET/CT-negative, 33.0 months (P = 0.086); pelvic MRI-positive, 24.9 months vs. pelvic MRI-negative, 33.1 months (P<0.001). Median OS values were as follows: BMB/BMS-positive, 22.3 months vs. BMB/BMS-negative, 29.8 months (P = 0.240); PET/CT-positive, 27.9 months vs. PET/CT-negative, 33.9 months (P = 0.365); pelvic MRI-positive, 27.3 months vs. pelvic MRI-negative, 35.8 months (P = 0.062). Conclusion Pelvic MRI is effective for detecting BMinv in DLBCL patients, providing a more accurate indication of PFS than BMB/BMS and PET/CT do. It may ultimately be used to improve the accuracy of clinical staging, guide patient treatment, and evaluate prognosis.

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Bone marrow involvement as a rare manifestation of relapsed choroidal melanoma

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20203475 ◽

2020 ◽

Vol 8 (8) ◽

pp. 3110

Author(s):

Nusrat Bashir ◽

Farzana Manzoor ◽

Bilal Musharaf ◽

Ruby Reshi

Keyword(s):

Bone Marrow ◽

Case Reports ◽

Bone Marrow Involvement ◽

Choroidal Melanoma ◽

Bone Marrow Aspiration ◽

Bone Marrow Metastasis ◽

Common Site ◽

Immune Histochemistry ◽

Rare Manifestation ◽

Disseminated Disease

Choroidal Melanoma is the most common primary intra-ocular malignancy. Incidence of primary choroidal melanoma is about 6 cases per 1 million population. It disseminates hematogenously. The most common site of metastasis is liver. Metastatic melanoma involving the bone marrow is rare, occurring in 5% of patients with disseminated disease. However, Choroid melanoma with bone marrow involvement is very rare. Only a few case reports are published in literature. Authors present a case of bone marrow metastasis from choroid melanoma in 55 years old female who has been treated for primary choroidal melanoma by enucleation of left eye three years back. In the evaluation of symptomatic anemia, features suggestive of bone marrow infiltration by choroidal melanoma were observed on bone marrow aspiration and biopsy. The diagnosis was confirmed by positivity of immune-histochemistry markers HMB-45 and Melana.

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Clinical Pathological Features of Peripheral T Cell Lymphoma with Concurrent Bone Marrow Involvement

American Journal of Clinical and Experimental Medicine ◽

10.11648/j.ajcem.20180601.14 ◽

2018 ◽

Vol 6 (1) ◽

pp. 22

Author(s):

Mohamed Masoud

Keyword(s):

Bone Marrow ◽

T Cell ◽

Cell Lymphoma ◽

Bone Marrow Involvement ◽

T Cell Lymphoma ◽

Pathological Features ◽

Peripheral T Cell Lymphoma

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Whole-body magnetic resonance imaging, including diffusion-weighted imaging, for diagnosing bone marrow involvement in malignant lymphoma

British Journal of Haematology ◽

10.1111/j.1365-2141.2010.08093.x ◽

2010 ◽

Vol 149 (4) ◽

pp. 628-630 ◽

Cited By ~ 24

Author(s):

Thomas C. Kwee ◽

Rob Fijnheer ◽

Inge Ludwig ◽

Henriette M.E. Quarles van Ufford ◽

Cuno S. Uiterwaal ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Bone Marrow ◽

Magnetic Resonance ◽

Malignant Lymphoma ◽

Diffusion Weighted Imaging ◽

Bone Marrow Involvement ◽

Whole Body ◽

Resonance Imaging ◽

Diffusion Weighted ◽

Body Magnetic Resonance Imaging

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An Unusual Presentation of Acute Biphenotypic Leukemia without Bone Marrow Involvement

Blood ◽

10.1182/blood.v112.11.3995.3995 ◽

2008 ◽

Vol 112 (11) ◽

pp. 3995-3995

Author(s):

Ulas D Bayraktar ◽

Maricer Escalon

Keyword(s):

Bone Marrow ◽

Flow Cytometry ◽

Lymph Nodes ◽

Bone Marrow Involvement ◽

Whole Body ◽

Medium Size ◽

High Dose ◽

Axillary Lymph ◽

Cervical Lymph Nodes ◽

Biphenotypic Leukemia

Abstract Acute biphenotypic leukemia (ABL) represents a minority of acute leukemia cases (around 5%) in which blasts co-express markers of different lineages (myeloid, T-cell or B-cell). ABL without bone marrow involvement is exceedingly rare. Case report: An 18-year-old man presented with slowly enlarging, non-tender cervical lymph nodes. He had no other symptoms. Family history included Hodgkin’s disease in his mother and maternal great aunt, histiocytosis X in his maternal cousin, and non-Hodgkin’s lymphoma in his paternal grandfather. Physical exam revealed multiple small cervical and axillary lymph nodes. Laboratory analyses including complete blood count, peripheral blood smear, complete metabolic profile, mononucleosis screen, and hepatitis and HIV serologies were unremarkable. Histopathological examination of the left cervical lymph node revealed rare germinal centers with an interfollicular proliferation of generally medium size cells with a fine blastic chromatin pattern and scant cytoplasm. CD34 was positive in more than half of the cells. Between 30% and 80% of the cells were positive for TdT (Figure 1), CD3, CD4, and CD7. Myeloperoxidase (Figure 2) and lysozyme were positive in about 20% of the cells. Flow cytometry revealed an immature myeloid cell population coexpressing CD33, CD13, CD7, and CD34. Chromosomal analysis revealed a complex karyotype. Bone marrow exam was unremarkable and no evidence of leukemia was observed. Flow cytometry of the bone marrow aspirate revealed only 4% of the cells to be CD34+. Whole body PET scan showed extensive uptake in bilateral axillae, neck, and inguinal regions without any extranodal involvement. The patient received hyper-CVAD regimen (alternating cycles of cyclophosphamide, vincristine, adriamycin, dexamethasone and high dose methotrexate, cytarabine) for 8 cycles and remains in remission five months after the end of hyper-CVAD protocol. To our knowledge, this is the third case reported in the literature with acute biphenotypic leukemia not involving the bone marrow. However, our case cannot accurately be referred to as leukemia since the bone marrow is not involved; neither can it be named as lymphoblastic lymphoma because of its myeloid differentiation. Therefore, we will refer to it as extramedullary granulocytic sarcoma with biphenotypic features. Figure 1 Figure 1. Figure 2 Figure 2.

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The utility of 18-F-fluorodeoxyglucose positron emission tomography in evaluation of bone marrow involvement by non-Hodgkin lymphoma (NHL)

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.8077 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 8077-8077

Author(s):

A. Muslimani ◽

H. Farag ◽

S. Francis ◽

T. P. Spiro ◽

H. A. Daw ◽

...

Keyword(s):

Bone Marrow ◽

Fdg Pet ◽

Bone Marrow Involvement ◽

False Negative ◽

Pet Scan ◽

High Rate ◽

Whole Body ◽

Image Guided ◽

Significant Difference ◽

Fdg Pet Scan

8077 Introduction: In NHL, the anatomic extent of the disease is an important factor influencing the overall survival. Clinically, NHLs are classified as indolent, aggressive, or highly aggressive. Bone marrow (BM) involvement is a sign of extensive disease, and iliac crest (IC) BM biopsy (BMB) is the established method for the detection of BM infiltration. However, IC BMB is associated with a high rate of false- negative result. We assess the ability of 18F-FDG PET scan to ascertain the presence of BM involvement in NHL. Methods: We retrospectively reviewed charts from January 2002 through November 2006 of histologically proven NHLs. 87 patients (pts) were eligible for our study (38 males, 49 females; age range 42–81 years). All pts were examined by whole-body 18F-FDG-PET scan for initial staging, and all had unilateral posterior IC BMB. BM involvement was established following the result of 1) unilateral posterior IC BMB, and 2) image-guided BMB following positive 18F-FDG-PET scan in selected patients. Results: Among the PET+ / IC BMB- group, 3 pts had a positive CT-scan guided BMB at the site of involvement detected by the 18F-FDG-PET scan (2 from the humerus,1 from the femur); the remaining 7 pts did not have a site-directed biopsy. Our data demonstrate an overall sensitivity of 0.76 for the PET scan detecting BM involvement in all pts and specificity of 0.88. We point out that the 0.88 specificity may be spuriously low, this is a result of the fact that of the 10 PET+ / IC BMB- pts 7 have not had directed biopsy to the site of involvement detected by the18F-FDG- PET-scan. Further analysis revealed no significant difference between the sensitivity (P = 0.21) and specificity (p = 0.99) between I- NHL and A/HA- NHL groups. Conclusion: 18F-FDG-PET scan shows potential to detect BM involvement in NHL. In particular, image-guided repeat BMB may be considered in pts with negative initial IC BMB, whose 18F-FDG-PET scan demonstrates BM involvement in a different site. No significant financial relationships to disclose. [Table: see text]

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