Introduction
A novel virus called severe acute respiratory syndrome coronavirus-2
(SARS-CoV-2) first appeared in China through rapidly progressing
pneumonia cases and then gave rise to a pandemic. At the time of writing
this manuscript,coronavirus disease 2019 (COVID-19) has claimed more
than 720,000 lives around the world [1]. The pandemic is still
ravaging many parts of the world, and fears of a more widespread second
wave are growing.
The exact pathophysiology of COVID-19, the disease caused by SARS-CoV-2,
has yet to be fully elucidated. According to preliminary studies, the
virus enters the cells via ACE2 cell surface receptors [2, 3]. As
these receptors are abundant in lung tissue, the disease affects the
lungs more severely than other parts of the body. As in the case of
other newly described disease entities, the histopathological
examination of affected tissues is of paramount importance to better
understand the pathophysiology of COVID-19. However, with the fear of
spreading the disease, the autopsy of COVID-19 victims is prohibited or
advised against, even in developed countries. This reluctance to perform
autopsies translates to the relative scarcity of autopsy studies, which
are not commensurate with the commonality of COVID-19. This approach has
been criticized by some authors [4, 5]. Performing autopsies in
COVID-19 decedents is considered safe, as long as the necessary safety
procedures are implemented. The risk of contracting COVID-19 while
performing autopsy has been shown to be exceedingly small [6]. As a
result of the efforts of the scientific community, albeit still
insufficient, the number of autopsy studies on COVID-19 patients has
slightly increased in recent literature [7–11].
One way to overcome the regulatory barriers against performing autopsy
and the fear of contraction is postmortem biopsy. As the operator spends
less time performing the procedure and with less exposure to the tissues
of the decedent, unlike in autopsy, postmortem biopsies seem to be a
reasonable and acceptable alternative to the autopsy of COVID-19
patients. However, as in the case of autopsies, postmortem biopsy
studies are not sufficient during the COVID-19 pandemic. To the best of
our knowledge, only three studies in the literature have reported
postmortem biopsy findings in COVID-19 decedents [12-14].
More postmortem biopsy studies are needed to confirm the efficiency of
the procedure in terms of acquiring a sufficient amount of affected
tissue. As far as we know, none of the postmortem studies have yet taken
spleen samples from COVID-19 decedents. Thus, we aimed to perform a case
series in which postmortem core needle biopsies of the lung, liver,
heart, and spleen of COVID-19 decedents were conducted. We also
evaluated the correlation of pulmonary radiological findings with
postmortem pathologic findings.