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.