Elective lung resection after treatment for COVID-19 pneumonia

Abstract

A 65-year-old man with coronavirus disease 2019 (COVID-19) was admitted to our hospital. Computed tomography detected bilateral pneumonia with a lung nodule suspicious for lung cancer. Lobectomy was performed 3 months after the treatment for COVID-19 without any complications. The surgical specimen revealed fibrosis below the pleura with a small collection of lymphocytes and intravascular hemorrhagic thrombosis, and no residual RNA was detected. This is the first report describing a surgical specimen after recovery from COVID-19 pneumonia, and suggests that elective thoracic surgery can be performed safely, depending on the patient's respiratory function, without infectious risk.

Keywords: COVID-19; Lung cancer; SARS-CoV-2.

Figures

Fig. 1

a, b The computed tomography scan on admission showed patchy consolidation with ground grass opacity in all lung lobes and a solid nodule (arrow). The consolidation worsened 2 weeks (c), and improved d 6, e 10, and f 16 weeks after admission, however, subpleural curvilinear shadow of the right lower lobe remained 16 weeks after admission (arrows)

Fig. 2

Time table, and inspection and d-dimer value results of the patient. His oxygenation evaluated using the saturation of percutaneous and arterial oxygen improved, and the pulmonary function test improved markedly from 6 to 12 and 16 weeks after admission. The d-dimer value was high during the infection, and returned to the normal level before surgery

Fig. 3

a–f Histologically, subpleural fibrosis in the alveolar wall (arrows) was widely observed (a: Hematoxylin–Eosin staining, Scale bar = 500 µm, b: Elastica van Gieson stain, Scale bar = 200 µm) and focally along the alveolar septum (c: Hematoxylin–Eosin staining, Scale bar = 500 µm, d Elastica van Gieson stain, Scale bar = 200 µm). e Infiltration of inflammatory cells including neutrophils, lymphocytes, plasma cells and eosinophils was partially observed (Hematoxylin–Eosin staining, Scale bar = 100 µm). f Organized hemorrhagic thrombosis were found in peripheral pulmonary vessels (Elastica van Gieson stain, Scale bar = 200 µm)