Italy was the first European nation to be massively infected by SARS-COV 2 . Up to the end of May 2020 more than thirty-three thousand deaths had been recorded in Italy with a large prevalence among males, those over 75 years of age, and in association with co-morbidities . We describe the lung pathological and immunohistochemical post-mortem findings at the autopsy of 9 patients who died of SARS-COV 2 associated disease . We found in the lung tissues of all patients histological changes consistent with diffuse alveolar damage in various evolution phases ranging from acute exudative to acute proliferative to fibrotic phase . Alveolar damage was associated a prominent involvement of the vascular component in both the interstitial capillaries and in the mid-size vessels, with capillary fibrin micro-thrombi, as well as organized thrombi even in medium sized arteries, in most cases not related to sources of embolism . Eosinophilic infiltrate was also seen, probably reactive to pharmacological treatment . Viral RNA of SARS-COV 2 was detected from the lung tissues of all the nine patients . Immunohistochemistry for the receptor of the SARS-COV 2, ACE2, and its priming activatorTMPRSS2 revealed that both proteins co-localize in airway cells . In particular, the ACE2 protein was expressed in both endothelial cells and alveolar type I and II pneumocytes in the areas of histological diffuse alveolar damage (DAD). Pneumocytes but not endothelial cells also expressed TMPRSS2 . There are no distinctive histological features of SARS-COV 2 infection with respect to SARS-COV 1 and other DAD with different aetiology . The identification of the cause of death in course of SARS-COV 2 infection is more likely multi-factorial . This article is protected by copyright . All rights reserved.