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CHAPTER htl

DIAGNOSTIC HISTOCHEMISTRY

PATHOLOGY is an inherently subjective discipline, and therefore is often referred to as both an art and a science. Over the years, laboratory physicians have implemented special tissue stains and molecular techniques to limit subjectivity in the discipline. Beginning in the late 19th century, histochemical stains were developed to assess diagnostic biochemical reactions in tissue. Histochemistry has recently seen a resurgence in popularity because of the higher costs of other newer methods. Today, this technique is used by almost every pathology laboratory across the world. This book comprehensively covers all diseases for which that technique plays a central role in diagnosis. Every anatomic region is covered in detail with examples of appropriate staining techniques, and the book is heavily illustrated with more than 850 color photomicrographs. This is the first monograph to be published on histochemistry in 15 years, and it is the only one that is diagnostically oriented. Mark R. Wick (M.D. University of Virginia, Charlottesville) is a board-certified anatomic pathologist and the Associate Director of Surgical Pathology at the University of Virginia Health Sciences Center, as well as a professor of pathology at the University of Virginia School of Medicine. Dr. Wick is a renowned pathologist with expertise in several subdisciplines of pathology. He is the Editor-in-Chief of the American Journal of Clinical Pathology and has edited or co-edited several other books in surgical pathology.

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Cambridge University Press 978-0-521-87410-6 - Diagnostic Histochemistry Edited by Mark R. Wick Frontmatter More information

DIAGNOSTIC HISTOCHEMISTRY

Edited by

Mark R. Wick, M.D.

University of Virginia, Charlottesville

© Cambridge University Press

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Cambridge University Press 978-0-521-87410-6 - Diagnostic Histochemistry Edited by Mark R. Wick Frontmatter More information

CHAPTER imp

CAMBRIDGE UNIVERSITY PRESS Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, Sao Paulo, Delhi ~ Cambridge University Press 32 Avenue of the Americas, New York, NY 10013-2473, USA www.cambridge.org Information on this title: www.cambridge.org/9780521874106 Ó Mark R. Wick 2008 This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published 2008 Printed in Hong Kong by Golden Cup A catalog record for this publication is available from the British Library. Library of Congress Cataloging in Publication Data Diagnostic histochemistry / edited by Mark R. Wick. p. ; cm. Includes bibliographical references and index. ISBN 978-0-521-87410-6 (hardback) 1. Histochemistry. 2. Molecular diagnosis. I. Wick, Mark R., 1952­II. Title. [DNLM: 1. Histocytochemistry­methods. 2. Diagnosis. 3. Histological Techniques­methods. 4. Pathology. QS 531 D536 2008] RB43.7.D524 2008 572­dc22 2007052025 ISBN 978-0-521-87410-6 hardback Every effort has been made in preparing this book to provide accurate and up-to-date information that is in accord with accepted standards and practice at the time of publication. Nevertheless, the authors, editors, and publisher can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors, and publisher therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use. Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party Internet Web sites referred to in this publication and does not guarantee that any content on such Web sites is, or will remain, accurate or appropriate.

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Cambridge University Press 978-0-521-87410-6 - Diagnostic Histochemistry Edited by Mark R. Wick Frontmatter More information

CHAPTER ded

To JANE, ROBERT, & MORGAN, who allowed me to take time from them to spend on completing this volume.

And, to all of my teachers in Pathology, who long ago gave me a sound foundation in laboratory science and stimulated my interest in Histochemistry.

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Cambridge University Press 978-0-521-87410-6 - Diagnostic Histochemistry Edited by Mark R. Wick Frontmatter More information

Contents

Contributors Preface xi

ix

1. TISSUE PROCUREMENT, PROCESSING, AND STAINING TECHNIQUES 1 Mark R. Wick, MD, Nancy C. Mills, HT, QIHC (ASCP), and William K. Brix, MD 2. DIAGNOSTIC HISTOCHEMISTRY IN DISEASES OF THE HEAD AND NECK 28 Bruce M. Wenig, MD 3. DIAGNOSTIC HISTOCHEMISTRY IN PULMONARY PATHOLOGY 59 Mark R. Wick, MD 4. DIAGNOSTIC HISTOCHEMISTRY OF MEDIASTINAL DISEASES 84 Mark R. Wick, MD, and Nancy C. Mills, HT, QIHC (ASCP) 5. DIAGNOSTIC HISTOCHEMISTRY IN CARDIAC DISEASES 109 Philip G. Robinson, MD, and Azorides R. Morales, MD 6. DIAGNOSTIC HISTOCHEMISTRY IN GASTROINTESTINAL DISORDERS 127 Patrick L. Fitzgibbons, MD, and Jay M. Packer, MD 7. DIAGNOSTIC HISTOCHEMISTRY IN HEPATIC PATHOLOGY 152 Julia C. Iezzoni, MD 8. DIAGNOSTIC HISTOCHEMISTRY OF RENAL AND UROLOGIC DISEASES 170 Helen P. Cathro, MB, ChB, MPH, Steven S. Shen, MD, PhD, and Luan D. Truong, MD 9. DIAGNOSTIC HISTOCHEMISTRY OF THE GYNECOLOGIC TRACT 206 Joseph T. Rabban, MD, MPH, and Charles J. Zaloudek, MD

vii

10. DISEASES OF THE MALE GENITAL SYSTEM 230 Helen P. Cathro, MB, ChB, MPH, Mark A. Weiss, MD, and Stacey E. Mills, MD 11. DIAGNOSTIC HISTOCHEMISTRY IN BREAST PATHOLOGY 261 Jamie Shutter, MD, and Mark R. Wick, MD 12. APPLIED HISTOCHEMISTRY IN DISORDERS OF THE ENDOCRINE SYSTEM 280 Mauro Papotti, MD, Marco Volante, MD, and Gianni Bussolati, MD, F.R.C. Path 13. DIAGNOSTIC HISTOCHEMISTRY IN DERMATOPATHOLOGY 307 Mark R. Wick, MD, and James W. Patterson, MD 14. DIAGNOSTIC HISTOCHEMISTRY IN MYOPATHIC DISEASES AND SOFT TISSUE LESIONS 350 Richard A. Prayson, MD, Xiaofei Qiu, MD, PhD, and Elizabeth Montgomery, MD 15. DIAGNOSTIC HISTOCHEMISTRY OF HEMATOLYMPHOID DISEASES 378 Mark R. Wick, MD, Nathan R. Shumaker, MD, and JoAnne M. Davis, MT (ASCP), SH 16. DIAGNOSTIC HISTOCHEMISTRY IN DISEASES OF THE NERVOUS SYSTEM 413 M. Beatriz S. Lopes, MD 17. DIAGNOSTIC HISTOCHEMISTRY IN OPHTHALMIC PATHOLOGY 436 Amy Lin, MD, and Robert Folberg, MD Index 451

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Cambridge University Press 978-0-521-87410-6 - Diagnostic Histochemistry Edited by Mark R. Wick Frontmatter More information

CHAPTER con

Contributors

WILLIAM K. BRIX, MD Department of Pathology University of Virginia Health System Charlottesville, VA GIANNI BUSSOLATI, MD, F.R.C. PATH Department of Biomedical Sciences and Human Oncology University of Turin Italy HELEN P. CATHRO, MB, CHB, MPH Department of Pathology Division of Surgical Pathology and Cytopathology University of Virginia Medical Center Charlottesville, VA JOANNE M. DAVIS, MT (ASCP), SH Department of Pathology University of Virginia Health System Charlottesville, VA PATRICK L. FITZGIBBONS, MD Department of Pathology St. Jude Medical Center Fullerton, CA ROBERT FOLBERG, MD Department of Pathology University of Illinois­Chicago Chicago, IL JULIA C. IEZZONI, MD Department of Pathology Division of Surgical Pathology and Cytopathology University of Virginia Health System Charlottesville, VA

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AMY LIN, MD Department of Pathology University of Illinois­Chicago Chicago, IL M. BEATRIZ S. LOPES, MD Department of Pathology Division of Neuropathology University of Virginia School of Medicine Charlottesville, VA NANCY C. MILLS, HT, QIHC (ASCP) Department of Pathology University of Virginia Health System Charlottesville, VA STACEY E. MILLS, MD Division of Surgical Pathology and Cytopathology University of Virginia Medical Center Charlottesville, VA ELIZABETH MONTGOMERY, MD Department of Pathology Johns Hopkins University School of Medicine Baltimore, MD AZORIDES R. MORALES, MD Department of Pathology University of Miami Miller School of Medicine and Jackson Memorial Hospital Miami, FL JAY M. PACKER, MD Department of Pathology Good Samaritan Hospital Los Angeles, CA

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Cambridge University Press 978-0-521-87410-6 - Diagnostic Histochemistry Edited by Mark R. Wick Frontmatter More information

x C ONTRIBUTORS

MAURO PAPOTTI, MD Department of Clinical and Biological Sciences University of Turin at San Luigi Hospital Orbassano (Torino), Italy JAMES W. PATTERSON, MD Division of Surgical Pathology and Cytopathology University of Virginia Medical Center Charlottesville, VA RICHARD A. PRAYSON, MD Department of Anatomic Pathology Cleveland Clinic Foundation Cleveland, OH XIAOFEI QIU, MD, PHD Department of Pathology Johns Hopkins University School of Medicine Baltimore, MD JOSEPH T. RABBAN, MD, MPH Division of Surgical Pathology Department of Pathology University of California­San Francisco Medical Center San Francisco, CA PHILIP G. ROBINSON, MD Department of Pathology University of Miami Miller School of Medicine Miami, FL STEVEN S. SHEN, MD, PHD Department of Pathology and Laboratory Medicine The Methodist Hospital Houston, TX Department of Pathology Weill Medical College of Cornell University New York, NY NATHAN R. SHUMAKER, MD Department of Pathology

University of Virginia Health System Charlottesville, VA JAMIE SHUTTER, MD Department of Pathology and Cell Biology University of South Florida Tampa, FL LUAN D. TRUONG, MD Departments of Pathology and Medicine Baylor College of Medicine Houston, TX Methodist Hospital Houston, TX MARCO VOLANTE, MD Department of Biomedical Sciences and Human Oncology University of Turin Italy MARK A. WEISS, MD The Urology Center Cincinnati, OH BRUCE M. WENIG, MD Department of Pathology and Laboratory Medicine Beth Israel Medical Center New York, NY MARK R. WICK, MD Department of Pathology University of Virginia Health System Charlottesville, VA CHARLES J. ZALOUDEK, MD Division of Surgical Pathology Department of Pathology University of California­San Francisco Medical Center San Francisco, CA

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Cambridge University Press 978-0-521-87410-6 - Diagnostic Histochemistry Edited by Mark R. Wick Frontmatter More information

CHAPTER prf

Preface

READERS (OR BROWSERS) OF THIS TEXT may have opened it with the expectation that the title was not completely accurate, and that immuno-histochemistry would be at least one of the subjects it considered. That assumption is incorrect. The book you have in your hands is devoted to histochemistry, and that discipline alone, as it applies to anatomic pathology. Why histochemistry, in the twenty-first century? will be the next question. Surely, with the current availability of immunohistology, molecular diagnostics, cytogenetics, proteomics, etc., one can obtain needed diagnostic information through a variety of other technological avenues. That statement is true enough, but it does not mean that one should discard older disciplines simply because they are no longer novel. The application of histochemical methods to diagnostic pathology has a long and rich history. It began in the late 1800s, linked to such names as Ehrlich, Mallory, Koch, Heidenhain, Masson, Biebrich, Warthin, Bielschowsky, Rio de Hortega, and other greats in laboratory science. Advances in this area of study accrued steadily, and, up until roughly 1970, histochemistry was ``state of the art'' for anatomic pathologists. Even the growth of electron microscopy at that point did not significantly blunt the use of histochemical stains in pathologic diagnosis. In the decade after that, however, the burgeoning availability of diagnostic immunohistochemistry did begin to eclipse histochemical applications in laboratory medicine. Slowly but surely, trainees in pathology--and their teachers-- eschewed the daily use of the latter methods in favor of newer procedures. Knowledge concerning the mechanisms of histochemical stains--and the principles of tissue processing and tissue chemistry--began to evaporate in the collective consciousness of pathologists. Thus, today, practitioners may know the names of a few stains that are not immunologically based, but they usually have very

xi

little detailed understanding of how the stains are done, what their biochemical bases are, or what their case-based applications can be. Hence, we come to the reason for this book. The editor firmly believes that no area of scientific endeavor should be forgotten or abandoned if it still has utility and can add to diagnostic certainty. Furthermore, if effective older methods are quicker and cheaper than new ones, there is all the more reason to maintain their viability and implementation. Given the fact that automated commercial platforms are now available to produce histochemical preparations-- as is also true of immunohistochemical ones--such stains can be done rapidly indeed. They are less expensive than most other evaluations in pathology, they are still reimbursed by the healthcare system, and, most importantly, they still add to diagnostic conclusions when used in the correct manner. The format of this volume is quite different from that of preceding texts on histochemistry. They have typically focused only on the technical aspects of the stains in question, often adopting a ``procedure manual''­like approach, with little or no discussion of practical applications. Instead, only a general discussion of the actual methodology of histochemistry is presented here; the main emphasis is on how the stains can be used in practice and what information they can provide. Authors of chapters in this book have been asked to provide several case-based presentations to further those goals. Concerted efforts have been made to populate this text with good-quality color illustrations of various pathologic entities and corresponding stains that can be applied to them. However, it should be said that not all histochemical preparations readily yield themselves to the taking of perfect photographs, because of technical attributes of the stains themselves. Therefore, some forebearance of that fact is asked of readers.

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Cambridge University Press 978-0-521-87410-6 - Diagnostic Histochemistry Edited by Mark R. Wick Frontmatter More information

xii P REFACE

For those who wish to have more technical details than those presented here--in line with those contained in past books on the topic--several of the latter are currently in print and they represent excellent procedural resources (1­ 3). In addition, a variety of Internet sites are devoted to histotechnological procedures and are additional valuable references (4­7). The main goals of this presentation are to educate young pathologists on a subject with which they likely have only superficial familiarity, and to refresh the histochemical knowledge of more experienced practitioners. The staining techniques presented here are still worthy of clinical use on a regular basis, and they undeniably augment diagnostic information that can be obtained using other analytical evaluations.

5. Histological Staining Techniques http://www.bris.ac.uk/vetpath/cpl/histmeth.htm#Top (Accessed 5/4/07). 6. Histonet Archives http://www.histosearch.com/histonet/ (Accessed 5/4/07). 7. The Stains File http://home.primus.com.au/royellis/stains.html (Accessed 5/4/07).

Acknowledgments

References

1. Filipe MI, Lake BD (Eds): Histochemistry in Pathology (2nd Ed.), Churchill Livingstone, New York, 1990. 2. Carson FL: Histotechnology: A Self-Instructional Text (2nd ed.), ASCP Press, Chicago, 1997. 3. Bancroft JD, Gamble M: Theory & Practice of Histological Techniques, Churchill-Livingstone, New York, 2002. 4. Cytochemistry & Histochemistry? http://focosi.immunesig.org/histochemistry.html (Accessed 5/4/07).

The editor is grateful to all of the chapter authors of this text, who enthusiastically and skillfully contributed their expertise. In addition, the faculty members, housestaff, and histotechnologists in the Department of Pathology at the University of Virginia were uniformly supportive of, and helpful with, this project. Finally, much gratitude is due to Mr. Marc Strauss, medical acquisitions editor of Cambridge University Press, for his help and patience during the writing of this volume. Mark R. Wick, M.D. Divisions of Surgical Pathology-Cytopathology & Autopsy Pathology University of Virginia Health System Charlottesville, Virginia May 2007

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