具有异常组织形态和冯·科萨染色阴性的特发性皮肤钙质病:一个诊断缺陷

Trent Irwin, Mugahed Hamza, E. George, Ata S Moshiri
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引用次数: 0

摘要

皮肤钙质沉着症的特征是真皮/皮下出现嗜碱性结晶或无定形钙。皮肤钙质沉着症有许多不同的临床亚型和相关的病因,可能导致临床医生考虑这种诊断。Von Kossa和/或茜素红特殊染色可用于病理学家突出不溶性钙盐的沉积,特别是在组织学模糊或微妙的情况下。病例报告:我们报告一个27岁男性的病例,他表现为右臀部下肿块,临床诊断为表皮包涵性囊肿。大体病理示囊肿样结构内灰白色糊状物质。组织病理学检查显示无定形蓝灰色物质池,夹杂着罕见的混杂粗钙化沉积物,周围环绕着异物巨细胞。标本未见囊壁。一些特殊的染色,包括冯·科萨染色,最初是阴性的。经过进一步的检查,发现在切片之前,在组织学实验室中石蜡块上应用了表面脱钙溶液。假设这可能是导致异常形态的原因,对石蜡块进行再处理,随后的H和E染色切片显示特征性的亲碱性钙沉积,von Kossa染色相应呈阳性。结论:尽管von Kossa和/或茜素红特殊染色可以帮助病理学家进行诊断,但大多数病例的组织病理学诊断是明显的。考虑到表面脱钙后不寻常的组织形态和在再处理前最初缺乏von Kossa染色,本报告有助于使病理学家意识到这种潜在的诊断缺陷。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Idiopathic calcinosis cutis with unusual histomorphology and negative von Kossa stain: A diagnostic pitfall
Introduction: Calcinosis cutis is characterized by basophilic crystalline or amorphous calcium within the dermis/subcutis. Calcinosis cutis has many different clinical subtypes and associated etiologies that may lead clinicians to consider this diagnosis. Von Kossa and/or Alizarin red special stains may be used by pathologists to highlight deposition of insoluble calcium salts, especially in histologically ambiguous or subtle cases. Case Report: We report the case of a 27-year-old male who presented with an inferior right buttock mass clinically diagnosed as epidermal inclusion cyst(s). Gross pathology revealed a gray-white pasty substance within a cyst-like structure. Histopathologic examination demonstrated pools of amorphous blue-gray material with rare deposits of admixed coarse calcifications surrounded by foreign-body giant cells. No cyst wall was seen in the specimen. Special stains, including von Kossa, were initially negative. Following additional review, it was discovered that surface decalcifying solution had been applied to the paraffin block in the histology lab prior to microtome sectioning. Hypothesizing that this could be the cause of the unusual morphology, the paraffin block was reprocessed and subsequent H and E stained sections displayed characteristic basophilic calcium deposits, which were correspondingly positive by von Kossa stain. Conclusion: The histopathologic diagnosis of calcinosis cutis is apparent by HandE in most cases, though von Kossa and/or Alizarin red special stains can be used to aid the pathologist. Given the unusual histomorphology following surface decalcification and initial lack of von Kossa stain prior to reprocessing, this report serves to make pathologists aware of this potential diagnostic pitfall.
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