Tornos C, Silva E, el-Naggar A, Pritzker K P
Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Am J Surg Pathol. 1990 Oct;14(10):961-8. doi: 10.1097/00000478-199010000-00010.
Most calcifications detected by mammography and specimen radiography are readily identified by histologic sections stained with hematoxylin and eosin (H&E) or the von Kossa stain. However, calcifications composed of calcium oxalate crystals are not always seen in sections stained with H&E or with von Kossa. To study the incidence of calcium oxalate crystals in breast biopsies, we used polarized light microscopy to review 153 needle-localization breast biopsies. Birefringent crystals were observed in 19 cases (17 benign and 2 malignant), but typical calcium phosphate microcalcifications were revealed by H&E in only 16 of these 19 cases. Multiple H&E sections through the blocks of the remaining three cases did not reveal typical microcalcifications. These crystals did stain with silver nitrate/rubeanic acid with 5% acetic acid pretreatment but failed to stain with von Kossa and alizarin red at pH 4.2. This suggested that they were composed of calcium oxalate. Analytical electron microscopy performed in one of the three cases without typical microcalcifications demonstrated only a calcium peak of energy-dispersive x-ray analysis and an electron-diffraction pattern compatible with calcium oxalate monohydrate. We conclude that discrepancies between the amount of microcalcifications seen on the mammogram or on the x-ray film of the specimen or the paraffin blocks and the amount of microcalcifications seen on the H&E slides may be explained by the presence of calcium oxalate crystals. These crystals are detected with specimen radiography but are not easily seen on H&E slides unless polarized light microscopy is used. Polarized light microscopy and silver nitrate/rubeanic acid with 5% acetic acid pretreatment should be used for breast biopsy specimens when typical microcalcifications are not seen on H&E-stained sections.
大多数通过乳腺X线摄影和标本射线摄影检测到的钙化灶，在苏木精和伊红（H&E）染色或冯科萨（von Kossa）染色的组织学切片中很容易识别。然而，由草酸钙晶体组成的钙化灶在H&E染色或冯科萨染色的切片中并不总是能看到。为了研究乳腺活检中草酸钙晶体的发生率，我们使用偏光显微镜检查了153例针吸定位乳腺活检标本。在19例（17例良性和2例恶性）中观察到双折射晶体，但在这19例中只有16例通过H&E显示出典型的磷酸钙微钙化。对其余3例的组织块进行多次H&E切片检查，未发现典型的微钙化。这些晶体在经过5%醋酸预处理的硝酸银/硫氰酸染色中呈阳性，但在pH值为4.2的冯科萨染色和茜素红染色中呈阴性。这表明它们是由草酸钙组成的。对3例无典型微钙化的病例之一进行分析电子显微镜检查，仅显示能量色散X射线分析的钙峰和与一水合草酸钙相符的电子衍射图谱。我们得出结论，乳腺X线片或标本或石蜡块的X线片上所见的微钙化数量与H&E切片上所见的微钙化数量之间的差异，可能是由草酸钙晶体的存在所解释的。这些晶体通过标本射线摄影可以检测到，但除非使用偏光显微镜，否则在H&E切片上不容易看到。当在H&E染色切片上未看到典型微钙化时，乳腺活检标本应使用偏光显微镜和经过5%醋酸预处理的硝酸银/硫氰酸染色。
