Mochel Mark C, Arakaki Ryan Y, Wang Guilin, Kroshinsky Daniela, Hoang Mai P
Department of Pathology, Harvard Medical School and Massachusetts General Hospital, Boston, MA 02114, USA.
Am J Dermatopathol. 2013 Jul;35(5):582-6. doi: 10.1097/DAD.0b013e31827c7f5d.
Calciphylaxis is a rare and life-threatening disease characterized by cutaneous necrosis and vascular calcification. Often, skin biopsy specimens are not diagnostic because of the limited depth of the specimen, biopsy site, and clinical stage. To better understand the utility of various histologic features in rendering the diagnosis of calciphylaxis and to compare von Kossa versus Alizarin red stains in the detection of calcium deposits, we retrospectively analyzed the histologic features and histochemical stain findings of 56 skin biopsies from 27 consecutive patients seen at Massachusetts General Hospital from October 2002 to April 2012, with confirmed diagnosis of calciphylaxis and compared with that of 19 skin biopsies from 17 patients with other disease processes. All forms of vascular calcification and vascular thrombosis were significantly associated with cutaneous calciphylaxis. Perieccrine calcium deposition, highly specific to calciphylaxis, was the only form of calcium deposition noted in 4 (7%) skin biopsies from patients with calciphylaxis. Although the staining appears to be comparable, the deposits seen on Alizarin red appeared larger and were birefringent. Although subtle, perieccrine calcification may aid in the diagnosis of calciphylaxis in settings where typical vascular and extravascular calcification are not identified. Performing both von Kossa and Alizarin red stains might increase the detection of calcium deposit.
钙过敏是一种罕见且危及生命的疾病，其特征为皮肤坏死和血管钙化。通常，由于活检标本的深度有限、活检部位及临床分期等因素，皮肤活检标本无法用于诊断。为了更好地了解各种组织学特征在钙过敏诊断中的作用，并比较冯·科萨（von Kossa）染色与茜素红染色在检测钙沉积方面的效果，我们回顾性分析了2002年10月至2012年4月在马萨诸塞州综合医院连续收治的27例确诊为钙过敏患者的56份皮肤活检标本的组织学特征和组织化学染色结果，并与17例患有其他疾病的患者的19份皮肤活检标本进行比较。所有形式的血管钙化和血管血栓形成均与皮肤钙过敏显著相关。汗腺周围钙沉积是钙过敏的高度特异性表现，是在4例（7%）钙过敏患者的皮肤活检标本中发现的唯一钙沉积形式。尽管两种染色效果似乎相当，但茜素红染色显示的沉积物更大且具有双折射性。尽管很细微，但在未发现典型血管和血管外钙化的情况下，汗腺周围钙化可能有助于钙过敏的诊断。同时进行冯·科萨染色和茜素红染色可能会增加钙沉积的检出率。
