Noh Songmi, Kim Sun Ho, Cho Nam Hoon, Kim Se Hoon
Department of Pathology, Yonsei University College of Medicine, Severance Hospital, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
Endocr Pathol. 2015 May;26(2):178-84. doi: 10.1007/s12022-015-9370-y.
Approximately 90% of neoplasms found in the sellar region are adenoma of the pituitary gland. The use of frozen sections for the diagnosis of pituitary adenomas has an accuracy of 90% and is useful in evaluating complete tumor removal. However, it is sometimes difficult to diagnose pituitary adenomas using frozen sections because of the small sample size and marked artifact, and the contiguity of the pituitary adenoma with normal pituitary gland tissue. In this study, we evaluated the use of our modified reticulin stain to make correct decision in frozen section with reduced stain time and investigated the objective diagnostic criteria of pituitary adenoma with reticulin stain. We used Gomori's silver impregnation methods to stain reticulin fibers in frozen pituitary gland sections of 36 samples from 24 patients. We modified the conventional staining method by reducing the overall staining time. We diagnosed pituitary lesion according to our interpretation criteria and compared the results to those of the conventional method and findings of hematoxylin and eosin-stained slides. Reticulin fiber staining of normal adenohypophysis outlines the supporting stroma around the blood vessels and shows regular of the gland meshwork interconnecting the capillaries. In contrast, reticulin fiber staining of the adenomatous tissue shows loss of meshwork or frequent fragmentation. Our modified reticulin stain is more rapid than the established method and shows similar levels of accuracy. Independent evaluation by two pathologists showed discrepancies in diagnosis in four out of 36 cases with modified reticulin stain. Our rapid modified reticulin staining method for frozen sections may be useful as a diagnostic tool for pituitary adenomas and can complement routine hematoxylin and eosin staining.
蝶鞍区发现的肿瘤约90%为垂体腺瘤。使用冰冻切片诊断垂体腺瘤的准确率为90%,有助于评估肿瘤是否完整切除。然而,由于样本量小、伪像明显以及垂体腺瘤与正常垂体组织相邻,有时难以通过冰冻切片诊断垂体腺瘤。在本研究中,我们评估了改良网状纤维染色法在冰冻切片中缩短染色时间以做出正确诊断的应用,并研究了网状纤维染色诊断垂体腺瘤的客观标准。我们采用Gomori银浸染法对24例患者的36份垂体冰冻切片中的网状纤维进行染色。我们通过缩短总体染色时间对传统染色方法进行了改良。我们根据自己的解读标准诊断垂体病变,并将结果与传统方法及苏木精-伊红染色玻片的结果进行比较。正常腺垂体的网状纤维染色勾勒出血管周围的支持性基质,并显示出连接毛细血管的腺网结构规则。相比之下,腺瘤组织的网状纤维染色显示网状结构丧失或频繁断裂。我们改良的网状纤维染色比既定方法更快,且准确率相当。两位病理学家的独立评估显示,在36例改良网状纤维染色病例中,有4例诊断存在差异。我们用于冰冻切片的快速改良网状纤维染色方法可能作为垂体腺瘤的诊断工具,并且可以补充常规苏木精-伊红染色。
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