Zhou Chong, Vink Robert, Byard Roger W
The University of Adelaide Medical School, Frome Road, Adelaide, SA, 5005, Australia.
Forensic Science SA, 21 Divett Place, Adelaide, SA, 5000, Australia.
J Forensic Sci. 2017 Jan;62(1):229-232. doi: 10.1111/1556-4029.13235. Epub 2016 Oct 27.
Armanni-Ebstein lesions have been considered pathognomonic for diabetes mellitus and appear as markedly swollen renal tubular epithelial cells with cytoplasmic clearing and glycogen accumulation. However, the extent to which hyperosmolarity contributes to the Armanni-Ebstein phenotype is unclear. Ten sheep were injected intravenously with 20% mannitol at 11 mOsm/kg, and subsequent histological evaluation of the kidneys showed variable degrees of osmotic nephrosis and cytoplasmic clearing of renal tubular epithelial cells similar to that seen with Armanni-Ebstein lesions. However, although morphological changes similar to Armanni-Ebstein lesions could be produced, no intracytoplasmic glycogen was demonstrated with periodic Acid-Schiff (PAS) stain. This suggests that while hyperosmolarity may contribute to the development of an Armanni-Ebstein phenotype, glycogen accumulation may result from the more complex metabolic effects of glucose on renal tubular epithelial cells. Thus, when Armanni/Ebstein-like vacuolizations are seen at autopsy, a confirmatory PAS stain is recommended because of the potential effect of hyperosmolar states.
阿马尼亚克-埃布斯坦病变一直被认为是糖尿病的特征性病变，表现为肾小管上皮细胞明显肿胀，胞质清亮，伴有糖原积聚。然而，高渗状态对阿马尼亚克-埃布斯坦表型的影响程度尚不清楚。给10只绵羊静脉注射20%甘露醇，剂量为11 mOsm/kg，随后对肾脏进行组织学评估，结果显示出现了不同程度的渗透性肾病，肾小管上皮细胞胞质清亮，类似于阿马尼亚克-埃布斯坦病变所见。然而，尽管可以产生与阿马尼亚克-埃布斯坦病变相似的形态学变化，但过碘酸-希夫（PAS）染色未显示胞质内有糖原。这表明，虽然高渗状态可能有助于阿马尼亚克-埃布斯坦表型的发展，但糖原积聚可能是葡萄糖对肾小管上皮细胞更复杂的代谢作用所致。因此，尸检时若发现类似阿马尼亚克/埃布斯坦的空泡化，由于高渗状态的潜在影响，建议进行PAS染色以确诊。
