Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Urology, University of Minnesota, Minneapolis, MN, USA.
Urolithiasis. 2022 Feb;50(1):21-28. doi: 10.1007/s00240-021-01275-1. Epub 2021 Jun 6.
Jackstone calculi, having arms that extend out from the body of the stone, were first described over a century ago, but this morphology of stones has been little studied. We examined 98 jackstones from 50 different patient specimens using micro-computed tomography (micro CT) and infrared (IR) spectroscopy. Micro CT showed that jackstone arms consisted of an X-ray lucent core within each arm. This X-ray lucent core frequently showed sporadic, thin layers of apatite arranged transversely to the axis of the arm. The shells of the jackstones were always composed of calcium oxalate (CaOx), and with the monohydrate form the majority or sole mineral. Study of layering in the shell regions by micro CT showed that growth lines extended from the body of the stone out onto jack arms and that the thickness of the shell covering of jack arms often thinned with distance from the stone body, suggesting that the arms grew at a faster radial rate than did the stone body. Histological cross-sections of decalcified jackstone arms showed the core to be more highly autofluorescent than was the CaOx shell, and immunohistochemistry showed the core to be enriched in Tamm-Horsfall protein. We hypothesize that the protein-rich core of a jack arm might preferentially bind more protein from the urine and resist deposition of CaOx, such that the arm grows in a linear manner and at a faster rate than the bulk of the stone. This hypothesis thus predicts an enrichment of certain urine proteins in the core of the jack arm, a theory that is testable by appropriate analysis.
杰克石的结石有从石头主体延伸出的臂,这种形态的结石在一个多世纪以前就被首次描述过,但对这种结石的形态特征却鲜有关注。我们用微计算机断层扫描(micro CT)和红外(IR)光谱法检查了 50 个不同患者样本中的 98 个杰克石。micro CT 显示,杰克石的臂由每个臂内的 X 射线不透明核心组成。这个 X 射线不透明的核心经常显示出有规律的、横向排列的薄层磷灰石。杰克石的外壳总是由草酸钙(CaOx)组成,且一水合物形式占大多数或唯一矿物。用 micro CT 研究外壳区域的分层表明,生长线从石头主体延伸到杰克石臂上,并且杰克石臂的外壳覆盖层的厚度通常随着距离石头主体的增加而变薄,这表明臂的生长速度比石头主体更快。脱钙杰克石臂的组织学横截面显示核心比 CaOx 外壳具有更高的自发荧光,免疫组化显示核心富含 Tamm-Horsfall 蛋白。我们假设杰克石臂的富含蛋白的核心可能优先结合尿液中的更多蛋白,并抵抗 CaOx 的沉积,从而使臂以线性方式和更快的速度生长,而不是石头的大部分。因此,这个假设预测杰克石臂核心中某些尿液蛋白的富集,这一理论可以通过适当的分析来验证。