Tang Y W, Procop G W, Zheng X, Myers J L, Roberts G D
Department of Laboratory Medicine and Pathology, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
Am J Clin Pathol. 1998 Mar;109(3):331-4. doi: 10.1093/ajcp/109.3.331.
Tissue specimens from a wide variety of anatomic locations are frequently examined for mycobacteria using a combination of cultures and special stains. Auramine-rhodamine (AR) staining is a sensitive method for detecting acid-fast bacilli (AFB) in tissue sections. We reviewed 85 AR-positive and 275 randomly selected AR-negative biopsy specimens collected during the past 2 years at the Mayo Clinic, Rochester, Minn. Pathologic diagnoses and culture results were also reviewed. Biopsy specimens containing necrotizing granulomas yielded the highest positivity rate for AFB (61 [47.7%]), followed by nonnecrotizing granulomas (14 [17.7%]). Poorly formed granulomas (5 [16.1%]) and acute inflammation (5 [15.6%]) were less frequently positive. Cases with fibrotic or hyalinized granulomas, nonspecific chronic inflammation, nonspecific reactive or reparative changes, no significant histologic abnormality, or malignancy failed to disclose AFB. These specimens, which were consistently negative for AFB, were responsible for 25% of the samples submitted. Of the 360 tissue specimens submitted, 166 had a corresponding mycobacterial culture. Mycobacteria were cultured only from the biopsy specimens that contained necrotizing granulomas (38.2%), nonnecrotizing granulomas (32.4%), poorly formed granulomas (30.0%), or acute inflammation (15.8%). Tissues with fibrotic or hyalinized granulomas, nonspecific chronic inflammation, nonspecific reactive or reparative changes, no significant histologic abnormality, or malignancy failed to yield positive cultures. These data suggest that biopsy specimens with these latter diagnoses are inappropriate specimens for mycobacterial culture or AR staining.
来自各种解剖部位的组织标本常采用培养和特殊染色相结合的方法检测分枝杆菌。金胺 - 罗丹明（AR）染色是检测组织切片中抗酸杆菌（AFB）的一种敏感方法。我们回顾了明尼苏达州罗切斯特市梅奥诊所过去两年收集的85份AR阳性和275份随机选择的AR阴性活检标本。还回顾了病理诊断和培养结果。含有坏死性肉芽肿的活检标本AFB阳性率最高（61例[47.7%]），其次是非坏死性肉芽肿（14例[17.7%]）。形成不良的肉芽肿（5例[16.1%]）和急性炎症（5例[15.6%]）阳性率较低。纤维化或透明变性肉芽肿、非特异性慢性炎症、非特异性反应性或修复性改变、无明显组织学异常或恶性肿瘤的病例未发现AFB。这些标本AFB始终为阴性，占送检样本的25%。在送检的360份组织标本中，166份有相应的分枝杆菌培养。仅从含有坏死性肉芽肿（38.2%）、非坏死性肉芽肿（32.4%）、形成不良的肉芽肿（30.0%）或急性炎症（15.8%）的活检标本中培养出分枝杆菌。有纤维化或透明变性肉芽肿、非特异性慢性炎症、非特异性反应性或修复性改变、无明显组织学异常或恶性肿瘤的组织培养未获阳性结果。这些数据表明，具有这些后述诊断的活检标本不适用于分枝杆菌培养或AR染色。
