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目的观察矽结节在沃森-斯塔理银染色(Warthin-Starry,WS)下的形态学特点,对其在矽肺组织病理学检查中的意义进行初步探讨。方法收集矽肺尸检病例6例,结节病病例21例(其中尸检病例3例、活检病例18例)。对石蜡包埋组织标本的连续切片进行HE染色、WS银染色、鼠抗人CD68单克隆抗体免疫组织化学链酶卵白素过氧化物酶法染色、透射电镜(TEM)标本制作及观察、X线质谱分析(X-RSA)[对矽结节/肉芽肿细胞(指类上皮细胞、尘细胞、多核巨细胞)胞质内的尘粒进行观察和分析]。结果HE染色下,肉芽肿内尘粒的沉积程度如下:在细胞性矽结节为(++或+++),在纤维性矽结节为(+),在结节病结节为(-);WS染色下,在2种形态的矽结节均为(+++),呈特征性的黑色结节状,在结节病结节为(+/++),经秩和检验,矽结节内尘粒的沉积程度明显高于结节病结节,差异有统计学意义(P<0.01)。免疫组织化学显示,2种疾病的肉芽肿细胞CD68抗体标记均阳性,其阳性程度与细胞内尘粒的含量呈反比。TEM下结节病的尘粒较小,矽结节内的尘粒较大,电子密度较高;X-RSA显示,2种疾病尘粒的主要元素成分相同,均为硅。结论WS银染色法可以显示出矽结节内有大量尘粒,其染色效果明显优于HE染色方法,WS银染色法与TEM观察及X-RSA并用,可以观察到病理样本中的微小矽肺病变,对矽肺病变的可能性具有提示作用。
Objective To observe the morphological characteristics of silicon nodules in Warthin-Starry (WS), and to explore its significance in the pathological examination of silicosis. Methods Six cases of silicosis autopsy were collected, 21 cases of sarcoidosis (including 3 autopsy cases and 18 biopsy cases). Serial sections of paraffin-embedded tissue specimens were stained with HE staining, WS silver staining, immunohistochemical streptavidin-peroxidase staining of mouse anti-human CD68 monoclonal antibody and transmission electron microscopy (TEM) Mass Spectrometry Analysis (X-RSA) [Observation and analysis of dust particles in the cytoplasm of silicone nodules / granulomatous cells (referred to as epithelial cells, dust cells, multinucleated giant cells)]. Results Under HE staining, the degree of deposition of dust particles in granulomas was as follows: in the cytoplasmic silicone nodules (++ or +++), in the fibrous silicone nodules (+) and in the sarcoidosis nodules ( -); Under the WS staining, the two kinds of silicon nodules were (+++), characterized by black nodules, nodules in sarcoidosis (+ / ++), by rank sum test , The deposition of dust particles in silicon nodules was significantly higher than that of sarcoidosis, the difference was statistically significant (P <0.01). Immunohistochemistry showed that CD68 antibody of granuloma cells in both diseases were positive, and its positive degree was inversely proportional to the amount of intracellular dust particles. The stenosis of TEM was smaller with smaller dust particles, larger dust particles in silicon nodules and higher electron density. X-RSA showed that the main elements of dust particles in the two diseases were the same and all were silicon. Conclusion The results of WS silver staining show that there are a lot of dust particles in the silicon nodules, and the staining effect is better than that of HE staining. WS microscopy combined with TEM and X-RSA can be used to observe the micro-silicosis in pathological samples , The possibility of silicosis has prompted role.