Special stains and immunostains

Non- Neoplastic Pulmonary Diseases:

HISTOCHEMICAL STAIN:

Periodic acid schiff (PAS):

PAS- Glycogen : Fungi

PAS with diastase pretreatment (Neutral mucin): Pulmonary Alveolar Proteinosis

Grocott : For Fungi ; Pneumocystis infection;

Ziel-Neelsen stain: For mycobacterial organisms; Tuberculosis

Elastic/van Gieson stain for:

(collagen) - Fibrosis ; (elastin) - Vasculature.

Eg. Interstitial fibrosis; Organizing pneumonia; Vasculitis;

Pulmonary Hypertension ; chronic lung rejection

Congo red : for amyloid (primary / secondary);

Perls’ prussian stain: for ferric iron. Eg. Pulmonary Hemorrhage ; ferruginous bodies.

von Kossa stain phosphate;

IMMUNOHISTOCHEMICAL / fluorescence:

Pneumocystis antibodies : Pneumocystis carinii

Cytomegalovirus antibody : Cytomegalovirus infection

OTHER ANALYSIS:

Polarising microscopy for birefringent material:

Talc ; Mica ; Pneumoconiosis .

Mineral analysis: (light or electron microscope)- Diagnosis in Asbestos-related diseases.

Neoplastic Pulmonary Diseases:

HISTOCHEMICAL STAIN:

Periodic acid Schiff (PAS): Clear cell tumours

PAS with diastase pretreatment (Neutral mucin): Adenocarcinoma

(Alcian blue pH 2.5 (Acid mucin): Mesothelioma (Mesothelioma-Online)

Combined Alcian blue/diastase PAS.(basement membrane / neutral mucin): Adenoid cystic Ca.

Argyrophil stains such as Grimelius for neuroendocrine granules of carcinoid tumours.

Immunohistochemical STAIN:

Immunohistochemical stains for NSE and PGP 9.5 have limited value in distinguishing small cell carcinoma from other types of carcinoma in small biopsies as they are often non-specific and unreliable.

More specific markers, such as chromogranin and N-CAM, are not easily identified in poorly differentiated tumours and small cell carcinoma.

CAM 5.2 and other cytokeratins give paranuclear dot positivity in small cell carcinoma and can be used as part of a panel.

Immunostains can be usefully applied in typing of neoplasms - CAM 5.2, leucocyte common antigen, desmin, synaptophysin, chromogranin, N-CAM, S100, surfactant;

Lymphocyte markers - B and T cell markers, light chains.

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