Interesting Pathology Cases
A case showing classic asbestos bodies in routine Hematoxylin and Eosin (H&E) stain, Iron stain and unstained thick sections, as well as varying severity of asbestosis.
Asbestos or Non-Asbestos?
The presentation contains several SEM images and corresponding EDS spectra of fibers recovered from human tissue. Are these asbestos or non-asbestos? If you have some expertise on such issues and are willing to assist in collecting consensus data, please e-mail Dr. Abraham (firstname.lastname@example.org) with your independent opinion. How would you classify these fibrous particles based on the information conveyed in these images and spectra? [Posted January 3, 2007]
Recognition and Identification of Cellulose Particles in Tissue Sections
A skin biopsy from a woman revealed necrotizing inflammation and some fat necrosis. There was focally abundant strongly birefringent material with some foreign body giant cell reaction. The photomicrographs illustrate the reaction, the crystalline material in H&E stains and with the silver stain (GMS). Several features help recognize cellulose particles and distinguish them from mineral talc particles. The cellulose particles often have a faint yellow or brown color and show cross or linear banding. Cellulose particles stain strongly with GMS stain but talc does not stain with GMS.
If necessary, additional analyses can be done using SEM/EDS to identify talc by its characteristic Mg and Si composition (See more on talcosis). Cellulose would show only Carbon and Oxygen peaks by EDS. To further delineate the molecular composition of such particles, Infrared or Raman spectroscopy may be useful, but these latter two are less available techniques than SEM/EDS.
In this case, the most likely source of the skin lesions was from self-injection of pharmaceutical tablets which contained microcrystalline cellulose as a tablet filler. There was no previous history of an open wound or any possible contamination by cotton dressing materials. It was not proven, but most likely a case of Munchausen’s Syndrome.