Tony Henwood JP, BAppSc, GradDipSysAnalys, CT(ASC)
Laboratory Manager
The Children's Hospital at Westmead,
Locked Bag 4001, Westmead, 2145, AUSTRALIA.
Tel: (02) 9845 3306
Fax: (02) 9845
3318
http://www.histosearch.com/homepages/TonyHenwood/default.html
http://us.geocities.com/tonyhenwoodau/index.html
Lecca S. Pilloni L.
Ambu R. Flore C. Callea F. Faa G.(Pathologica.
90(6):771-5, 1998 Dec)
Abstract
Conflicting results have been reported on
the usefulness of histochemistry for copper in the diagnosis of Wilson's Disease
(W.D.). In spite of the high number of methods proposed in the literature, no-one has shown to have the characteristics typical of a good histochemical
method: high sensitivity associated with high specificity. On this basis, it
seemed of interest to evaluate, in a large series of patients with W.D., the
diagnostic value of the most commonly used histochemical methods for copper (rhodanine, orcein and Timm's method). To this end, 74 liver needle biopsies
from patients affected by W.D., 39 males and 35 females, aged 4-60 years (mean
age 28.5 years), were stained with rhodanine (R), orcein (O) and Timm's (T) methods. On the basis of the histological picture, liver biopsies were
subdivided in four evolutive stages: stage I = steatosis; stage II = interface
hepatitis; stage III =
bridging fibrosis; stage IV = cirrhosis. In stage I,
histochemistry for copper was positive in 11 out of 21 cases: 6 cases were T+; 1
case R+ and 2 cases O+; 2 cases were T+, R+, O+. In stage II, 11 out of 14 cases
were positive for copper staining: 4 T+, 2 R+ and 2 O+; 3 cases were
contemporary positives for T, R, O. In stage III, 22 out of 25 cases resulted
positive: 8 T+, 3 R+ and 1 O+; 10 cases were positives, in the mean time, for
more of one method. In stage IV, 12 of 14 cases were positives: 5 T+, 2 R+, 2 O+
and 3 cases were contemporaneously positives for multiple methods. Our data show
that: 1) the percentage of positivity obtained using three histochemical methods
for copper is higher than using only one method. From a practical point of view,
it is mandatory to utilize, in clinical practice, multiple histochemical stains
in order to increase the diagnostic utility of histochemistry for copper; 2) the
Timm's method appears to be the most sensitive method for the demonstration of
copper in all stages of W.D.; 3) even though hepatic copper already abounds in
the early stages of W.D., this pool of intrahepatic copper is not yet
demonstrable with any of the three histochemical techniques
utilized.
Can anyone
tell me if all copper stains require use of control tissue that is
specifically diagnosed with Wilson's disease? Historically, as was passed along to me....copper controls had to come from a liver with Wilson's
disease. One of our doctors recently told me any liver with chronic cholestasis (ie. Primary biliary cirrhrosis or Primary schlerosing
cholangitis) is okay to use too. I recently stained some fetal liver
tissue and it looks great. I am hoping the consensus from histoland confers that PBC and PSC liver tissue that stains great for copper is okay to
use too.
Thankyou!
Deb King, HT (ASCP)
Sacramento, CA
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