Utility of Scanning Electron Microscopy Elemental Analysis Using the 'NanoSuit' Correlative Light and Electron Microscopy Method in the Diagnosis of Lanthanum Phosphate Deposition in the Esophagogastroduodenal Mucosa.

Ken Sugimoto,Takahiko Hariyama,Hisami Kato,Hideya Kawasaki,Haruhiko Sugimura,Satoshi Yamada,Satoshi Baba,Kazuya Shinmura,Kiyoshi Misawa,Hideo Yasuda,Isao Ohta,Satoshi Osawa,Masanori Sato

doi:10.3390/diagnostics10010001

Abstract

Background: We have recently developed the correlative light and electron microscopy of hematoxylin and eosin (H&E)-stained glass slides using the ‘NanoSuit’ method. The aim of this study is to explore the utility of the new NanoSuit-correlative light and electron microscopy method combined with scanning electron microscopy-energy dispersive X-ray spectroscopy elemental analysis for the diagnosis of lanthanum phosphate deposition in the H&E-stained glass slides. Methods: Nine H&E-stained glass slides of the upper gastrointestinal tract mucosa containing the brown pigmented areas by light microscopic observation, which were suspected as lanthanum phosphate deposition, were observed and analyzed by scanning electron microscopy-energy dispersive X-ray spectroscopy using the NanoSuit-correlative light and electron microscopy method. Results: In all nine slides, the new NanoSuit-correlative light and electron microscopy method combined with scanning electron microscopy-energy dispersive X-ray spectroscopy revealed the accumulation of both lanthanum and phosphorus in the tissue area corresponding to the brown pigment deposition. In addition to the existence of lanthanum phosphate in the stomach and duodenum, known target organs, we observed deposition in the esophagus for the first time. Furthermore, we observed lanthanum phosphate deposition in the background mucosa of stomach containing primary adenocarcinoma. Conclusions: Scanning electron microscopy-energy dispersive X-ray spectroscopy analysis using the NanoSuit-correlative light and electron microscopy method is useful for the diagnosis of lanthanum phosphate deposition in the H&E-stained glass slides. Lanthanum phosphate deposition occurs not only in the stomach and duodenum but also in the esophagus.

Highlights

Lanthanum carbonate is one of the therapeutic phosphate binders used to keep optimal serum phosphate levels in dialysis patients with end-stage renal disease [1]
Nine hematoxylin and eosin (H&E)-stained formalin-fixed paraffin-embedded (FFPE) slides of the upper gastrointestinal tract mucosa tissue containing the brown pigmented area by light microscopic observation, which were suspected as lanthanum phosphate deposition in routine pathological diagnosis, were used in this study
To explore whether scanning electron microscopy (SEM) observation using the NanoSuit-correlative light and electron microscopy (CLEM) method is useful for the diagnosis of lanthanum phosphate deposition in the gastrointestinal tract, we first performed SEM observation in six cases having a pathological record of brown pigment deposition, which were suspected as lanthanum phosphate deposition, in the H&E slides, either or both of stomach and duodenum (Figure 2a; representative images showing deposition exhibiting granular, needle-shaped, or amorphous structure), known as target organs of lanthanum phosphate deposition [8,12]

Summary

Introduction

Lanthanum carbonate is one of the therapeutic phosphate binders used to keep optimal serum phosphate levels in dialysis patients with end-stage renal disease [1]. The aim of this study is to explore the utility of the new NanoSuit-correlative light and electron microscopy method combined with scanning electron microscopy-energy dispersive X-ray spectroscopy elemental analysis for the diagnosis of lanthanum phosphate deposition in the H&E-stained glass slides. H&E-stained glass slides of the upper gastrointestinal tract mucosa containing the brown pigmented areas by light microscopic observation, which were suspected as lanthanum phosphate deposition, were observed and analyzed by scanning electron microscopy-energy dispersive X-ray spectroscopy using the NanoSuit-correlative light and electron microscopy method. Results: In all nine slides, the new NanoSuit-correlative light and electron microscopy method combined with scanning electron microscopy-energy dispersive X-ray spectroscopy revealed the accumulation of both lanthanum and phosphorus in the tissue area corresponding to the brown pigment deposition. We observed lanthanum phosphate deposition in the background mucosa of stomach containing primary adenocarcinoma

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