Elastic Tissue Stain Research Articles

A Case of Acrokeratoelastoidosis

A 28-year-old woman had a 13-month history of skin-colored, well-circumscribed, hyperkeratotic plaques on both heels. Histological examination showed hyperkeratosis and acanthosis in the epidermis. Special stain for elastic tissue revealed marked fragmentation, diminution and thickening of elastic fibers in the dermis. We report a rare case with the lesions of acrokeratoelastoidosis on both heels. (Ann Dermatol 13(2) 126~128, 2001).

Treatment of Elastosis Perforans Serpiginosa with the Flashlamp Pulsed Dye Laser

Elastosis perforans serpiginosa (EPS) is an uncommon and chronic dermatosis characterized by the transepidermal elimination of altered elastic fibers originating in the dermis. Frequently arranged in an arcuate or serpiginous pattern, the end stage of the disease is atrophic or stellate-shaped scars. Prior therapy has primarily involved cryotherapy with liquid nitrogen which may cause scar or keloid formation. We present our experience using the flashlamp pulsed dye laser to treat EPS. A young man with Down syndrome was referred by his primary care physician for treatment of a chronic dermatosis unresponsive to topical therapy. The clinical findings were consistent with EPS, and a biopsy specimen and elastic tissue stain confirmed the diagnosis histologically. After a successful test spot, treatment was begun on the erythematous papules using a flashlamp pulsed dye laser (585 nm) with a 5 mm spot size and fluences of 6.0-7.0 J/cm2. Treated areas showed moderate to marked improvement overall. There was less erythema, thickness, and scarring in treated areas compared with active or end-stage lesions. The flashlamp pulsed dye laser may be an effective treatment method for EPS.

Elastic tissue in scars and alopecia.

A recent report suggests that elastic fibers appear in scars in a time-dependent fashion. This observation prompted our investigation, because we have found elastic tissue stains helpful in determining the pattern of scarring in cases of permanent alopecia. We carried out this investigation to determine if the Verhoeff-Van Gieson (VVG) elastic stain can reliably differentiate scarred from non-scarred dermis and to test our hypothesis that elastic stained sections are helpful in distinguishing lichen planopilaris (LPP) from lupus erythematosus (LE), central progressive alopecia in black females ("follicular degeneration syndrome" and "hot comb alopecia" are other terms used to describe this condition) and classic ivory white idiopathic pseudopelade. We studied histological sections from surgical scars of known duration, stained with the VVG elastic stain and VVG-stained sections of scalp biopsies from patients with established lesions of permanent alopecia. In most cases, both vertical and transverse sections were examined. In every case, the VVG stain clearly differentiated scar from the normal surrounding dermis. Distinct patterns of elastic tissue allowed for correct classification in most of the well-established cases of permanent alopecia studied. We determined that the Verhoeff-Van Gieson stain is an excellent stain to evaluate the pattern of scarring in cases of permanent alopecia and elastic tissue stains may be helpful in the histological evaluation of alopecia.

Elastic tissue in fibroepithelial polyps.

Fibroepithelial polyps are common cutaneous lesions with an unknown etiology. We attempted to demonstrate that fibroepithelial polyps develop secondary to a focal loss of elastic tissue. Forty-five fibroepithelial polyps were examined. All were stained with Verhoeff-van Gieson stain for elastic tissue and examined. All but one specimen had a normal amount of elastin and none revealed abnormally shaped elastic fibers. Abnormal or decreased elastic tissue is not the cause of fibroepithelial polyps.

Age- and gender-related elastin distribution changes in human vocal folds

The composition of the lamina propria in human vocal folds has been shown to affect vocal performance. Elastin plays a significant role in the biomechanical effects of the lamina propria. We obtained 19 larynges from the state medical examiner from subjects whose cause of death was unrelated to the trachea and laryngeal regions. The sample contained male and female subjects in the infant, adult, and geriatric age groups. We stained the vocal folds for elastin with Verhoeff’s elastic tissue stain and studied them with use of an image analysis system configured for light microscopy. Distributions of elastin were measured from superficial to deep within the lamina propria (from epithelium to vocal muscle). These elastin distributions were then compared with the use of statistical software. The data showed that there was an increase in elastin content from the infant through geriatric stages. No gender-related differences were found. Infant folds had about 23% of the elastin found in adults, and geriatric subjects had about 879% of the elastin found in adults. Both of these results were statistically significant ( p < 0.05). The distributions were consistent with previous observations that the lamina propria is a layered structure with most of the elastin present in the intermediate layer. This layer was larger in geriatric subjects than in adult and pediatric subjects. We observed that the fiber diameter appeared to be larger in geriatric subjects (this observation is currently being verified with electron microscopy) whereas smaller, spiraled fibers appeared in pediatric subjects. (Otolaryngol Head Neck Surg 1998;119:314-22.)

Modification of Movat Pentachrome Stain with Improved Reliability of Elastin Staining

AbstractThe authors describe a modification of Movat pentachrome stain for the demonstration of elastin, sulfated macromolecules (proteoglycans, glycosaminoglycans and secreted mucins), collagens, myofibrils, and erythrocytes. The key modification is the use of a modified Verhoeff elastic tissue stain, which is more tolerant of minor variations in technique and does not require differentiation to a subjective endpoint. The resulting stained sections have a clear background and crisply defined cell and matrix components including both large and small elastic fibers. This stain is particularly useful for evaluating the matrix components of lung and vascular tissue in normal and diseased states. (The J Histotechnol 19:325–327, 1996)

Acrolocalized acquired cutis laxa

A 55-year-old man presented with a 14-year history of loose, redundant skin on the palmar aspects of the finger tips and toe pulps, which gave a peculiar 'chewing gum' appearance. Skin biopsies of involved areas showed a normal appearance, and only a discrete decrease in the elastic fibres could be identified with an elastic tissue stain. Ultrastructural examination, however, demonstrated marked fragmentation and degeneration of the elastic tissue. Localized cutis laxa in an acral distribution, was fully developed at presentation. He gave a history of repeated episodes of swelling and urticaria of the involved areas, which we regard as being the initial inflammatory stages of this disease process.

Elastic fibers in scar tissue.

The capacity of the skin to be stretched and to return to its resting position is correlated to the quantity and to the quality of the elastic fiber network. Although elastic fibers have been demonstrated in scars, the time course of their appearance in scars and their role in scar elasticity has not been elucidated. A study was therefore undertaken to evaluate the elastic fiber network in scars. The scars studied were from re-excision specimens following a biopsy performed for a benign or a malignant process. A total of 182 scars were evaluated in patients of different age groups. Miller's elastic tissue stain, considered to be superior to Verhoeff's van Giesen stain, was used. No elastic fibers were detected in any of 116 scars which were of less than 3 months' duration. In 66 scars present for over 3 months, a progressive increase in elastic fibers was present, first as focal and thin fibers, then as diffuse and thicker fibers. For scars of the same duration, a regional difference was noted in that scars from the back contained more and thicker elastic fibers than those from the cheek. When patients were stratified according to age, no appreciable difference was noted in the density of elastic fibers in both new and old scars between the different age groups. These results show that the synthesis of elastic tissue fibers in scars is a function of duration and site of the scar.

Characterization of malignant colon tumors with31p nuclear magnetic resonance phospholipid and phosphatic metabolite profiles

To further characterize selected pathologic features on a biochemical level, the authors analyzed the nuclear magnetic resonance metabolite and phospholipid spectra of 30 malignant colon tumors using 31P magnetic resonance spectroscopy. Eleven individual generic phospholipids were identified in the spectra of 17 phospholipid extracts, and 31 individual phosphatic metabolites were identified in the spectra of 13 perchloric acid extracts. The metabolites and lipids were quantified for statistical intergroup comparisons based on tumor stage, lymph node status, differentiation, mucin production, blood vessel invasion (BVI), and lymphatic vessel invasion (LVI). Significant elevations in the relative concentration of alpha-glycerol phosphate were noted when comparing AJCC tumor classification (T3 vs. T2, 0.92 +/- 0.14 vs. 0.46 +/- 0.11, P < 0.009), tumor differentiation (moderately vs. well differentiated, 0.92 +/- 0.14 vs. 0.46 +/- 0.11, P < 0.009), and BVI (presence vs. absence, 1.03 +/- 0.04 vs. 0.68 +/- 0.10, P < 0.028) by elastic tissue stain. Among the tissue phospholipids analyzed, the relative concentration of a choline phospholipid was significantly different when comparing moderately and poorly differentiated tumors (6.26 +/- 0.56 vs. 3.29 +/- 0.30, P < 0.001), T2 and T3 tumors (3.90 +/- 0.45 vs. 6.31 +/- 0.56, P < 0.009), and mucin-positive vs. mucin-negative tumors (4.46 +/- 0.56 vs. 6.83 +/- 0.76, P < 0.028). Differences in lymph node status of the cases analyzed in this study (lymph node positive vs. lymph node negative) were noted for tumors with elevated levels of sphingomyelin (8.13 +/- 0.40 vs. 6.88 +/- 0.16, P < 0.02), diminished levels of phosphatidylinositol (5.25 +/- 0.27 vs. 6.38 +/- 0.34, P < 0.02), elevated levels of beta-glycerol phosphate (5.30 +/- 0.70 vs. 1.20 +/- 0.06, P < 0.05), and elevated levels of glycerol 3-phosphoserine (0.48 +/- 0.01 vs. 0.23 +/- 0.02, P < 0.002). The characteristic differences in the phospholipid and intermediate phosphate metabolite profiles identified through magnetic resonance spectroscopic and histopathologic analysis may provide important information regarding the nature of tumor and cell membrane metabolism. Differences in these profiles may identify markers useful for biologic behavior, provide prognostic information, and characterize the impact of the pathologic features of colon cancer.

Linear focal elastosis in a young black man: A new presentation

We report the sixth case of linear focal elastosis. Our patient is a thin 29-year-old black man who was first seen with rows of papules with a yellow hue distributed symmetrically on the lumbar region of the back. The patient had been aware of these lesions since early childhood, and similar lesions reportedly had occurred in his late father. Light microscopic examination demonstrated dermal thickening but no change in the epidermis. The elastic tissue stain revealed fragmented elastic fibers throughout the dermis. This case meets previously defined diagnostic criteria for linear focal elastosis, which has been reported as isolated cases in elderly white or Japanese men. Our patient is the first young black man with a possible familial association.

Assessment of survival and microscopic changes in porcine skin flaps undergoing immediate intraoperative tissue expansion.

The technique of rapid intraoperative tissue expansion has been used with increasing frequency in the clinical setting over the last several years. This technique takes advantage of the skin's ability to immediately stretch and increase in surface area when expanded under a constant load. Sixteen random-pattern, rapidly expanded skin flaps on 10 domestic male pigs were studied to assess the predictive value of the fluorescein test for flap viability after rapid intraoperative tissue expansion. Partial fluorescence was found to be a more accurate predictor of flap survival in the experimental rapidly expanded flaps when compared to full fluorescence. Partial fluorescence was found to under-predict flap survival by 0.3 to 0.5 cm, whereas full fluorescence was found to under-predict flap survival by 2.5 cm. Additionally, histologic and ultrastructural changes were examined in rapidly expanded skin from the hip region in three pigs. The only microscopic change noted between control and experimental flaps was dilated capillaries in the dermis of expanded skin, which was noted by electron microscopy. Collagen and elastic tissue changes were not demonstrated in rapidly expanded pig skin by electron microscopy, direct immunofluorescence, collagen, and elastic tissue stains.

Necrosis of the hand after extravasation of intravenously administered phenytoin

Extravascular escape of intravenously administered phenytoin can result in serious local soft tissue complications. Injury can range from simple phlebitis to chemical cellulitis or, in extreme cases, frank tissue necrosis that necessitates amputation. The histopathologic findings include extensive necrosis and sloughing of epidermis, widespread necrosis of dermis, subcutaneous tissue, muscles and nerves, and extensive thrombotic occlusion of vessel lumens. Results of elastic tissue stains reveal that the thrombosed vessels are exclusively veins and venules. Vascular fibrinoid necrosis, leukocytoclasis, and true inflammatory vasculitis are not features. This is the first detailed report of the histopathologic alterations associated with this therapeutic misadventure.

Posterior Fossa Venous Angioma – Can it be Resected?: Review of the Literature through a Case Report

Posterior Fossa Venous Angioma – Can it be Resected?: Review of the Literature through a Case Report

Vascular invasion of colorectal carcinoma readily visible with certain stains.

We made use of hematoxylin and eosin (H&E) stain, Verhoeff van-Gieson stain for elastic tissue (EVG), and factor VIII-related antigen (FVIII-RA) to stain tissues excised from 94 patients with colorectal carcinoma. Of these 94, 49 died of disease within two years (Group I), and 45 survived for five years or longer (Group II) after surgery. In the tissues from both groups, the use of EVG stain revealed a higher incidence of vascular invasion than was seen with H&E stain. In Group I, the rates were 28.6 percent and 61.2 percent with H&E and EVG, respectively, and those in Group II were 4.4 percent and 31.1 percent, respectively. Conversely, the FVIII-RA stain showed a decrease in the incidence of vascular invasion in both groups. In Group I, when vascular invasion was examined in EVG-stained tissues, the incidence was 81.3 percent in cases of hematogenous metastases and 23.5 percent in those without hematogenous metastases (P less than 0.01). These differences were not evident with H&E. When observing the site of vascular invasion in tissues of the colorectal wall stained with EVG, intramural and extramural types of vascular invasion were seen in 20 percent and 80 percent of cases in Group I and in 93 percent and 7 percent of those in Group II, respectively. Thus, not only the frequency, but also the site, of vascular invasion into the colorectal wall evidenced with EVG stain provides a more precise prediction of the recurrence of hematogenous metastases.

Linear Focal Elastosis

We studied an 86-year-old Japanese man with linear focal elastosis. The lesions were asymptomatic yellow striae in the lumbar region, histologically composed of massive, well-demarcated basophilic fibers that stained positively with elastic tissue stains. Electron microscopy revealed fine, reticular or granular electron-dense materials, and elastic fiber microfibril-like materials in the matrix, in addition to numerous mature and immature elastic fibers. These findings suggest that active elastogenesis was occurring in the lesions. The four cases reported so far have the three common features of age, sex, and lesion location.

A Modified Verhoeff Elastic-van Gieson Stain

A simplified version of the modified Verhoefs elastic-van Gieson stain is presented. This method uses a timed differentiation of the elastic tissue stain coupled with van Gieson counterstain. The van Gieson counterstain is balanced so that the picric acid completes the differentiation without loss of staining of the finer elastic fibrils. The entire procedure takes about 20 min to perform. (The J Histotechnol 14:113, 1991)

Immunohistochemical demonstration of actinically damaged elastic fibers in keratoacanthomas: an aid in diagnosis

The inclusion of elastic fibers within the epithelium of keratoacanthomas is a phenomenon suggested to be an aid in differentiating this lesion from squamous cell carcinoma. Antilysozyme antibodies have recently been noted to stain actinically damaged elastic fibers but not those from sunprotected skin. In this study, 54 keratoacanthomas and 46 squamous cell carcinomas were stained with a histochemical elastic tissue stain and polyclonal antibody to lysozyme using an immunoperoxidase technique. Elastic fibers were demonstrated in keratoacanthomas (37/54, 68%) significantly more often than squamous cell carcinomas (12/46, 26%) (p less than 0.001) using both techniques. This study confirms that the inclusion of elastic fibers occurs significantly more often in keratoacanthomas than squamous cell carcinomas. These elastic fibers were also actinically damaged, suggesting a role for sun damage in the evolution of keratoacanthoma.

Cutaneous angiolipoleiomyoma

We describe eight cases of cutaneous angiolipoleiomyoma, a rare tumor previously reported only once under the term cutaneous angiomyolipoma. Clinically, the tumors were acquired, solitary, asymptomatic nodules that were always acral in location. Patients' ages ranged from 33 to 77 years (median 52.6 years); the male/female ratio was 7:1. Signs of tuberous sclerosis or renal angiomyolipoma were absent in all cases. Histologically, the tumors were subcutaneous, well circumscribed, and composed of smooth muscle, vascular spaces, connective tissue, and mature fat. In some tumors the fat was the predominant component, and in others smooth muscle predominated. Elastic tissue stains revealed that some blood vessels had developed an elastic lamina whereas other blood vessels lacked it. Additional histologic features occasionally observed included vascular thrombi, glomus bodies, and focal mucin deposition.

The clinical significance of vascular invasion in colorectal cancer

A number of investigators have examined the influence of vascular invasion by tumor in colon, rectal, and colorectal cancer. Some consider the presence of vascular invasion an unfavorable prognostic feature and propose treatment recommendations based on its presence. Vascular invasion has two distinct components: blood vessel invasion and lymphatic vessel invasion. The use of elastic tissue stains enhance both the detection of blood vessel invasion and its differentiation from lymphatic vessel invasion. Almost all series report an increased incidence of blood vessel invasion with increasing stage and grade. Although the influence of blood vessel invasion and lymphatic vessel invasion on patterns of failure is variable, both are associated with a decrease in survival; however, treatment recommendations based solely on the presence of blood vessel invasion or lymphatic vessel invasion should be made with caution.

Light microscopic findings

Routine elastic tissue stains reveal an increased concentration of dermal elastic tissue. The fully developed elastic fiber with abundant elastin is the primary target in PXE. The oxytalin and elaunin fibers in that papillary dermis, which are composed predominantly of microfibrils, are spared. The von Kossa stain for carbonate or phosphate is the best and most sensitive stain to detect early (or late) calcification. Early changes are not visible with H&E staining. In more advanced lesions, the foci of fully calcified and fragmented fibers take on a bluish hue with H&E staining methods. Advanced lesions show positive von Kossa staining around eccrine sweat glands and in the elastic lamina of larger cutaneous vessels. Alizarin red stains for calcium are positive and identify the cation as calcium. Alcian blue stains are positive for acid mucopolysaccharides, showing pooling throughout the dermis. Interpretation is often difficult. Periodic acid-Schiff stains show no abnormalities. Collagen appears normal on all stains. Arteries from surgical specimens may show calcification in the elastic laminae, confirming the systemic nature of PXE.