Presence Of Periodic acid-Schiff Research Articles

A new genetic variant of hereditary apolipoprotein A-I amyloidosis: a case-report followed by discussion of diagnostic challenges and therapeutic options

BackgroundHereditary amyloidosis refers to a wide spectrum of rare diseases with different causative mutations in the genes of various proteins including transthyretin, apolipoprotein AI and AII, gelsolin, lysozyme, cystatin C, fibrinogen Aα-chain, β2-microglobulin, apolipoprotein CII and CIII.Case presentationAmong hereditary amyloidosis subtypes, we describe here a specific case of Apolipoprotein AI amyloidosis (AApoAI), where the diagnosis began from an almost asymptomatic hepatomegaly followed by the development of primary hypogonadism. Baseline laboratory tests showed increased liver enzymes, while imaging tests revealed a suspected infiltrative liver disease. Patient underwent into liver biopsy and histological examination detected the presence of periodic acid-Schiff (−) and Congo-red (+) amorphous eosinophilic material within normal liver tissue. In the typing of amyloid by immunoelectron microscopy, the liver appeared heavily infiltrated by anti-apoAI (+) amyloid fibrils. Gene sequencing and mutational analysis revealed a single-base mutation at position c.251 T > C resulting in an amino acid substitution from leucine to proline in the mature ApoAI protein. This amino acid change led to lower cleavage and ApoAI deposition into the involved organs. Few years later, our patient remaining without treatment, came with symptoms consistent with primary hypogonadism but testicular involvement with ApoAI deposits could not be proven since the patient refused testicular biopsy. Based on this case, we recap the diagnostic challenges, the clinical manifestations, and the potential treatment options for this indolent hereditary amyloidosis subtype.ConclusionsThis case-report enlarges the clinical picture of ApoAI-driven disease and its complex genetic background and in parallel suggests for a more systematic approach in any case with strong suspicion of hereditary amyloidosis.

A Rare Occurrence of Pulmonary Alveolar Proteinosis after Lung Transplantation

We present a case of pulmonary alveolar proteinosis (PAP) initially diagnosed 28 months after left single-lung transplantation for idiopathic pulmonary fibrosis. The diagnosis was based upon the presence of periodic acid-Schiff (PAS)-positive and surfactant immunostain-positive acellular lipoproteinaceous material within alveoli seen on transbronchial biopsy as well as in bronchoalveolar lavage fluid. The patient eventually also displayed a characteristic "crazy paving" pattern on radiographic imaging. Granulocyte macrophage-colony stimulating factor antibodies were negative, consistent with secondary PAP. PAP is a rare interstitial lung disease with only a few reported cases occurring after lung transplantation. The etiology is thought to be related to a defect in macrophage function caused by immunosuppression. Reduced immunosuppression has been associated with stabilization, but not reversal, of the condition in the case reported here. PAP is an exceptionally rare cause of dyspnea and radiographic infiltrates after lung transplantation and may be related to toxicity of immune-suppressive medications.

Treated Whipple Disease With Erythema Nodosum Leprosum–Like Lesions

Pathologically, Whipple disease (WD) is characterized by the accumulation of myriad macrophages parasitized by Tropheryma whipplei (TW) bacilli denoted by periodic acid-Schiff (PAS) positivity. These PAS+ macrophages are typically found in the duodenum associated with lymphangiectasia. Recently, we reported the presence of PAS+ macrophages and free TW in erythema nodosum leprosum (ENL)-like lesions and normal skin in a patient with WD who suffered from the immune reconstitution inflammatory syndrome (IRIS). We extend that report by describing the clinical and pathologic findings over 5 years of follow-up. First, the IRIS gradually diminished and abated over 18-month time. Second, at no point did WD recur, and all duodenal and skin biopsies tested by polymerase chain reaction were negative for TW DNA. Third, PAS+ macrophages were identified in 26 of 27 skin biopsies (96%) and decreased along with free TW over time. Fourth, ENL-like lesions had significantly greater numbers of PAS+ macrophages than normal skin. Moreover, normal abdominal skin (region of ENL-like lesions) had greater PAS+ counts than arm skin (not a site of IRIS). Last, lymphangiectases, a histologic sign of lymphostasis, was found in all skin biopsies. Overall, these findings implicate bacillary burden as a factor in the immune tolerance to live TW in active WD and the initiation of ENL-like nodules against dead/nonreplicative TW in treated WD. In addition, poor lymphatic drainage is likely responsible for the gradual clearance of TW from the skin and the impaired delayed-type hypersensitivity reaction (absence of activated macrophages) against TW found in WD, presumptively due to reduced/absent immune cell trafficking necessary for lymphocyte-macrophage interactions and induction of adaptive immunity.

Acinic Cell Carcinoma: An Unusual Cause of Bronchial Obstruction in a Child

Primary acinic cell carcinomas of the lung are rare tumors, usually presenting in adulthood as parenchymal or endobronchial masses. These lesions are generally recognized by their morphological pattern and the presence of periodic acid-Schiff (PAS)-positive, diastase-resistant cytoplasmic granules. We describe a case of pri-mary acinic cell carcinoma of the bronchus in a 4-year-old girl. The tumor has the typical acinar structures:weakly PAS-positive, diastase-resistant cytoplasmic granules and intra-acinar laminated calcific structures. A lobectomy was done with a clear bronchial resection margin. The child is well with no evidence of recurrence or metastasis 2 years postresection.

Testicular morphological changes during the seasonal reproductive cycle in the bullfrog Rana catesbeiana

Spermatogenesis and steroidogenesis undergo seasonal variations during the reproductive cycle in amphibians. Testicular morphological and morphometric seasonal variations as well as interstitial lipidic inclusions and intralobular glycoconjugates were evaluated during seasonal cycle of Rana catesbeiana. Testes of frogs collected during the annual seasons were weighed for calculation of GSI (Gonadosomatic index). Seminiferous lobule diameters (DSL) and volume densities of seminiferous lobules (VvSL), excretory ducts (VvED), and interstitial tissue (VvIT) were analyzed. Semithin sections were submitted to Periodic Acid-Schiff (PAS) and Alcian Blue (AB) methods for detection of glycoconjugates, while lipidic inclusions were detected by Sudan Black B. GSI showed no significant variations during the year. Since VvED and VvIT increased significantly during summer and were inversely proportional to VvSL, a compensatory effect between the testicular compartments may be related to the maintenance of GSI. During autumn/winter, larger lobular diameters were observed in comparison to spring/summer when spermiogenesis and spermiation were commonly observed. The increased VvIT and the numerous lipidic inclusions in the interstitial cells during summer suggest a relationship between spermiogenesis and steroidogenesis. Besides the structural stability variations occurring in the IT and SL, a possible paracrine interaction between ED and IT should be also involved in the IT development during summer. The presence of PAS and AB-positive globular structures were observed in the seminiferous lobules and excretory ducts. These structures containing acid glycoconjugates appear to be Sertoli cell apical portions, which are accumulated in the lumen of the seminiferous lobules mainly during spermiation.

Effects of brief postponement of the preovulatory LH surge on ovulation rates and embryo formation in eCG/prostaglandin-treated heifers

The aim of this study was to investigate whether prolongation of the period of preovulatory follicular development after superovulation reduces heterogeneity of oocytes of stimulated follicles with respect to the potential to mature, to ovulate, to be fertilized and to develop into embryos. Heifers were treated with eCG on Day 10 and prostaglandin (PG) 48 h later. At the time of eCG administration some of the heifers received a norgestomet implant (N) to suppress the LH surge. After 96 to 104 h, N was removed and an LH surge was induced with GnRH (G) (N/G); the other animals served as controls. Matured oocytes (Experiment A: n=9, 139 [N/G] and 11, 125 [Conrol] heifers, oocytes), zygotes and oviducts (Experiment B: n=8, 44 [N/G] and 9, 72 [Control] heifers, zygotes) and embryos (Experiment C: n=11, 205 [N/G] and 11, 165 [Control] heifers, embryos) were collected at 22 to 26 h, 38 to 52 h and 7 days after the LH surge, respectively. Hatched blastocyst formation of matured oocytes (Experiment A) was analyzed after 11 days of IVC after IVF. In vivo fertilization rate of zygotes, the presence of periodic acid-Schiff (PAS) positive granules in the oviduct (Experiment B) and stage of development of embryos (Experiment C) were analyzed stereomicroscopically. The mean interval between PG and the LH surge was 53.8±3 (SD) (N/G) vs. 42.4±4 h (Control). The maximum peripheral estradiol-17β concentration (529±36 [SEM] [N/G] vs. 403±17 pmol/L [Control]) and the response to superovulation (25.4±2 [N/G] vs. 18.7±2 [Control]) were higher in N/G than in Control heifers. Hatched blastocyst formation rate (37.4 [N/G] vs. 33.6% [Control]), in vivo fertilization rate (69.0±14 [N/G] vs. 73.0±10% [Control]) and the yield of total embryos (3.8±1 [N/G] vs. 5.6±2 [Control]) did not differ between groups. The percentage of heifers with abundant PAS-positive granules in the distal ampulla (0 [N/G] vs. 31% [Control]) was reduced after N/G treatment. Prolongation of the period of preovulatory follicular development increased the number of mature follicles and ovulations but did not result in higher embryo yield, possibly because of an impaired oviductal environment.

In vitro capacitation of ejaculated spermatozoa and in vitro fertilization in dairy goats

The aim of this study was to investigate whether prolongation of the period of preovulatory follicular development after superovulation reduces heterogeneity of oocytes of stimulated follicles with respect to the potential to mature, to ovulate, to be fertilized and to develop into embryos. Heifers were treated with eCG on Day 10 and prostaglandin (PG) 48 h later. At the time of eCG administration some of the heifers received a norgestomet implant (N) to suppress the LH surge. After 96 to 104 h, N was removed and an LH surge was induced with GnRH (G) (N/G); the other animals served as controls. Matured oocytes (Experiment A: n=9, 139 [N/G] and 11, 125 [Conrol] heifers, oocytes), zygotes and oviducts (Experiment B: n=8, 44 [N/G] and 9, 72 [Control] heifers, zygotes) and embryos (Experiment C: n=11, 205 [N/G] and 11, 165 [Control] heifers, embryos) were collected at 22 to 26 h, 38 to 52 h and 7 days after the LH surge, respectively. Hatched blastocyst formation of matured oocytes (Experiment A) was analyzed after 11 days of IVC after IVF. In vivo fertilization rate of zygotes, the presence of periodic acid-Schiff (PAS) positive granules in the oviduct (Experiment B) and stage of development of embryos (Experiment C) were analyzed stereomicroscopically. The mean interval between PG and the LH surge was 53.8±3 (SD) (N/G) vs. 42.4±4 h (Control). The maximum peripheral estradiol-17β concentration (529±36 [SEM] [N/G] vs. 403±17 pmol/L [Control]) and the response to superovulation (25.4±2 [N/G] vs. 18.7±2 [Control]) were higher in N/G than in Control heifers. Hatched blastocyst formation rate (37.4 [N/G] vs. 33.6% [Control]), in vivo fertilization rate (69.0±14 [N/G] vs. 73.0±10% [Control]) and the yield of total embryos (3.8±1 [N/G] vs. 5.6±2 [Control]) did not differ between groups. The percentage of heifers with abundant PAS-positive granules in the distal ampulla (0 [N/G] vs. 31% [Control]) was reduced after N/G treatment. Prolongation of the period of preovulatory follicular development increased the number of mature follicles and ovulations but did not result in higher embryo yield, possibly because of an impaired oviductal environment.

Complex carbohydrates at the ocular surface of the mouse: An ultrastructural and cytochemical analysis

Scanning electron microscopy (SEM) of mouse cornea and conjunctiva fixed with picric acid-paraformaldehyde-glutaraldehyde (PA-P-G) mixture revealed a thin layer of amorphous material covering the microvilli of the corneal surface cells. At the transmission electron microscopic (TEM) level, this layer of material stained positively with dialyzed iron, alcian blue and cationized ferritin, all of which are markers for anionic sulfate or carboxyl groups. The croneal surface was negative for high iron diamine, which specifically stains sulfate groups. These results indicate that the murine ocular surface is rich in carboxyl groups. Treatment with neuraminidase prior to fixation significantly reduced ( P < 0·005) cationic ferritin binding, suggesting that most of the carboxyl groups at the ocular surface are associated with sialic acid residues. The corneal surface also stained positively at the TEM level when a periodic acid-thiocarbohydrazide-silver protein sequence (PA-T-SP) was applied. This result indicated the presence of periodic acid-Schiff (PAS)-positive glycoprotein and glycolipid at the ocular surface.

Cytological Changes of the Conjunctiva in Immunoglobulin-producing Dyscrasias

The conjunctivae of 15 patients with confirmed immunoglobulin-producing dyscrasias were examined by cytological techniques. Of 13 patients with no gross ocular symptoms, 10 showed distinct epithelial cell changes and/or the presence of periodic acidSchiff (PAS)-positive cells. Two other patients with gross abnormalities of the conjunctiva revealed the presence of PAS-positive cells, Dutcher bodies, and lymphocytoid-plasma cells. Lymphomatous deposition may develop in the conjunctiva and present as conjunctival nodules or as a diffuse infiltration. It is concluded that the cytological preparation of conjunctival smears may serve as a sensitive indicator of systemic immunoglobulin-producing dyscrasias.

Ultrastructure of lineus ruber (rhyncocoela) epidermis

Recent evidence indicates that nemertean epidermis is capable of absorbing certain organic solutes from sea water via mediated transport mechanisms, as well as secreting mucoid substances. Morphological studies suggest that these functions may be restricted to distinct epidermal cell populations. Mucous secretion at the free surface of the epidermis is the result of synthesis and release activities of cells in both the epidermis and dermis (cutis). Secretion of dermal origin passes through the epidermis to the worm's exterior in slender cytoplasmic processes ( canaux d'evacuation) in the form of membrane bound vesicles. A single gland cell type, located entirely within the epidermis, releases externally a granular product histochemically identified as largely protein plus some amount of carbohydrate with low periodic acid-Schiff's reactivity. The close juxtaposition of granular endoplasmic reticulum and Golgi apparati to the secretory material is consistent with the composition of this secretory product. Interstitial cells possess microvilli projecting from their apical surface, in addition to cilia. The outer surface of the plasmalemma covering these ciliary projections is unadorned, but microvilli possess a fuzzy coat. At the peripheral ends of the microvilli, the coat is filamentous, while at their base the coat consists of foliate structures. Cationic colloidal iron binding suggest that the filamentous portion of the fuzzy coat contains the greatest proportion of the acidic surface charge. The presence of periodic acid-Schiff's positive material in this region suggests that the fuzzy coat also contains carbohydrate. Lateral boundaries of the interstitial cell lacks obvious junctional specializations; however, the apical 150 nm intracellular space narrows to 40 nm and continues in a tortuous interdigitating path to the base of the adjacent interstitial cells. Where the apex of these cells is broad, the interdigitations are shallow, but the basal half of the interstitial cells have deep complex infoldings. Cytoplasmic organelles other than the nucleus, mitochondria and some granular endoplasmic reticulum, are restricted to the apical half of the cytoplasm. The presence of closely apposed Golgi complexes and smooth endoplasmic reticulum, multivesicular bodies, lysosome-like dense vesicles and coated vesicles suggests that these cells may play a role in intracellular digestion of phagocytized paniculate matter from the external environment. The amplification of the interstitial cell's free surface suggests that these cells are primarily responsible for mediated solute transport across the epidermis.