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[Form variants of globular hyaline microthrombi. Light microscopy, immunohistochemical and scanning and transmission
Abstract:
Globular hyaline microthrombi are characterized by their diameter (2-30 micron), globular form, and positive PAS and PTAH reaction. They are a morphologic indicator of disturbed microcirculation and hemostasis, such as that occurring in shock. In two of our cases, we observed large globular hyaline microthrombi, some with central webbed degradation progressing to the formation of closed or open hollow globules. The electron microscopic findings were similar to those observed by other investigators in typical shock bodies. On the basis of the morphologic findings, the authors conclude that degradation phenomena start at the center of globular hyaline microthrombi and can progress to the surface where accelerated fibrinolysis is possible. The cellular elements that other investigators have described as a possible condensation center for fibrin precipitate proved to be structurally intact cells that are apparently located in niches of open hollow globules or in the center of circular hyaline microthrombi. The diagnostic relevance, vitality, and temporal classification are discussed.
Insights
Globular hyaline microthrombi, indicators of shock, show central degradation and hollow formation. This suggests fibrinolysis occurs at the microthrombi surface, with intact cells found within.
Area of Science:
- Pathology
- Microcirculation Research
- Hemostasis Studies
Context:
- Globular hyaline microthrombi (GHMs) are morphologic indicators of disturbed microcirculation and hemostasis, often seen in shock.
- These microthrombi are characterized by specific size (2-30 microns), globular shape, and positive periodic acid-Schiff (PAS) and phosphotungstic acid-hematoxylin (PTAH) staining.
- Previous research has noted cellular elements within microthrombi, but their role and structure were debated.
Purpose:
- To investigate the degradation process and structural characteristics of large globular hyaline microthrombi.
- To clarify the role and morphology of cellular elements within microthrombi using electron microscopy.
- To discuss the diagnostic relevance, vitality, and temporal classification of these microthrombi.
Summary:
- Observed large GHMs with central webbed degradation, leading to hollow globule formation.
- Electron microscopy revealed findings consistent with typical shock bodies, showing intact cellular elements within niches or centers of microthrombi.
- Concluded that degradation initiates centrally and progresses outward, potentially facilitating fibrinolysis at the surface.
Impact:
- Provides detailed ultrastructural insights into microthrombi degradation in shock.
- Clarifies the nature of cellular components within microthrombi, refuting prior interpretations of condensation centers.
- Enhances understanding of microthrombi formation, degradation, and potential diagnostic utility in clinical settings.