在十二指肠活检中,是否需要PAS污点来排除Whipple病?
Ahmed Bakhshwin1, Lauren Ashley Duckworth2, Paula Toro Castano2
1Department of Pathology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
International journal of surgical pathology
|June 20, 2024
概括
定期的酸-Schiff与扩散酶 (PAS/D) 染色对于诊断缺少泡性巨细胞的十二指肠活检中的惠普尔病是没有用处的. 当初始组织学显示没有特征性发现时,即使有临床怀疑,这种测试是不必要的.
科学领域:
- 胃肠病学 胃肠病学
- 传染性疾病 传染性疾病
- 组织病理学 组织病理学
背景情况:
- 威普尔病是由Tropheryma whipplei引起的,是一种罕见的细菌感染.
- 它主要影响小肠,导致吸收不良的腹.
- 诊断通常涉及使用PAS/D染色在小肠活检上的泡状巨中识别Tropheryma whipplei细菌.
研究的目的:
- 为了评估在十二指肠活检中PAS/D染色的诊断产量.
- 为了确定在H&E染色上没有可见的泡性巨细胞的情况下PAS/D染色的实用性.
- 评估PAS/D染色的必要性,以排除在十二指肠活检中怀普尔病.
主要方法:
- 从1993年到2021年用PAS/D染色的十二指肠活检的回顾性审查.
- 基于组织形态特征的活检的分类:不显著的,非特异性的变化,或泡状的质细胞聚合物.
- PAS/D结果与随访临床和微生物学数据的相关性.
主要成果:
- 在193个PAS/D染色的十二指肠活检中,没有一个缺乏H&E上的泡状囊细胞是PAS阳性的.
- 13个活检显示PAS阳性囊细胞;9个被证实是Tropheryma whipplei.
- 在临床要求PAS/D的活检中 (n=124),只有2.4%的结果呈阳性,所有结果都证实了惠普尔病.
结论:
- 不需要PAS/D染色来排除缺少泡性巨细胞聚合物的十二指肠活检中的惠普尔病.
- 当初的H&E组织学不显著时,该测试提供了最小的附加值.
- 没有特征性组织学发现的临床怀疑病例通常会导致诊断测试的负面结果.
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