Formalin pigment artifact deposition in autopsy tissue: predisposing factors, patterns of distribution and methods for removal

Chatzopoulos, Kyriakos; Treeck, Benjamin Van; Venable, Elise R; Serla, Vishnu; Wirth, Trenton D.; Amirahmadi, Fazi; Peterson, Alissa; Lin, Peter T.

doi:10.1007/s12024-020-00240-5

Cited by 6 publications

(6 citation statements)

References 13 publications

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“…As formalin pigment deposition has been documented more often in decomposed remains, regardless of acid-base status, and it is unclear how helpful its identification would be in determining ketoacidosis in these cases. 29 Besides histologic features, other findings of this study also deserve mention. Hypothermia cases were older compared with the DKA cases, with the majority of hypothermia cases being older than 55 years.…”

Section: Discussionmentioning

confidence: 58%

“…The deposition of formalin pigment is an artifact of forensic histopathology, more commonly reported to occur in acidic environments. In the study by Chatzopoulos et al, 29 the basal compartment of the renal tubular epithelial cells were found to be among the tissues most affected by formalin pigment deposition. Interestingly, Zhou et al 5 described preferential localization of formalin pigment to the subnuclear vacuoles observed in cases of DKA or alcoholic ketoacidosis.…”

Section: Discussionmentioning

confidence: 95%

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Renal Tubular Epithelial Subnuclear Vacuolization in Hypothermia and Diabetic Ketoacidosis—A Retrospective Autopsy Study

Tekin

Righi²,

Quinton³

2021

Am J Forensic Med Pathol

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Subnuclear vacuolization of the renal tubular epithelium refers to discrete lipid vacuoles displacing the nuclei toward the lumen. This phenomenon has been associated with conditions sharing fatal ketoacidosis as a common denominator. This retrospective study aimed to investigate renal tubular epithelial subnuclear vacuolization and other postmortem examination findings in fatal hypothermia and diabetic ketoacidosis (DKA) cases.Fourteen cases with hypothermia and 19 cases with DKA were included. More cases with DKA had focal or diffuse subnuclear vacuolization compared with hypothermia cases (89% vs 43%; P = 0.007). In 6 cases with DKA, formalin pigment was detected within subnuclear vacuoles, whereas no case with hypothermia had formalin pigment deposition. Comparative analyses of hypothermia and DKA cases revealed further differences: Vitreous beta-hydroxybutyrate was higher in the DKA group compared with the hypothermia group (P = 0.044), whereas blood ethanol concentrations were higher in the latter (P = 0.008). Hypothermia cases were older compared with the DKA cases (P = 0.022).When all cases were included in the statistical analysis, cases with subnuclear vacuolization had higher vitreous beta-hydroxybutyrate and blood ethanol concentrations (P = 0.029 and 0.023, respectively). The findings corroborate the results of previous studies suggesting a link between subnuclear vacuolization and increased levels of ketoacidosis.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 95%

Renal Tubular Epithelial Subnuclear Vacuolization in Hypothermia and Diabetic Ketoacidosis—A Retrospective Autopsy Study

Tekin

Righi²,

Quinton³

2021

Am J Forensic Med Pathol

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“…Formalin pigment artifact deposition (FPAD) (30,35) The number of formalin pigment artifact deposition was counted following shown in previous observations. Cellular structure morphology (36,37) (Cell shrinkage or Distortion)…”

Section: Morphology Scoring Criteriamentioning

confidence: 99%

The Impact of Pre-analytical Quality Initiatives on Cholangiocarcinoma Diagnostics in Thailand

Koonmee

Sangkhamanon²,

Intarawichian³

et al. 2022

Front. Public Health

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Cholangiocarcinoma (CCA) is the most prevalent malignancy in Thailand, with unfortunate late diagnosis and frequent metastatic disease outcomes. An accurate tissue diagnosis is the first and most important step in the treatment of CCA. Tissue quality and preservation during the pre-analytical phase play major roles in the proper histological evaluation and potential biomarker testing. This study evaluated the impact of using the “Cholangiocarcinoma Screening and Care Program (CASCAP)” container, as an innovative tool to address pre-analytical challenges faced by pathology laboratories in Thailand. This is a comparison study examining the quality of CCA specimens using the CASCAP container vs. the conventional method, using hematoxylin and eosin (H&E) and immunohistochemistry (IHC). CCA tissue quality using the CASCAP container significantly reduced artifact deposition while improving the cellular structure and nuclear and cytoplasmic morphologies. The immunohistochemical expression of cytokeratin 19 (CK19), a prognostic marker in CCA, significantly improved in the CASCAP container group in comparison with the conventional method. This innovation is proven to significantly enhance the CCA tissue quality diagnostics and prognostic biomarker testing, hence improving overall cancer care, diagnosis, and treatment in Thailand.

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“…For the removal of the formalin pigment, unstained slides should be treated with alcoholic solutions containing picric acid, sodium hydroxide or ammonium hydroxide. 22) In the liver, aggregated bilirubin pigments may be confused with the specific DAB products (Figure 22). A trouble-shooting tip is as follows.…”

Section: D)mentioning

confidence: 99%

Pitfalls and Caveats in Applying Immunostaining to Histopathological Diagnosis

Tsutsumi¹

2021

Preprint

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Immunostaining is an essential histochemical technique for analyzing pathogenesis and making a histopathological diagnosis. The needs are prompted by technical development and refinement, commercial availability of a variety of antibodies, deepened knowledge of immunohistochemical markers, accelerated analysis of morphofunctional correlations, progress in molecular target therapy, and the expectation of advanced histopathological diagnosis. However, immunostaining does have various pitfalls and caveats. We should learn from mistakes and failures, as well as from false positivity and false negativity. The present review article describes various devices, technical hints and trouble-shooting guides to keep in mind in performing immunostaining.

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Formalin pigment artifact deposition in autopsy tissue: predisposing factors, patterns of distribution and methods for removal

Cited by 6 publications

References 13 publications

Renal Tubular Epithelial Subnuclear Vacuolization in Hypothermia and Diabetic Ketoacidosis—A Retrospective Autopsy Study

Renal Tubular Epithelial Subnuclear Vacuolization in Hypothermia and Diabetic Ketoacidosis—A Retrospective Autopsy Study

The Impact of Pre-analytical Quality Initiatives on Cholangiocarcinoma Diagnostics in Thailand

Pitfalls and Caveats in Applying Immunostaining to Histopathological Diagnosis

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