Hematoxylin and Eosin Tissue Stain in Mohs Micrographic Surgery: A Review

Abstract

The success of MMS depends on high-quality tissue sections. The staining process should be optimized to be reproducible and reliable. To readily identify and resolve poor staining quality, a firm understanding of the principles upon which tissue staining is based and its pitfalls is necessary.

On the horizon: Optical imaging for cutaneous squamous cell carcinoma

“…During the Mohs procedure, the tumor is mapped, inked, and the entire wound bed is histologically assessed while the patient waits. This process is repeated until clear margins are obtained …”

Commentary: Optimal Staining of Frozen Sections: A Conundrum

“…Some surgeons also prefer toluidine blue to H&E because of its ability to detect stroma around basal cell carcinoma easily, particularly when H&E stains can be difficult to interpret with tangentially sectioned adnexal structures . The majority of Mohs surgeons prefer H&E staining because of its excellent cellular detail and differentiating abilities for the multitude of malignancies that they see in a busy referral practice . Toluidine blue is also a mutagen in the Ames test, and as Gunson and colleagues indicate, many of the chemicals we use in the laboratory are potentially toxic, carcinogenic, and teratogenic, including the formalin (an aqueous solution of formaldehyde) used in Davis's protocol .…”

“…3 The majority of Mohs surgeons prefer H&E staining because of its excellent cellular detail and differentiating abilities for the multitude of malignancies that they see in a busy referral practice. 4 Toluidine blue is also a mutagen in the Ames test, and as Gunson and colleagues indicate, many of the chemicals we use in the laboratory are potentially toxic, carcinogenic, and teratogenic, including the formalin (an aqueous solution of formaldehyde) used in Davis's protocol. 1,5,6 Our standard autostainer protocol (which has a built-in fume hood) uses a glyoxal-based formalin substitute and a d-limonene-based xylene substitute, eliminating some of the more-problematic organic compounds.…”

Imaging White Blood Cells using a Snapshot Hyper-Spectral Imaging System

“…Since blood counts were first utilized as a means to diagnose diseases or radiation exposure, many fields of research have explored solutions to improve count accuracy as well as scalability. The first and easiest solution was to simply stain the cells in order to allow lab technicians to see the different blood cells more clearly [27]. Within the past two decades, automated systems have been developed to perform white blood cell counts but require blood samples to be taken from a patient and processed.…”

“…WBC nuclei and the cytoplasm surrounding them). Unstained RBCs and WBCs are very difficult to distinguish due to the fact that there is little contrast between cell structures without the use of a label or stain [27], [63]. If a stain cannot be applied to the cells in order to allow for the application of in vivo cell detection, then an alternative image capture method must be explored.…”