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• W2313392211 abstract "To the Editor.—We read with interest the article by Sigdel, Gemind, and Tomashefski1 describing the use of a modified Russell Movat pentachrome stain for distinguishing microcrystalline cellulose (MCC) from other particles found in lung tissue specimens, which was published in the February 2011 edition of the Archives.The authors report consistent yellow-staining of MCC, which was distinctly different from talc and calcium oxalate. In addition, the elastin stain component is valuable because it helps pathologists determine whether the MCC is intravascular, which is an important feature in cases of intravenous drug use involving crushed oral medications as the source of MCC.A histochemical approach to the identification of colorless birefringent particles in pathology specimens has its limitations, and we concur with the authors that the histochemical stains used in the study are not specific for the identification of MCC. The size range of crystals reported for MCC (20–200 µm) is large enough for identification using infrared spectroscopy, and indeed, this was performed in one of the cases described.2 This technique can be used to identify MCC, talc, and calcium oxalate and can detect the presence of protein in composite crystals.The benefit of a histochemical characterization of birefringent crystals, such as MCC, is that it is widely available, relatively quick, and inexpensive compared with infrared spectroscopy. For these reasons, we support the authors' histochemical approach and would like to add to their discussion some observations reflecting our experience at the Armed Forces Institute of Pathology and the work of the late Frank B. Johnson, MD. We have validated all the histochemical stain results discussed with infrared spectroscopy and additional analyses.The stain we find most helpful for the detection of cellulose (both MCC and other forms) is the Sirius red stain for amyloid (Figure).3,4 The connective tissue version of this stain has a high-red background, which makes interpretation more difficult. Neither talc nor calcium oxalate are stained with Sirius red stain for amyloid. We essentially agree that there is no readily available histochemical stain for talc and other silicates in tissue. Although oil red O (with a 72-hour incubation) will stain talc crystals,4 in our experience, that staining tends to be weak. Calcium oxalate will stain with Von Kossa, but not with Alizarin red (pH 4.1–4.3).3 Most calcium salts and salts containing other divalent metal cations, such as zinc, will stain with Alizarin red, and therefore, the combination of Von Kossa and Alizarin red stains is somewhat specific for calcium oxalate and is helpful for distinguishing calcium oxalate from other calcium salts.3,5 These histochemical staining results are summarized in the Table.We agree that Grocott methenamine silver, Congo red, and periodic acid–Schiff usually stain cellulose; however, modified cellulose, such as cellulose acetate may not stain with periodic acid–Schiff.4 We believe that the information we present is pertinent to the authors' work and may help pathologists to distinguish between birefringent, colorless particles in lung sections by histochemical means, should confirmatory analysis be unavailable." @default.
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• W2313392211 date "2011-08-01" @default.
• W2313392211 modified "2023-09-27" @default.
• W2313392211 title "Histochemical Identification of Microcrystalline Cellulose, Calcium Oxalate, and Talc in Tissue Sections" @default.
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• W2313392211 doi "https://doi.org/10.5858/2011-0134-ler" @default.
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