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Dermpath > Stains > Flashcards

Stains Flashcards

1
Q

Verhoeff-van Gieson (VVG)

A

targets elastic fibers, collagen, and connective tissue; most commonly used collagen/elastin stain; distinguishes between various perforating diseases

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2
Q

Masson trichrome

A

targets collagen fibers, smooth muscle; stains the inclusions (red) in infantile digital fibromatosis

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3
Q

Movat’s pentachrome

A

targets elastic fibers, collagen, smooth muscle, fibrin; stains the inclusions (red) in infantile digital fibromatosis

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4
Q

Phosphotungistic acid hematoxylin (PTAH)

A

targets collagen, smooth muscle, fibrin; stains the inclusions (blue) in infantile digital fibromatosis

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5
Q

Oil-red-O

A

targets lipids; stains red

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6
Q

Sudan black B

A

targets lipids; stains black

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7
Q

Scarlet red

A

targets lipids; stains red-brown

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8
Q

Perls / Prussian blue

A

targets hemosiderin / iron; stains blue; most commonly used in conjunction with Fontana-Masson to distinguish between melanin (black on FM) and hemosiderin pigment. [Does not stain iron in intact RBCs so not a good choice for talon noir.]

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9
Q

Von Kossa

A

targets calcium; stains brown-black; most commonly used “calcium stain,” but actually stains the anions rather than calcium itself → less calcium-specific than Alizarin red

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10
Q

Alizarin red

A

targets calcium; stains red-orange; more specific for calcium than Von Kossa

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11
Q

Alcian blue pH 0.5

A

Targets Sulfated acid MPS (heparin, chondroitin, dermatan sulfates); stains blue; most mucin in normal skin is sulfated acid MPS. [Hyaluronic acid is nonsulfated and does not stain.]

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12
Q

Alcian blue pH 2.5

A

Targets Nonsulfated acid MPS (hyaluronic acid); stains blue; in diseases w/ incr. mucin (lupus, GA, follicular mucinosis), most mucin is hyaluronic acid. [HIGH-luronic acid stains with Alcian Blue at HIGH pH.] Note: sulfated acid MPS stain with Alcian blue at both pH’s

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13
Q

Colloidal iron

A

targets Acid MPS (sulfated and nonsulfated); stains blue; Hyaluronidase may be added to distinguish between HA and other mucin types

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14
Q

Mucicarmine

A

targets epithelial mucin; stains pink-red; used primarily for sialomucin, adenocarcinoma, Paget’s disease, and Cryptococcus (capsule). Not good for dermal mucins.

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15
Q

Periodic acid Schiff (PAS)

A

targets neutral MPS (BM), fungi, glycogen; stains pink; Primarily used to highlight BMZ material. Also positive in clear cell acanthoma and trichilemmoma (glycogen). Does not stain acid MPS (HA and other mucins).

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16
Q

Toluidine blue

A

Most commonly used as mast cell stain – targets mast cell granules. Also targets Acid MPS but rarely used for mucin. Stains red-purple.

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17
Q

Congo red

A

targets amyloid; stains pink-red w/apple-green birefringence on polarization; Most commonly used amyloid stain. In real world, not always reliable for macular/lichen amyloid

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18
Q

Thioflavin T

A

targets amyloid (on fluorescence microscopy); stains yellow-green;

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19
Q

Cresyl violet

A

targets amyloid; stains red; Of note, cotton dyes (Pagoda red, Dylon) also stain amyloid

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20
Q

Stains that target Collagen / Elastic fibers

A

VVG

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21
Q

Stains that target Smooth Muscle

A

Masson trichrome; Movat’s pentachrome; PTAH

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22
Q

Stains that target Lipids

A

Oil-red-O; Sudan black B; Scarlet Red (must be performed on frozen tissue)

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23
Q

Stains that target Iron / Hemosiderin

A

Perls / Prussian Blue

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24
Q

Stains that target Calcium

A

Von Kossa; Alizarin Red (more specific)

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25
Q

Stains that target Mucin

A

Alcian Blue (pH 0.5 and 2.5); Colloidal iron; Mucicarmine; PAS; Toluidine Blue

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26
Q

Stains that target Amyloid

A

Congo Red; Thioflavin T; Cresyl Violet

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27
Q

Stains that target Melanin

A

Fontana-Masson; silver nitrate

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28
Q

Stains that target Mast Cells

A

Leder (chloracetate esterase); Tryptase; Giemsa; Toluidine Blue; CD117 / c-KIT (immuno)

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29
Q

Stains that target Microbes

A

PAS; PAS-D; GMS; Gram stain; Fite stain; Ziehl-Nieelsen; Auramine-Rhodamine; Warthin-Starry; Steiner; Giemsa

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30
Q

Stains that target nerve axons

A

Bodian

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31
Q

Stains that target DNA / RNA

A

methyl green pyronin (RNA / DNA); Feulgen (DNA)

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32
Q

Silver Stains

A

Fontana-Masson; silver nitrate; GMS; Warthin-Starry; Steiner

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33
Q

Fontana-Masson

A

targets melanin; stains black; most commonly used in conjunction w/Perls stain to distinguish hemosiderin vs melanin. Vitiligo has complete loss of epidermal staining.

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34
Q

Silver nitrate

A

targets melanin; stains black

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35
Q

Leder (chloracetate esterase)

A

targets mast cell cytoplasm and granules; stains red; effective even in degranulated skin. [Note: only Leder and c-KIT / CD117 are reliable in degranulated skin.]

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36
Q

Tryptase

A

targets mast cell granules; stains brown or red

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37
Q

Giemsa

A

targets mast cell granules; stains purple-blue

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38
Q

Periodic acid Schiff w/diastase (PAS-D)

A

targets fungi, neutral MPS (BM); stains pink; helpful for BMZ thickening (lupus, DM), and thickened vessel walls (porphyria)

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39
Q

Gomori methenamine silver (GMS)

A

targets fungi; stains fungal wall black; Green background (counterstain)

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40
Q

Gram stain (Brown-Hopps and Brown-Brenn)

A

targets bacteria; stains red or blue; Gram(−) bacteria not well-visualized in skin biopsies

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41
Q

Fite

A

targets m. leprae, nocardia, atypical mycobacteria; stains red; Stain of choice for “partially acid-fast” organisms (M.leprae, Nocardia), and atypical mycobacteria as these are over-decolorized by Ziehl-Neelsen. Peanut oil and gentle decolorization process allows for better color preservation than in ZN.

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42
Q

Ziehl-Neelsen

A

targets AFB; stains red; most commonly used AFB stain but less effective for M. leprae and atypical AFB (use Fite instead)

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43
Q

Auramine-Rhodamine

A

targets AFB; stains yellow on fluorescence microscopy

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44
Q

Warthin-Starry

A

targets spirochetes; stains black; also stains organisms in bacillary angiomatosis, granuloma inguinale (Donovan bodies), rhinoscleroma. Disadvantage: nonspecific (“dirty”) staining pattern – has been largely replaced by spirochete immunostain.

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45
Q

Steiner

A

targets spirochetes; stains black; same staining pattern as Warthin-Starry

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46
Q

Stains that target Spirochetes

A

Warthin-Starry; Steiner

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47
Q

Stains that target AFB

A

Auramine-Rhodamine; Ziehl-Neelsen; Fite

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48
Q

Bodian

A

targets nerve axons (filaments); stains black; Positive in neurofibromas, traumatic neuromas, and PEN; negative in schwannoma (lacks axons)

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49
Q

Methyl green pyronin

A

Targets RNA and DNA; stains pink or blue-green; requires frozen tissue

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50
Q

Feulgen

A

targets DNA; stains red-purple

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51
Q

Immunostains for B Cells

A

CD20; PAX-5; CD79a; CD19; CD45; IgG light chains

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52
Q

Immunostains for dermal dendritic cells

A

Factor XIIIa (papillary dermis–wound healing, phagocytosis; antigen presentation); CD34 (reticular dermis)

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53
Q

Notable CD34+ tumors

A

DFSP, spindle cell / pleomorphic lipoma, Kaposi sarcoma (endothelial), neurofibroma (diffuse NF can be misdiagnosed as DFSP!), fibrofolliculoma / trichodiscoma, trichilemmoma / DTL (epithelial), solitary fibrous tumor, leukemia cutis, Kaposiform hemangioendothelioma (endothelial), epithelioid hemangioendothelioma (endothelial), sclerotic fibroma, pleomorphic fibroma, superficial angiomyxoma, superficial acral fibromyxoma (and cellular digital fibroma), cellular angiofibroma of vulva/genital region, ischemic fasciitis. LOST in scleroderma / morphea

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54
Q

Immunostains for endothelial cells

A

CD31; CD34 (less specific); ERG; FLI-1 nuclear stain; Ulex europaeus agglutinin 1; factor VIII ag; vimentin

55
Q

Immunostains for fibroblasts

A

Vimentin; Procollagen I (also expressed in DFSP, AFX, NSF, scleromyxedema)

56
Q

Immunostains for histiocytes / macrophages

A

CD68; CD163 (more specific); lysozyme, α1 antitrypsin, HAM-56+ (esp. JXG and xanthogranulomas), CD11b; CD14b; factor XIIIa; MAC-387 (true macrophages); vimentin

57
Q

Immunostains for keratinocytes

A

Cytokeratin; p63

58
Q

Immunostains for Langerhans cells

A

S100; CD1a; Langerin (CD207; stains Birbeck granules and is extremely specific); peanut agglutinin; vimentin

59
Q

Immunostains for Lymphatics

A

D2-40 (podoplanin); LYVE-1 (negative in blood vessel endothelium); vimentin

60
Q

Immunostains for Mast Cells

A

c-KIT (CD117); tryptase

61
Q

Immunostains for Melanocytes

A

S-100; HMB-45; MART-1 / Melan-A; MITF nuclear stain; p16 (positive in Spitz); p75/NGFR; SOX-10 nuclear stain; tyrosinase; vimentin

62
Q

Immunostains for Merkel Cells

A

CK20 (perinuclear dot), neurofilament (esp. helpful for CK20-neg MCC); NSE

63
Q

Immunostains for Myofibroblasts

A

SMA (“tram-track” pattern); note that myofibroblasts do not express desmin (vs true smooth muscle cells)

64
Q

Immunostains for NK Cells

A

CD56 (most commonly used); CD57; granzyme A/B; TIA-1

65
Q

Immunostains for Nerve Axons

A

neurofilament; NSE

66
Q

Immunostains for Schwann Cells

A

S100; GFAP; MBP

67
Q

Immunostains for Neutrophils

A

MPO

68
Q

Immunostains for Plasma Cells

A

CD138; CD79a; CD45

69
Q

Immunostains for Plasmacytoid Dendritic Cells

A

CD123 (useful for lupus, GA)

70
Q

Immunostains for Sebaceous Glands

A

EMA; adipophilin; androgen receptor; cytokeratin

71
Q

Immunostains for Smooth Muscle

A

SMA (diffuse pattern); Desmin

72
Q

Immunostains for Sweat Glands

A

CEA; EMA; GCDFP-15 (apocrine > eccrine); cytokeratin

73
Q

Immunostains for T Cells

A

CD2; CD3 (most specific cell marker); CD4; CD5; CD7; CD8; CD45 (LCA); CD45Ra (naïve T-cells); CD45Ro (memory T-cells; positive in MF); FOX-P3 (Treg cells)

74
Q

CD20

A

most commonly used B-cell marker; absent in plasma cells; target for rituximab

75
Q

PAX-5

A

targets B-cells; more sensitive and specific than CD20

76
Q

CD79a

A

targets B-cells and plasma cells

77
Q

CD19

A

targets B-cells; useful in monitoring response to rituximab because CD20-negative B-cells may arise following therapy

78
Q

CD45

A

targets B-cells; LCA; expressed on all hematopoietic cells except platelets and RBCs

79
Q

IgG light chains

A

targets B-cells

80
Q

Factor XIIIa

A

targets dermal dendritic cells in papillary dermis, including histiocytes / macrophages–cells involved in phagocytosis, antigen presentation, and wound healing; abundant in dermatofibroma

81
Q

CD34

A

targets dermal dendritic cells in reticular dermis and endothelial cells

82
Q

CD31

A

targets endothelial cells; previous gold standard but has been supplanted by newer stains

83
Q

ERG

A

newer stain targeting endothelial cells; very sensitive and specific

84
Q

FLI-1

A

nuclear stain for endothelial cells; better than CD31 and CD34 but not as good as ERG

85
Q

Ulex europaeus agglutinin 1

A

targets endothelial cells

86
Q

Factor VIII Ag

A

targets endothelial cells

87
Q

Vimentin

A

targets: endothelial cells; fibroblasts; histiocytes / macrophages; Langerhans cells; lymphatics; melanocytes

88
Q

Procollagen I

A

targets fibroblasts; also expressed in DFSP, AFX, NSF, and scleromyxedema

89
Q

CD68

A

targets histiocytes / macrophages

90
Q

CD163

A

targets histiocytes / macrophages (more specific than CD68)

91
Q

Lysozyme

A

targets histiocytes / macrophages

92
Q

α1 antitrypsin

A

targets histiocytes / macrophages

93
Q

HAM-56

A

targets histiocytes / macrophages; esp. good for JXG and related xanthogranulomas

94
Q

CD11b

A

targets histiocytes / macrophages

95
Q

CD14b

A

targets histiocytes / macrophages

96
Q

MAC-387

A

targets true macrophages

97
Q

Cytokeratin

A

targets keratinocytes

98
Q

p63

A

targets keratinocytes

99
Q

S-100

A

targets: Langerhans cells; melanocytes; Schwann cells

100
Q

CD1a

A

targets Langerhans cells

101
Q

Langerin

A

aka CD207; stains Birbeck granules–extremely specific for Langerhans cells

102
Q

CD207

A

aka Langerin; stains Birbeck granules–extremely specific for Langerhans cells

103
Q

peanut agglutinin

A

targets Langerhans cells

104
Q

D2-40

A

aka podoplanin; targets lymphatics

105
Q

podoplanin

A

aka D2-40; targets lymphatics

106
Q

LYVE-1

A

targets lymphatics; negative in blood vessel endothelium

107
Q

c-KIT

A

aka CD117; targets mast cells

108
Q

CD117

A

aka c-KIT; targets mast cells

109
Q

tryptase

A

targets mast cells

110
Q

HMB-45

A

aka gp100; targets melanocytes; less sensitive but more specific than S100; typically negative in desmoplastic melanoma

111
Q

gp100

A

aka HMB-45; targets melanocytes; less sensitive but more specific than S100; typically negative in desmoplastic melanoma

112
Q

MART-1 / Melan-A

A

targets melanocytes; less sensitive but more specific than S100; typically negative in desmoplastic melanoma

113
Q

MITF

A

nuclear stain for melanocytes; positive in only 30% of desmoplastic melanomas

114
Q

p16

A

targets melanocytes; positive in Spitz nevi; often lost or diminished in spitzoid melanoma and ASTs

115
Q

p17

A

aka NGFR; targets melanocytes; useful in desmoplastic melanoma, esp when S100 negative

116
Q

NGFR

A

aka p75; targets melanocytes; useful in desmoplastic melanoma, esp when S100 negative

117
Q

SOX-10

A

nuclear stain for melanocytes; helpful in distinguishing desmoplastic melanoma from scar tissue

118
Q

tyrosinase

A

targets melanocytes

119
Q

CK20

A

targets Merkel cells; perinuclear dot pattern

120
Q

neurofilament

A

targets Merkel cells–especially helpful for CK20-negative MCCs; also targets nerve axons

121
Q

NSE

A

targets Merkel cells

122
Q

SMA

A

targets myofibroblasts; tram-track pattern

123
Q

CD56

A

targets NK cells; most commonly used stain

124
Q

CD57

A

targets NK cells

125
Q

granzyme

A

targets NK cells; also positive in cytotoxic T cells

126
Q

TIA-1

A

targets NK cells; also positive in cytotoxic T cells

127
Q

GFAP

A

targets Schwann cells

128
Q

MBP

A

targets Schwann cells

129
Q

MPO

A

targets neutrophils; especially useful stain in histiocytoid Sweet’s

130
Q

CD138

A

targets plasma cells

131
Q

CD79a

A

targets plasma cells

132
Q

CD45

A

targets plasma cells, T cells, B cells

133
Q

CD123

A

targets plasmacytoid dendritic cells; these are increased in lupus (but not DM) and increased in GA (but not NLD or rheumatoid nodules)

Dermpath (4 decks)

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