Tag Archives: skin cancer

Grocott Hexamine-Silver Special Stain For Fungus – Method and Tips

The Grocott Hexamine-Silver special stain is the method of choice for a large majority of histopathology laboratories for the demonstration of all fungi. The formalin-fixed sections are exposed to chromic acid which reacts with fungal cell wall polysaccharide components to form chromic acid-aldehydes. These then reduced by a hexamine-silver solution at an alkaline pH. This causes them to be selectively blackened.  It should be noted that this method is not specific for fungi but rarely fails to demonstrate any fungi within the test tissue.

Below is the author’s method of choice.


5% aqueous chromic acid (chromium trioxide)

1% aqueous sodium metabisulphite

Stock hexamine-silver solution = 100ml 3% aqueous hexamine + 5% aqueous silver nitrate.

Working hexamine-silver solution = 2ml 5% aqueous sodium tetraborate (borax) + 25ml distilled water. Mix, then add 25ml stock hexamine-silver solution.

0.1% aqueous gold chloride

5% sodium thiosulphate

0.2% light green in 0.2% acetic acid


1. Take sections to water.

2. Treat sections with chromic acid for 1 hour.

3. Wash thoroughly in tap water.

4. Treat with sodium metabisulphite solution for 1 minute.

5. Wash well in tap water.

6. Wash well in several changes of distilled water.

7. Treat sections with working hexamine solution (preheated in coplin jar at 56 degrees Celsius) at 56 degrees Celsius for 10-20 minutes. Check control sections to see if fungi are a dark brown colour, if not return to solution checking regularly at 3 minute intervals until correct colour achieved.

8. Wash in several changes of distilled water.

9. Treat sections with 0.1% aqueous gold chloride for 3 minutes.

10. Wash well in distilled water.

11. Treat sections with 5% sodium thiosulphate for 5 minutes.

12. Wash well with tap water.

13. Counterstain with 0.2% light green in 0.2% acetic acid for 1 minute.

14. Wash well in tap water.

15. Dehydrate, clear and mount.



– As with all other silver stains wash everything that you are going to use thoroughly with distilled water.

– Store the stock hexamine-silver solution at 4 degrees Celsius away from sunlight. It will keep for 1-2 months. If a white precipitate forms give it a good shake and it should redissolve.

– Do not extend the time in chromic acid too long as this can over oxidize the carbohydrates to carboxylic acid and therefore not take up the silver stain.

– Do not reduce the time in chromic acid as this will lead to under oxidation and therefore no take up of the silver stain.

– The chromic acid can be reused but its efficiency will decrease after each use.

– If the control sections are failing to stain even after extending the staining time in the heated hexamine-silver solution you have more than likely forgotten to add the borax. If so, you can just add it and continue with the stain.

– If you have a large amount of silver precipitate over your sections it is probably due to using low-grade silver.

– If you forget the sodium thiosulphate step you will not realise until after retrieving the slide from storage further in the future, as the remaining silver not removed will react with sunlight turning black.

– Try to keep your counterstain fairly light as dark counterstaining can mask fungal elements.


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Perls’ Technique For The Demonstration of Haemosiderin – Method and Tips

Iron is absorbed in the duodenum by cells called enterocytes. It is then stored or combined with a transport protein molecule. This iron-protein complex is then taken to the bone marrow where the iron is incorporated into the substance known as haemoglobin which is involved in oxygen transportation.

Iron can be stored in the bone marrow and spleen in its ferric state (Fe3+) as haemosiderin when combined with protein. When haemoglobin is broken down by tissues this results in the formation of haemosiderin.

When there is excess iron in the body haemosiderin can be found deposited in organs that are involved with iron storage such as the spleen, bone marrow and liver. This condition is known as haemosiderosis.

A condition called haemochromatosis exists where the body indiscriminately absorbs iron resulting in the deposition of copious amounts of haemosiderin in many tissues.

Haemosiderin founds in histology sections is usually derived from the breakdown of damaged erythrocytes and can also be found absorbed by macrophages (siderophages).

The method used by the wide majority of histology laboratories for the demonstration of haemosiderin is the Perls’ technique. This method works by the hydrochloric acid (HCL) splitting off the bound protein which then allows the potassium ferrocyanide to bind with the Fe3+ and form ferric ferrocyanide (Prussian blue).

Below is the author’s favoured method.


2% hydrochloric acid (HCL)

2% aqueous potassium ferrocyanide

1% aqueous neutral red


1. Take sections to water

2. Mix equals parts of HCL and potassium ferrocyanide and filter onto sections. Leave for 15 minutes.

3. Wash for 5 minutes in running tap water.

4. Counterstain with neutral red for 1 minute.

5. Dehydrate, clear and mount.


– Always include a positive control.

– Stronger staining results can be found by carrying out step 2 at higher temperatures (e.g. 37-56°C). This can result in false positive results. This author has found room temperature to suffice.

– The washing step (step 3) should not be decreased below 5 minutes as thorough washing is required to prevent a heavy dye precipitate resulting from the neutral red counterstain.

– The author has found neutral red to be the best counterstain. Do not use safranin as this can stain the Prussian blue granules a dark purple colour.

– Always mount in a DPX-type mountant as other mounting media results in fading of the stain.

– A common artefact is the presence of blue granules on and around the section. This can be due to expired HCL or potassium ferrocyanide. It can also be due to iron contaminants in the tap water. This can be fixed by replacing all steps from the cutting of the sections to the mounting of the stained slide that involve tap water with distilled water.

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Modified Ziehl–Neelsen Stain For Leprosy Bacilli – Method and Tips

Leprosy bacilli in comparison with tubercle bacilli are much less acid- and alcohol-fast. The leprosy bacilli’s lipid envelope is also much more affected by the fat solvents traditionally used to dewax sections (i.e. Xylene). Due to these factors a modification on the standard Ziehl-Neelsen technique is used for the demonstration of leprosy bacilli.

Below is the author’s preferred technique.


Dewaxing solution – equal parts of liquid paraffin and rectified turpentine

Carbol Fuchsin – as per standard Ziehl-Neelsen technique

Methylene blue counterstain – as per standard Ziehl-Neelsen technique

10% sulphuric acid


1. Dewax in ‘dewaxing solution’ described above for 30 minutes.

2. Blot dry and wash in running water for approximately 10 minutes.

3. Stain with filtered Carbol Fuchsin for 30 minutes at room temperature.

4. Wash well in tap water.

5. Differentiate in 10% sulphuric acid until section is pale pink.

6. Wash well in tap water.

7. Counterstain with Methylene Blue for 15 seconds.

8. Wash well in tap water.

9. Blot dry, clear and mount.


– This author always puts sections on ‘sticky’ slides to prevent any floating off.

– There are many variations on the ‘softer dewaxing solution’ for the modified Ziehl-Neelsen technique for leprosy bacilli including:

– Two parts xylene to one part vegetable oil / clove oil / groundnut oil / olive oil / cottonseed oil.

– Residual oil on the section after washing prevents shrinkage of the section.

– Place slides directly from heater into dewaxing solution as this helps quicken the dewaxing

– Some methods use a weaker acid-alcohol solution for differentiation, but this author prefers 10% sulphuric acid as it is quicker.

– Don’t be alarmed when the section is placed into the sulphuric acid as it will turn a black colour. It will return to a pink colour when placed back in water.

– Ensure the counterstain colour isn’t too intense as this can mask some leprosy bacilli and even turn them a purple colour.

– This is author lets the sections dry after washing after counterstaining and then directly mounts them.

I welcome any other tips and comments.

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Lack of UV-A Protection In Daily Moisturising Creams

Came across another interesting article in the May edition of ‘The Archives of Dermatology’ 2011. The article is entitled ‘Lack of UV-A Protection In Daily Moisturising Creams’ on page 618.

Ultraviolet radiation (UV) contains UVA, UVB and UVC subtypes. The major source of UV exposure for humans is sunlight. The earths ozone layer blocks approximately 98% of all UV radiation and the 2% which reaches the earths surface 99% is of the UVA subtype. UVB can cause direct DNA damage whereas UVA causes indirect damage of DNA via the formation of free radicals. Therefore it is important any sunscreen solution contains both UVA and UVB filters.

This article reported the estimated long-range UVA1 protection of 29 creams.

Major points of note from the article include

– most daily facial creams contain ingredients known as UV filters claiming broad spectrum UV protection

– Sun protection factor (SPF) doesn’t reflect UV-A1 protection

– UVA penetrates window glass whereas UVB is blocked, therefore women working indoors need to protect themselves from UVA exposure

– of the 29 creams 6 didn’t contain any UVA1 filters

I recommend reading the full article as it is an interesting read. Below is a link to the article.

Lack of UV-A Protection in Daily Moisturizing Creams
Steven Q. Wang; Jacqueline M. Goulart; Henry W. Lim
Arch Dermatol. 2011;147(5):618-620

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Verhoeff Van Gieson Elastin Special Stain – Method and Tips

Elastin is a connective tissue protein which allows the tissues of the body to return to their original shape after distortion or stretching. Elastin fibres can be of varying size and diameter and are particularly well seen histologically in sites such as the lung, heart, blood vessels and the dermis.

Histological demonstration of elastin fibres (or lack of them) are important in diagnostic pathology for conditions such as arteriosclerosis, temporal arteritis and elastosis. Fine elastic fibres are not so easily seen on standard haemtoxylin and eosin (H+E) staining therefore special stains which demonstrate elastin clearly are vital.

There are many elastin special stain techniques such as Weigert-Type, Orcein, Aldehyde-Fuchsin and Verhoeff’s. The most common is Verhoeff’s technique of staining elastin due to its quick method and strong elastin colour result. Below is the author’s favoured method for demonstrating elastin which is a version of the Verhoeff’s.


Verhoeff’s solution – (5ml 5% alcoholic haematoxylin) + (2ml 10% aqueous ferric cholride) + (2ml Lugol’s iodine) MAKE IMMEDIATELY PRIOR TO USE.

Note – Lugol’s iodine = 2g potassium iodine dissolved in ~4ml of distilled water, then dissolve 1g iodine, then make up to 100ml.

2 % aqueous ferric chloride

Van Gieson counterstain = (100ml saturated aqueous picric acid) + (1% aqueous acid fuchsin), boil for 3 mins then filter.


1. Take sections to water.

2. Stain with Verhoeff’s solution for 15-20 mins

3. Wash well in tap water

4. Differentiate in 2% aqueous ferric chloride until only elastin fibres remain darkly stained.

5. Wash in tap water for 5 mins.

6. Counterstain with Van Gieson for 3 mins.

7. Dehydrate, clear and mount.


– aim for slight under-differentiation as the Van Gieson stain will continue the differentiation though more slowly.

– dehydrate quickly as alcohol can leach some of the Van Gieson stain from the section. You can accelerate dehydration by blotting the section with filter paper.

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Persistent Melanocytic Nevi: A Review and Analysis of 205 cases

Great article in the June 2011 issue of the ‘Journal of Cutaneous Pathology’ regarding persistent melanocytic naevi. Good reading for those interested in the subject.

Things of note are

– female predominance (reason unclear)

– back is the most common site followed by abdomen then chest

– mean time between original biopsy then biopsy of persistent naevus was 9.7 months

– dysplastic naevi were most likely to recur

– persistent melanocytic naevi were more likely to be initially removed via shave biopsy


Link to the article below

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Melanoma Research – Sex differences in survival of cutaneous melanoma are age dependent

Came across an interesting article in the latest issue of the Melanoma Research journal regarding differences in survival rates based on sex. It has been previously observed that women have a better survival rate for melanoma than men. This has also been observed in other cancers such as lung adenocarcinoma and colon cancer.

The study reveals that the slight survival benefit women with melanoma experience, disappears after the age of 60. This is mirrored, but also conflicts with other studies referenced within the article.

Proposed reasons for this female survival benefit include women being more prudent in the personal examination of the skin, women having a greater percentage of lower limbs melanomas which are associated with a better prognosis and immune gender differences.

Below is a link to the article abstract

 I recommend getting the whole article if it is possible.

 Thanks for reading and I welcome any comments.

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