Morin Stain Detects Aluminum-Containing Macrophages in Macrophagic Myofasciitis and Vaccination Granuloma With High Sensitivity and Specificity.
Macrophagic myofasciitis (MMF) is an inflammatory condition associated with the intramuscular (i.m.) injection of aluminum adjuvant-containing vaccines. It is clinically characterized by myalgia, weakness, and chronic fatigue and histologically by aggregates of cohesive macrophages with abundant basophilic, periodic acid-Schiff (PAS)-positive, diastase-resistant granules that percolate through the peri- and endomysium without eliciting substantial myofiber damage. The definitive diagnosis of MMF requires demonstration of aluminum within these macrophages. We evaluated the Morin stain, a simple, 2-step histochemical stain for aluminum, as a confirmatory diagnostic tool for MMF. Among 2270 muscle biopsies processed at UTSW between 2010 and 2015, a total of 12 MMF cases and 1 subcutaneous vaccination granuloma case were identified (11 pediatric, 2 adults). With the Morin stain, all 13 cases showed strong granular reactivity within the cytoplasm of macrophages but not in myofibers or connective tissue. Three cases of inflammatory myopathy with abundant macrophages (IMAM), 8 cases of granulomatous inflammation and 23 other deltoid muscle biopsies used as controls were all negative. Morin stain could be used in both formalin-fixed paraffin-embedded and cryostat sections. Thus, Morin stain detects aluminum with high sensitivity and specificity in human muscle and soft tissue and may improve the diagnostic yield of MMF and vaccination granuloma.
Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA.
Rati
R
Chkheidze
Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA.
Dennis K
DK
Burns
Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA.
Charles L
CL
White
Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA.
Diana
D
Castro
Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA.
Julie
J
Fuller
Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA.
Chunyu
C
Cai
D000276:Adjuvants, Immunologic / Q000009:adverse effects*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000535:Aluminum / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004396:Coloring Agents; D005208:Fasciitis / Q000139:chemically induced / Q000378:metabolism*; D005260:Female; D005419:Flavonoids; D006099:Granuloma / Q000473:pathology*; D006801:Humans; D007202:Indicators and Reagents; D007223:Infant; D007231:Infant, Newborn; D007279:Injections, Subcutaneous; D008264:Macrophages / Q000737:chemistry / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D018485:Muscle Fibers, Skeletal / Q000473:pathology; D012680:Sensitivity and Specificity; D016707:Tissue Fixation; D014611:Vaccination / Q000009:adverse effects*; D055815:Young Adult; D047309:Flavones
D000276:Adjuvants, Immunologic; D000535:Aluminum; D004396:Coloring Agents; D005419:Flavonoids; D007202:Indicators and Reagents; C008548:morin; D047309:Flavones
Aluminum adjuvant; Inflammatory myopathy with abundant macrophages; Macrophagic myofasciitis; Vaccination granuloma