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Pulmonary Pathology Online

Special Investigations (Useful chromatic stains and immunostains) in Pulmonary Pathology

 Dr Sampurna Roy MD                                     




Non-Neoplastic Pulmonary Diseases:

Histochemical Stain:

Periodic acid schiff (PAS):

PAS -  Glycogen :  For Fungi

PAS with diastase pretreatment (Neutral mucin): Pulmonary Alveolar Proteinosis 

Grocott : For Fungi ; Pneumocystis infection;

Ziel-Neelsen stain:   For Mycobacterial organisms;  Tuberculosis

Elastic/van Gieson stain for:

(Collagen) - Fibrosis ;   (Elastin) - Vasculature.

Example.  Interstitial fibrosis; Organizing pneumonia; Vasculitis;

Pulmonary Hypertension ; chronic lung rejection

Congo red  : For amyloid (primary / secondary);

Perls’ prussian stain: For ferric iron. Example. Pulmonary Hemorrhage ; ferruginous bodies.

von Kossa stain phosphate;

Immunohistochemical / Fluorescence:

Pneumocystis antibodies :    Pneumocystis carinii

Cytomegalovirus antibody :  Cytomegalovirus infection  

Other Analysis :

Polarising microscopy for birefringent material:             

Talc  ; Mica ;  Pneumoconiosis .

Mineral analysis: (light or electron microscope)- Diagnosis in Asbestos-related diseases.

Neoplastic Pulmonary Diseases:

Histochemical Stain : 

Periodic acid Schiff (PAS):   Clear cell tumours

PAS with diastase pretreatment (Neutral mucin): Adenocarcinoma        

(Alcian blue pH 2.5 (Acid mucin):   Mesothelioma (Mesothelioma-Online)

Combined Alcian blue/diastase PAS (basement membrane / neutral mucin): Adenoid cystic Carcinoma.

Argyrophil stains such as Grimelius: For neuroendocrine granules of carcinoid tumours.

Immunohistochemical Stain :

Immunohistochemical stains for NSE and PGP 9.5 have limited value in distinguishing small cell carcinoma from other types of carcinoma in small biopsies as they are often non-specific and unreliable.

More specific markers, such as chromogranin and N-CAM, are not easily identified in poorly differentiated tumours and small cell carcinoma.

CAM 5.2 and other cytokeratins give paranuclear dot positivity in small cell carcinoma and can be used as part of a panel.

Immunostains can be usefully applied in typing of neoplasms  -  CAM 5.2, leucocyte common antigen, desmin,synaptophysin, chromogranin, N-CAM, S100, surfactant; 

Lymphocyte markers - B and T cell markers, light chains.


Summary of Immunostains useful in the diagnosis of Pulmonary Tumours: 

Histochemistry and Immunohistochemistry in the diagnosis of Mesothelioma

Carcinoembryonic antigen                                             Adenocarcinoma




Surfactant apoprotein A

Thyroid transcription Factor 1                                         (Thyroid and pulmonary origin)


Calretinin ;                                                                      Mesothelioma

Cytokeratin 5 / 6 ; 

Thrombomodulin ;


Chromogranin A ; Synaptophysin ; CD56 :                        Neuroendocrine Tumours.



Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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