Application of stereology to dermatological research

Quantification of Immunohistochemically Stained Cells in Skin Biopsies

Immunohistochemical quantification of inflammatory cells in skin biopsies is a valuable tool for diagnosing skin diseases and assessing treatment response. The quantification of individual cells in biopsies is time-consuming, tedious, and difficult. In this study, we presented and compared two methods for the quantification of CD8⁺ T cells in skin biopsies from patients with psoriasis using both commercial software (Adobe Photoshop) and open-source software (Qupath). In addition, we provided a detailed, step-by-step description of both methods. The methods are scalable by replacing the CD8 antibody with other antibodies to target different cells. Moreover, we investigated the correlation between quantifying CD8⁺ cells normalized to area or epidermal length and cell classifications, compared cell classifications in QuPath with threshold classifications in Photoshop, and analyzed the impact of data normalization to epidermal length or area on inflammatory cell densities in skin biopsies from patients with psoriasis. We found a satisfactory correlation between normalizing data to epidermal length and area for psoriasis skin. However, when non-lesional and lesional skin samples were compared, a significant underestimation of inflammatory cell density was found when data were normalized to area instead of epidermal length. Finally, Bland–Altman plots comparing Qupath and Photoshop to quantify inflammatory cell density demonstrated a good agreement between the two methods.

Engraftment of bioengineered three-dimensional scaffold from human amniotic membrane-derived extracellular matrix accelerates ischemic diabetic wound healing

Human amniotic membrane (HAM) is traditionally used for the treatment of non-healing wounds. However, high density of HAM-matrix (HAM-M) diminishes cellular contribution for successful tissue regeneration. Herein we investigated whether a bioengineered micro-porous three-dimensional (3D) HAM-scaffold (HAM-S) could promote healing in ischemic wounds in diabetic type 1 rat. HAM-S was prepared from freshly decellularized HAM. Then, 30 days after inducing diabetes, an ischemic circular excision was generated on rats' skin. The diabetic animals were randomly divided into untreated (Diabetic group), engrafted with HAM-M (D-HAM-M group) and HAM-S (D-HAM-S group). Also, non-diabeticuntreated rats (Healthy group) were considered as control. Stereological, molecular, and tensiometrical assessments were performed on post-surgical days 7, 14, and 21. We found that the volumes of new epidermis and dermis, the numerical density of epidermal basal cells and fibroblasts, the length density of blood vessels, the numbers of proliferating cells and collagen deposition as well as biomechanical properties of healed wound were significantly higher in D-HAM-S group in most cases compared those of the diabetic group, or even in some cases compared to D-HAM-M group. Furthermore, in D-HAM-S group, the transcripts for genes contributing to regeneration (Tgf-β, bFgf and Vegf) upregulated more than those of D-HAM-M group, when compared to diabetic ones. Overall, the HAM-S had more impact on delayed wound healing process compared to traditional use of intact HAM. It is therefore suggested that the bioengineered three dimensional micro-porous HAM-S is more suitable for cells adhesion, penetration, and migration for contributing to wounded tissue regeneration.

Ointment of Ximenes americana promotes acceleration of wound healing in rats1

Purpose

To evaluate the healing potential of the Ximenia americana hydroalcoholic extract in 10% cream in excisional wound models in rats.

Methods

Sixty male adults Wistar rats were submitted to skin and subcutaneous tissue surgery in the right and left thoracic regions, divided into three experimental groups: Standard submitted to treatment with only the base vehicle, Treated wounds treated with hydroalcoholic extract of X. americana applied on 10%, Lanette base and Control, untreated wounds. The treatment was performed daily and the wounds evaluated microscopically by the quantification of fibroblasts, collagen fibers and blood vessels.

Results

The histomorphometric analysis showed a significant increase in the number of fibroblasts, collagen fibers and blood vessels in the treated group.

Conclusion

The topical action of the cream based on Ximenia americana shows angiogenic effects and improves the replacement of collagen, suggesting its use for the development of herbal remedy in the treatment of cutaneous wound healing.

Use of the optical disector in canine mammary simple and complex carcinomas

Grading of canine mammary carcinomas (CMC) is associated to subjective assessments made by the pathologists. Due to its unbiased nature, stereology can be used to objectively quantify morphological parameters associated with grading and malignancy. However, the use of stereology in CMC has not been fully disclosed. The nuclear numerical density [N_V (nuclei, tumor)] is a cellularity-associated parameter that can be estimated by the optical disector. Herein, it was estimated in 44 CMC and its association with clinicopathologic factors - such as tumor size, histological subtype and grade, vascular/lymph node invasion, nuclear pleomorphism, and survival - was evaluated. Considering all the cases, the mean N_V (nuclei, tumor) was 1.6 × 10⁶ ± 0.5 × 10⁶ nuclei/mm³ . Lower values were attained in complex carcinomas, comparing to simple carcinomas, in tumors smaller than 5 cm, with low mitotic activity and in those with high nuclear pleomorphism. No statistically significant association with grade or vascular/lymph node invasion was observed, but tumors with disease progression had lower nuclear densities. The N_V (nuclei, tumor) and the correlated parameters mirror to some extension those in human breast cancer, suggesting an interesting interspecies agreement. This first estimation of the nuclear numerical density in CMC highlights the feasibility of the optical disector and their utility for objective morphological assessments in CMC. The association between nuclear numerical density and disease progression warrants future studies.

Structural Alteration in Dermal Vessels and Collagen Bundles following Exposure of Skin Wound to Zeolite-Bentonite Compound

Background. This study examines the impact of one-time direct application of haemostatic agent zeolite–bentonite powder to wounded skin on the healing process in rats. Materials and Methods. 24 male Sprague-Dawley rats were randomly allocated into two groups (n = 12): (1) the rats whose wounds were washed only with sterile normal saline (NS-treated) and (2) those treated with zeolite–bentonite compound (ZEO-treated). The wound was circular, full-thickness, and 2 cm in diameter. At the end of the 12th day, six animals from each group were randomly selected and terminated. The remaining rats were terminated after 21 days. Just after scarification, skin samples were excised and sent for stereological evaluation. Results. The results showed a significant difference between the two groups regarding the length density of the blood vessels and diameter of the large and small vessels on the 12th day after the wound was inflicted. Besides, volume density of both the dermis and collagen bundles was reduced by 25% in the ZEO-treated rats in comparison to the NS-treated animals after 21 days. Conclusions. One-time topical usage of zeolite–bentonite haemostatic powder on an animal skin wound might negatively affect the healing process through vasoconstriction and inhibition of neoangiogenesis.

Lentigo maligna - anatomic location as a potential risk factor for recurrences after non-surgical treatment

Background

A higher incidence of lentigo maligna (LM) recurrences on the nose was previously observed in our cohort after non‐surgical treatment.

Objectives

To determine histological parameters that might be related to the previously observed higher incidence of LM recurrences on the nose after non‐surgical treatment.

Methods

We randomly selected 22 surgical specimens of LM on the nose and 22 on the cheek. Histopathological analysis was performed on haematoxylin and eosin stained and microphthalmia transcription factor immunohistochemically stained slides. The number of pilosebaceous units (PSU) per mm, maximum depth of atypical melanocytes along the skin appendages and maximum depth of the PSU itself were determined.

Results

The nose had a significantly higher density of PSU than the cheek. The atypical melanocytes extended deeper along the PSU on the nose with a mean (SD) depth of 1.29 mm (0.48) vs. a mean depth of 0.72 mm (0.30) on the cheek (P < 0.001). The maximum depth of the PSU on the nose was greater than on the cheek, mean (SD) depth of 2.28 mm (0.41) vs. 1.65 mm (0.82) (P = 0.003).

Conclusions

The higher recurrence risk of LM on the nose after non‐surgical treatment that we previously observed in our cohort is most likely based on a higher density of atypical melanocytes and also their deeper extension into the follicles. These results shed more light on our previous findings and learn that anatomical location is relevant for the risk of recurrence of LM after non‐surgical treatment.

Stereological Quantification of Cell-Cycle Kinetics and Mobilization of Epithelial Stem Cells during Wound Healing

We describe a stereology method to obtain reliable estimates of the total number of proliferative and migratory epithelial cells after wounding. Using pulse and chase experiments with halogenated thymidine analogs such as iododeoxyuridine (IdU) and chlorodeoxyuridine (CldU), it is possible to track epithelial populations with heterogeneous proliferative characteristics through skin compartments. The stereological and tissue processing methods described here apply widely to address important questions of skin stem-cell biology.

Stereology: a novel technique for rapid assessment of liver volume

Background

The purpose of this study was to test the stereology method using several grid sizes for measuring liver volume and to find which grid provides an accurate estimate of liver volume.

Materials and methods

Liver volume was measured by volumetry in 41 sets of liver MRI. MRI was performed before and after different weight-reducing regimens. Grids of 3, 4, 5, and 6 cm were used to measure liver volume on different occasions by stereology. The liver volume and the changes in volume before and after treatment were compared between stereology and volumetry.

Results

There was no significant difference in measurements between stereology methods and volumetry (p > 0.05). The mean differences in liver volume between stereology based on 3-, 4-, 5-, and 6-cm grids and volumetry were 37, 3, 132, and 23 mL, respectively, and the differences in measurement of liver volume change were 21, 2, 19, and 76 mL, respectively. The mean time required for measurement by stereology was 59–190 s.

Conclusion

Stereology employing 3- and 4-cm grids can rapidly provide accurate results for measuring liver volume and changes in liver volume.

Main Messages

• Statistical methods can be used for measuring area/volume in radiology.

• Measuring liver volume by stereology by 4-cm grids can be done in less than two minutes.

• Follow-up of liver volume is highly accurate with stereological methods.

Stereological estimation of epidermal volumes and dermo-epidermal surface area in normal skin

Quantitative morphological studies of the healthy epidermis are essential in providing a range of parameter estimates that can be considered within the range of normality. Stereology is a set of statistical tools that provides potentially unbiased and precise estimates of 3-dimensional tissue characteristics from 2-dimensional sections. We set out to establish reference values for the volume of the viable epidermis contained within a four-millimetre punch biopsy (V(epi)), the volume of the stratum corneum (V(SC)) and the surface area of the dermo-epidermal junction(A(DEJ)) in 4 predetermined body regions by use of stereology. Four-millimetre punch biopsies were taken from 20 freshly diseased corpses, fixed in formalin and embedded in paraffin. V(epi), V(SC) and A(DEJ) were established stereologically for all 4 body locations followed by pairwise comparison of means after Bonferroni correction. V(epi) was significantly larger in the sole compared to all other body locations (p < 0.01). Furthermore, linear regression analysis showed a strong linear relationship between V(epi) and V(SC) in the sole (r = 0.70). Our results suggest that the viable layers of the epidermis might also serve a mechanical function, either directly or by providing the stratum corneum with keratinocytes to support the hyperkeratosis in the weight-bearing parts of the skin.