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| REVIEW ARTICLE |
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| Year : 2011 | Volume
: 3
| Issue : 1 | Page : 43-47 |
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Histopathologic bodies: An insight
Meena Kulkarni, Tripti Agrawal, Varsha Dhas
Department of Oral Pathology and Microbiology, Dr. D. Y. Patil Dental College and Hospital, DPU Pimpri, Pune, India
| Date of Web Publication | 29-Jul-2013 |
Correspondence Address:
Meena Kulkarni
Department of Oral Pathology and Microbiology, Dr. D. Y. Patil Dental College and Hospital, Pimpri, Pune - 411 018
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2231-0754.115782
 Abstract | | |
The histopathological analysis of the tissue includes a detailed study of cellular and nuclear structures and their altered presentation in a given pathology. This is carried out by using a large spectrum of staining procedures and a variety of microscopic techniques. One of the specific and interesting features is the observation of various histopathological bodies seen in different pathologies. The presence of histopathological bodies is often an important diagnostic-aid in identifying the underlying disease. Hence, the present article is an attempt to compile different histopathological bodies seen in various diseases with special emphasis on pathogenesis, microscopic and ultramicroscopic features of the same Keywords: Inclusion bodies, diagnosis, histopathologic bodies
How to cite this article:
Kulkarni M, Agrawal T, Dhas V. Histopathologic bodies: An insight. J Int Clin Dent Res Organ 2011;3:43-7 |
| Introduction | |  |
The histopathological bodies are either intracellular or extracellular abnormalities specific to certain diseases. These structures appear either within the cell nucleus, the cytoplasm or may be present in both, exhibiting characteristic staining properties. These represent peculiar morphological alterations in a tissue giving rise to a highly specific pattern.
The presence of histopathological bodies is often an important diagnostic aid in identifying the underlying disease. Hence, the present article is an attempt to compile different histopathological bodies seen in various diseases with special emphasis on pathogenesis, microscopic and ultramicroscopic features of the same.
According to etiopathogenesis, the histopathological bodies can be briefly classified as:
- Histopathologic bodies seen in physiological conditions.
- Histopathologic bodies seen in infectious diseases:
- Bodies seen in viral infections.
- Intra cytoplasmic inclusions
- Intra nuclear inclusions
- Bodies seen in bacterial infections.
- Bodies seen in fungal infections.
- Histopathologic bodies seen in various neoplams.
- Histopathologic bodies seen in autoimmune diseases.
- Histopathologic bodies seen in blood dyscrasias.
- Histopathologic bodies seen in cystic lesions.
Characteristic histopathologic bodies in physiologic conditions
Keratinized stratified squamous epithelium is known to show Odland bodies. They are also known as keratinosomes, lamellar bodies or membrane-coating granules. These bodies are seen in the upper spinous and granular cell layers. These bodies are rich in glycolipids and are discharged extracellularly to form a lipid rich permeability barrier preventing absorption of aqueous fluids. [1] Storage granules of th endothelial cells are known as Weibel Palade bodies. They store and release two principal molecules, von Willebrand factor and P-selectin, and thus play a dual role in hemostasis and inflammation .[2]
Characteristic bodies in infections
Many bacterial, viral and fungal infections are known to show specific presentations in form of histopathological bodies. These bodies are shown to have positive correlation with the pathogenesis of a specific infection. Certain bacterial infections like tuberculosis, diphtheria, and typhoid show typical light blue-grey, oval, basophilic staining areas in the cytoplasm of neutrophils. These structures are known as Dohle bodies and are seen in the peripheral blood smear. [3] The presence of Dohle bodies reflect the defective cell production and maturation of neutrophils. Special stains like Leishman-Giemsa stain and Romanowsky stain can be used for the demonstration of Dohle bodies. [4]
Certain viral infections like viral hepatitis and yellow fever show acidophilic inclusion bodies in the cytoplasm of hepatocytes, which are associated with ballooning degeneration. These bodies were named after the American Pathologist William T. Councilman as 'Councilman Bodies'. This histopathological appearance is due to hepatocytes undergoing apoptosis. [5]
Molluscum Contagiosum is a disease caused by Pox group of viruses in which large, ellipsoid, homogenous intracytoplasmic inclusions are seen in the stratum spinosum and stratum corneum of the infected epithelium. They are made of nuclear and cytoplasmic aggregates, usually proteins and represent the site of viral multiplication. These have been described as Henderson Peterson bodies. [6]
Some of the relatively common viral infections like gingivostomatitis and conjunctivitis caused by herpes simplex virus and some other infections caused by varicella zoster virus like chickenpox show the presence of Cowdry Type- A inclusion bodies. In routine histopathology, they appear as droplet -like masses of acidophilic material surrounded by clear halos within nuclei, with margination of chromatin on the nuclear membrane. [7],[8] These infections also show Lipschutz bodies which are characterized by the presence of eosinophilic nuclear inclusions with enlarged nuclei and clear halo. [9] The intranuclear eosinophilic amorphous or droplet- like bodies surrounded by clear halo are seen without any associated nuclear changes in adenovirus and poliovirus infections and are named as Cowdry Type- B inclusion bodies. [10]
Hodgkin's lymphomas and cytomegalic inclusion disease show characteristic 'Owl's eye' inclusion bodies. Cytomegalovirus is known to cause cytopathic effects in the affected cells thus giving a histological picture of large intranuclear viral inclusion bodies with thickened nuclear membrane presenting as owl's eye bodies. [11]
Some of the relatively uncommon fungal infections like Sporotrichosis show inclusion bodies within the giant cells. This histopathological appearance is named as 'Asteroid bodies' denoting their morphology. They appear as stellate inclusions with numerous rays radiating from the central core. [12],[13]
Some reactive lesions like epulis fissuratum in which there is an inflammatory fibrous hyperplasia of the surface epithelium, the epithelial cells show mucopolysaccharide keratin dystrophy which appears to have replaced individual cells. This is referred as 'plasma pooling' and this altered appearance is termed as 'Toto bodies'. Toto bodies are homogeneous, eosinophilic pools of material in the superficial spinous layer of the surface epithelium [Figure 1]. | Figure 1: Microphotograph of Toto bodies showing homogeneous, eosinophilic pools of material in the superfi cial spinous layer of the surface epithelium. (10× magnifi cation)
Click here to view |
Diagnostic histopathologic bodies in neoplasia
Some of the benign nerve tumors show a unique histopathological presentation like the presence of oval aggregates of eosinophilic globules containing parallel slits observed within the cellular sheets of neurofibroma. This peculiar presentation is known as 'Wagner- Meissner body'. This histologic presentation is seen in neurofibroma, and oral lesions of patients with von Recklinghausen's disease of skin, however Wagner- Meissner body is not pathognomonic. [14],[15] Schwannoma, a benign nerve sheath tumor, shows compactly arranged spindle shaped cells with a palisading pattern. This presentation is unique and pathognomonic to this tumor and can be very well appreciated in routine histopathology as Verocay bodies [Figure 2] [16],[17] Numerous benign and malignant epithelial and connective tissue tumors show 'Psammoma bodies' and the presence of these bodies categorize these lesions as psammomatoid variants of the family of these tumors. Lesions like psammomatoid juvenile ossifying fibroma, psammomatoid melanotic schwannoma, cystadenocarcinoma, psammomatoid meningioma are known to show psammoma bodies [Figure 3]. In routine hematoxylin and eosin stained sections they appear as spherical, concentrically laminated mass of calcified material. This histopathological presentation is formed due to necrosis followed by dystrophic calcification as its consequence. [18],[19],[20] Russell bodies, Pustulo- Ovoid bodies, Kamino bodies, and Dutcher bodies are few other examples of histopathologic bodies seen in the benign and malignant cells of a few rare neoplasia. Careful examination of the entire section may show the presence of these bodies in routinely stained sections Russell bodies appear as eosinophilic, large, homogenous immunoglobulin inclusions usually found in plasma cells. Several theories are put forward to explain the appearance of Russell bodies in the histologic sections of which the first one is by Downey (1911) and Kingsley (1924) which suggests that the death of plasma cells and their content is liberated in the surrounding tissues.  | Figure 2: Microphotograph of Verocay bodies showing compactly arranged spindle shaped cells with a palisading pattern. (10× magnifi cation)
Click here to view |
 | Figure 3: Microphotograph of Psammoma bodies showing spherical concentrically laminated mass of calcified material. (40× magnifi cation)
Click here to view |
Secondly, Jordan and Speidel (1929) proposed that Russell bodies are hemocytoblasts which fail to transform in a normal manner to erythrocyte or granulocytes. And lastly Michaels (1935) considered Russell bodies to be red blood corpuscles which have been taken up by plasma cells. [21],[22] Special stains like fuchsin, periodic acid Schiff, fibrin stain and Grunwald- Giemsa stain are used to demonstrate Russell bodies. They are frequently seen in multiple myeloma, helicobacter pylori infection, periapical granuloma, chronic inflammatory granulomata and plasmacytoma. [22],[23],[24] Pustulo- Ovoid bodies are round eosinophilic inclusions made of coalescing granules, representing lysosomes giving it granular appearance. These bodies are associated with granular cell tumors. [25] Kamino bodies are eosinophilic histopathologic bodies which appear as globules or aggregate at the dermal epidermal junction, up to the size of several keratinocytes with scalloped borders and crescent shaped periphery and are found to be associated with Spitz nevus and pigmented spindle cell nevus. The main content of Kamino bodies is found to be type IV and type VII collagen and therefore, they give a positive reaction to periodic Acid- Schiff's and trichrome stains. [26],[27] In 1959, Dutcher and Fahey described inclusion bodies that appear to be intranuclear inclusions of immunoglobulin protein which they named as Dutcher bodies. The ultrastructural examination of these bodies revealed them to be pseudo inclusions formed by cytoplasmic invagination into the nucleus. They are smooth, membrane-bound and surrounded by clumped chromatin. Dutcher bodies are associated with diffuse large B- cell lymphoma, multiple myeloma and chronic synovitis. They exhibit a positive staining reaction to periodic acid- Schiffs and Wright- Giemsa stains. [28],[29]
Histopathologic bodies seen in autoimmune diseases
Countless autoimmune disorders are recorded, out of which only a few affect the oral cavity. Apart from the wide range of clinical and histopathological manifestations of the autoimmune disorders, some of the autoimmune diseases show classical histological presentations. Disorders like lichen planus and discoid lupus erythematosus show eosinophilic 'Civatte bodies'. Civatte bodies' are present in the lower part of the epidermis and are composed of net like amorphous masses. When present in the epidermis, these bodies are composed of waverly arranged fine filaments entangled with melanosomes, desmosomes and other organelles. Formation of Civatte bodies is thought to be due to basal cell liquefaction degeneration and hypergranulosis. [30],[31] Ultrastructural studies have proven that Civatte bodies are derived from basal cells and connective tissue elements from the basement membrane zone. They give positive staining for keratin. [32]
Hematoxylin bodies appear as basophilic extracellular aggregation, thought to be nuclear material bound with immunoglobulin and are found in the connective tissue. They appear amorphous and are ovoid in shape which is pathognomonic in systemic lupus erythematous. [33],[34] They are seen in association with necrotic loci and contain dense chromatin as is evident ultrastructurally. [34] Jorge Schaumann in 1941 first described large concentrically lamellated structure present in the cytoplasm of the giant cells seen in Sarcoidosis as 'Schaumann bodies'. The ultrastructural studies have confirmed the presence of calcium and phosphorus and small quantities of iron in Schaumann bodies. They contain iron and calcium inclusion bodies usually calcium oxalate crystals. As they enlarge within the macrophages and giant cells they rupture the cytoplasmic membrane of cell and appear in extracellular matrix. [35] These excluded crystals serve as nidus for the further deposition of minerals leading to extracellular calcifications. [36],[37] Sarcoidosis, tuberculosis, hypersensitive pneumonitis and few other granulomatous conditions are reported to be associated with Schaumann bodies. [36]
Histopathologic bodies seen in blood dyscrasias
Blood disorders comprise of a wide range of diseases. They are known to have a variety of oral manifestations. Robert Heinz, a German physician, in 1890 described inclusions in red blood cells of patients with hemolytic anemia. They are named as Heinz bodies. Apart from hemolytic anemias, thalassemia and Glucose-6-phosphate dehydrogenase deficiency may also show Heinz bodies. They appear as small, irregular, deep purple granules in red blood corpuscles. Special stains like crystal violet and Wright's stain can be used to demonstrate these bodies. Heinz bodies are formed due to damaged DNA component usually through oxidation or due to change in the internal morphology of the amino acid residue within the red blood cells. These damaged cells are prematurely lysed and are removed by the macrophages. [38] Leukemia with megaloblastic anemia and Pernicious anemia show small, dark staining round inclusions in the red blood corpuscles known as Howell- Jolly bodies. This presentation of red blood cells is due to the remnant of DNA left during the maturation in the bone marrow and was first noted by William Henry Howell and Justin Marie Jolly. These bodies appear basophilic and their ring like appearance in red blood cells mimics parasites. [39],[40],[41] Peripheral blood smears of patient suffering from homozygous type of Thalassemia show intracellular inclusion bodies known as Fessas body. Decreased production of β-chain hemoglobin occurs which thereby leads to excessive deposition of α-chain hemoglobin in the red blood cells. Defective production of hemoglobin leads to severe hypochromic type of red blood cells and increased deposits of α-chain hemoglobin leads to premature lysis of the cell wall of red blood cells.
Histopathologic bodies seen in cystic lesion
One of the most commonly encountered cystic lesions in the oral cavity is the periapical cyst. A frequent finding in this cyst is the presence of Rushton bodies/ Hyaline bodies. In H and E stained sections, Rushton bodies/ Hyaline bodies appear as eosinophilic bodies showing varied shapes which are- linear, straight, curved, hairpin shaped, circular or polycyclic forms [Figure 4]. They often appear as having a granular core and sometimes are concentrically lamellated. Rushton bodies/ Hyaline bodies are found almost always within the epithelial lining and only rarely in the fibrous capsule. Ultrastructural examination reveals two forms- lamellated and homogeneous. The lamellar type is composed of alternating electron dense and electron lucent layers, the outermost layer always being electron dense. The granular type is composed of amorphous material in which fragments of red blood cells are seen. Some hyaline bodies are partly granular and partly lamellar. The surfaces of the epithelia in both the types show large number of hemidesmosomes, but no basal lamina. Amorphous material in the granular hyaline bodies appears very similar to the substance of the degenerating red blood cells, and extravasated red cells commonly found in the adjacent connective tissue.  | Figure 4: Microphotograph of Hyaline bodies showing eosinophilic structure of varied shapes like linear, straight and curved. (40× magnification)
Click here to view |
These bodies do not get stained by periodic acid-Schiff stain but show strong positivity with Masson's Trichrome, Orcein, Mallory aldehyde fuchsin, Papanicolaou and Gomori stains. They are usually seen in Radicular Cyst, Residual Cyst and Plexiform Ameloblastoma. [42],[43],[44],[45]
| Conclusion | | |
As disease progresses, various changes occur in the body which are biochemical in nature which lead to cellular changes. These cellular changes are visible at different stages of disease progression. As the presence of histopathological bodies is indicative of a disease; their disappearance is indicative of subsidence of the disease. The occurrence of these histopathological bodies at various stages in the course of the disease can be useful in staging of the diseases. Histopathological bodies in oral pathology have a great deal of significance in diagnosis of the diseases. These features are often indicative of etiology of the disease and some of these are pathognomonic.
In blood disorders, these pathological bodies represent the damage to hemoglobin or remnants of DNA. The biochemical nature of these bodies represents the pathological changes in the metabolism of the cell.
The histopathological bodies are significant for diagnosing, staging, treatment planning and also predicting the prognosis of the disease. The present paper is an attempt to compile histopathologic bodies, categorize them and systematically.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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