[Molecular pathologic detection of mycobacteria]. / Molekularpathologischer Nachweis von Mykobakterien.

In recent years, significant advances in the diagnosis of mycobacterial infections have been made by the introduction of direct pathogen detection methods. These techniques are usually based on the polymerase chain reaction (PCR) or on a transcription-mediated amplification (TMA) process. The majority of the protocols have been optimized for the detection of mycobacterial nucleic acids in fresh fluid or fresh tissue specimen. Unfortunately pathologists are frequently confronted with the problem that tissues with histologically suspicious lesions have been entirely fixed in formalin. As a result of this routine fixation, DNA and RNA are heavily degraded and the usually high sensitivity of the amplification techniques is greatly impaired. Consequently, only PCR protocols designed for small amplification targets are still suitable for an efficient detection of microbial DNA in formalin-fixed and paraffin-embedded tissues. We therefore adapted PCR assays with amplification products < 200 bp for the detection of M. tuberculosis-complex DNA (targets: IS6110 and 65 kDa-antigen gene) in routine biopsies. Although the sensitivities of the two assays varied significantly with the degree of DNA degradation, we were able to detect M. tuberculosis-complex specific DNA in about 25% of the tissues with a granulomatous inflammation and negative Ziehl-Neelson stain. Recently, we have added a third PCR-assay, which in combination with direct sequencing also allows us to detect DNA from M. leprae and several atypical mycobacteria species. PCR-analysis has significantly improved the diagnosis of mycobacterial infections by supplementing conventional histological examination of formalin-fixed and paraffin-embedded tissues.

Spindle cell pseudotumor due to Mycobacterium avium-intracellulare in patients with acquired immunodeficiency syndrome (AIDS). Positive staining of mycobacteria for cytoskeleton filaments.

A rare spindle-cell pseudotumor caused by Mycobacterium avium-intracellulare (MAI) that mimics a mesenchymal tumor, was recently reported (7,14). We report on three such pseudotumors in patients with the acquired immunodeficiency syndrome (AIDS), two involving lymph nodes and one involving the bone marrow. In the course of investigating the first-encountered example of this tumor for evidence of smooth-muscle origin of the spindle cells, it was noted that these cells stained positively for desmin by immunoperoxidase techniques (IPX), as did a variety of other cytoskeleton filaments of all sizes. Electron microscopic examination of one of these lesions revealed spindle cells containing lysosomes and large numbers of microorganisms compatible with MAI but no filaments or organelles suggestive of smooth-muscle cells. Further studies revealed that the typical lesions produced by MAI in patients with AIDS, namely aggregates of histiocytes or individual histiocytes laden with organisms, rather than the expansile spindle-cell pseudotumor, also strain strongly for cytoskeleton filaments, as do M. tuberculosis and Mycobacterium leprae. Awareness of the existence of this unusual manifestation of MAI infection in AIDS patients and its desmin positivity can avoid misdiagnosis of a primary or metastatic smooth-muscle neoplasm. The cell of origin appears to be the histiocyte.