PAS STAIN

PERIODIC ACID SCHIFF (PAS) STAIN
  • Classify mucins
    • Mucins are classified as
      • Mucopolysaccharides
        • Acid mucopolysacharides
        • Neutral polysaccharides
      • Glycoproteins
        • Neutral glycoproteins
        • Sialoglycoproteins
        • Sulfated sialoglycoproteins
  • What are mucopolysaccharides and give example of them
    • Both acid and neutral mucopolysaccharides contain hexosamine as chief carbohydrate content
    • Acid mucoplysaccharides – they contain hexuronic acid as their second carbohydrate constituent and are often bound to sulfuric acid. Examples are
      • Hyaluronic acid (simplest acid mucopolysaccharide) – abundant in synovial fluid, vitreous humor of the eye and whartons jelly of umbilical cord
      • Chondroitin sulfate – cartilage, connective tissue, tendons, blood vessels and skin
      • Heparin – produced by mast cells
      • Agar
    • Neutral mucopolysacharides – They contain hexoses (instead of hexuronic acid) as their second carbohydrate compound.
      • Chitin and capsules of some organisms like fungi and pneumococcus
  • What are the examples of Glycoproteins
    • These constitute the mucins secreted by GI epithelial cells, gonadotrophic and thyroid stimulating hormones, serum mucoproteins and agglutinogens
    • acid epithelial mucins secreted by GI tract epithelial cells are sialomucins, sulfomucins and sulfated sialoglycoproteins
    • Tracheobronchial tree – Sulfated mucin predominate on surface
    • Deeper mixed mucous glands – Sialomucins
  • what are Glycolipids
    • Cerebrosides (chiefly Phrenosin and kerasin) and abnormal kerasin found in Gauchers disease are PAS positive
  • What are the best fixatives for mucins and mucopolysaccharides
    • For mucins
      • Formol- calcium
      • Formol- alcohol
      • Acidic fixatives
      • Carnoys fluid
      • Mercurial fixatives – Zenkers, Bouins and Brazil
    • For acid mucopolysaccharides
      • Lead subacetate
      • Lead – formalin fixative
  • Prolonged formalin fixation reduces the strength of PAS why? how can this be reversed
    • Reduced strength of PAS reaction to mucins on prolonged fixation is due to polymerization.
    • This can be reversed by treating hydrated sections with 0.2 NaOH for 10 to 15 minutes prior to staining
  • What are the three dyes of Basic Fuchsin
    • Rosanilin
    • Pararosanilin
    • Magenta II
  • What is the Schiff reaction
    • H.Schiff (1866) showed that aldehydes restore the magenta colour to Fuchsin which has been decolorized (leucofuchsin) by sulfur dioxide
    • Leucofuchsin is colorless because its chromophoric double bond has been destroyed. Reoxidation slowly by exposure to light and air will restore double bond and the colour
  • what is the principle of PAS reaction
    • Periodic acid oxidizes glycogen, mucoprotein and other high molecular to aldehyde
    • Aldehydes which reacts with colourless Schiff reagent producing bright red or pink color
  • What is Feulgen Schiff reaction
    • Feulgen discovered that gentle acid hydrolysis of fixed tissues exposed the deoxypentose   of nuclei in a potentially aldehydic form but still bound to nuclei acid chain by phosphate links
    • later on exposure to Schiffs  reagent produces reddish purple colour in DNA containing structures
    • Ribonucleic acid (RNA) which contains ribose instead of deoxyribose of DNA, does not give Feulgen reaction because the glycol group of its ribose is substituted by phosphate
  • What are PAS positive substances
    • Glycogen
    • Neutral polysaccharides (capsules of bacteria and fungi)
    • Glycoproteins
      • mucin secretions of intestinal tract and glands
      • secretions of tracheobronchial tree
      • Gonadotrophic hormone
      • Thyroid stimulating hormone
      • Thyroglobulins
      • Serum mucoproteins
      • Hyaline proteinaceous renal casts
      • Russel bodies in plasma cells
      • cytoplasm of megakaryocytes
      • Fractions of serum albumin and globulin
      • Basement membrane
      • Reticulin and collagen
      • Sialoglycoproteins of ovarian pseudomucinous cystadenomas of ovary.
    • Glycolipids
      • Gangliosides in gray matter of brain, epithelioid cells and globoid cells in Krabbe’s Leukodystrophy and in Tay Sachs disease
      • cerebrosides in white matter
      • Kerasin in Gauchers disease
    • Non carbohydrate containing substances
      • Sphingomyelin (Neimann – Pick’s disease)
    • Pigments
      • Ceroid
      • Lipofuscin
      • Pigment in melanosis coli
    • Miscellaneous substances
      • Mast cells (less sulfated forms of heparin are PAS positive)
    • Plasmalogens
      • These are labile acetal phospholipids which are formed in tissues fixed only for a short time in formalin or has been mercury – fixed
  • What are PAS negative mucopolysaccharides
    • Acid mucopolysaccharides : Hyaluronic acid, Hyaluron sulfate, and chondroitic sulfate
    • Reactive groups are prevented from attack by HIO4   because of the affect of acid groups.
  • What is blocking of PAS reaction
    • On PAS stain, the red color of carbohydrate substance is due to presence of 1:2 glycol groups which are oxidized to stable dialdehydes
    • Blocking of PAS reaction is done by acetylation which blocks both 1,2-glycol and hydroxyamino group
    • This is used to differentiate whether false reaction is caused by preformed aldehyde groups. To demonstrate this false reaction  section is treated by Schiff reagent alone without periodic acid pretreatment, which will be recovered by aldehyde group
  • What are different methods of blocking PAS reaction
    • Acetylation – Placing hydrated sections for 1 to 24 hrs at 250 C or 1/2 to 6 hrs at 580 C in a mixture of 16 ml acetic anhydride and 24 ml anhydrous pyridine 
    • Benzoylation
    • Boration
    • Bromation
  • How is the blocking of PAS reaction reversed (Deacetylation)
    • This process is reversed by saponification
    • For this sections may be treated with 0.5% KOH in 70% alcohol for 30 minutes
    • During this procedure sections may detach hence 0.1% of chrome alum 1% of gelatin is used as adhesive
  • What is the technique of blocking preformed aldehyde groups in tissue sections
    • Treat sections with 10% aniline in acetic acid for 30 minutes at room temperature
    • wash in distilled water
    • Treat sections with Schiff reagent and continue as with routine PAS stain
  • What is PAS – diastase reaction
    • Sections are treated with 1% of malt diastase for 30 minutes at room temperature
    • Diastase digests the Glycogen in sections and later PAS staining will be negative
    • This is used to differentiate the glycogen form other PAS positive substances like mucins
  • What are the reagents required for PAS stain
    • Periodic acid 1%
    • Schiff’s reagent
    • Mayers Haematoxylin
  • What is the method for preparing Schiff’s reagent
    • Different methods available are
      • Lillie’s procedure
      • Itikawa and Ogura method
      • De Tomasi – Coleman method
      • Barger and Delamater method
    • Lillie’s procedure
      • Dissolve 1g basic fuscin and 1.19g Sodium metabisulfite in 100ml of 0.15N HCl.
      • Shake the solution at intervals for 2hrs
      • It should be clear and yellow to light brown
      • Add 0.5g of activated charcoal and shake 1 to 2 minutes
      • Filter into brown stock bottle and store at 0 to 40 C
  • How do we test the potency of Schiff’s reagent
    • Schiff’s reagent may be tested by adding a few drops to 3 to 5ml of 40% formaldehyde on a watch glass
    • Active reagent will give reddish purple colour rapidly.
    • If there is delayed development of colour it indicates the Schiff’s reagent is losing potency
  • What is the procedure for PAS stain
    •  Deparaffinize and hydrate to water.
    • Oxidize in 0.5% periodic acid solution for 5 minutes
    • Rinse in distilled water
    • Place in Schiff reagent for 15 minutes (Sections become light pink color during this step).
    • Wash in lukewarm tap water for 5 minutes (Immediately sections turn dark pink color).
    • Counterstain in Mayer’s hematoxylin for 1 minute.
    • Wash in tap water for 5 minutes.
    • Dehydrate and coverslip using a synthetic mounting medium.
    • Interpretation
      • PAS positive material – Magenta or Purplish red colour
      • Background – blue
  • Diagnostic importance of PAS stain
    • It is used to demonstrate glycogen and neutral mucoproteins. It is used to diagnose –
      • Poorly differentiated adenocarcinoma of various tissues like stomach, pancreas, lung
      • Hepatocellular carcinoma
      • Renal cell carcinoma
      • Seminoma
      • Dysgerminoma
      • Demonstrate intracytoplasmic crystals in alveolar soft part of sarcoma
      • demonstrate basement membrane
      • Demonstrate neutral mucin in Gastrointestinal tract
      • Demonstrate fungi in tissues
      • Diagnosis of block positivity in AML and AML diffuse cytoplasmic positivity in M5, M6, M9
References
  1. Cullings. Histotechniques. In: Lynch Medical Laboratory technology by Mathew J. Lynch, Stanely S. Raphael. Saunders publication 1983
  2. Dr. Ganga S. Pilli. Practical Pathology.2007  
  3. Sabitri Sanyal, Aparna Bhattacharya.Clinical Pathology A practical Manual. 3rd edition. 2017. 
By –
  • Dr. B. Syam Sundara Rao (Professor of Pathology, Narayana Medical College, Nellore)
  • Dr. V. Shanthi (Professor of Pathology, Narayana Medical College, Nellore)