Abstract • Mastocytosis, a disease that varies in its clinical presentation, is usually documented by histologic examination of lesional skin. However, no universally accepted histopathologic criteria exist for establishing the diagnosis of this disease. We have combined the method of morphometric point counting with the mast cell-specific stain, conjugated avidin, to accurately quantify mast cells in cutaneous tissue sections of mastocytosis. Using this histologic approach, we found that macules, papules, and nodules of mast cell disease had from ninefold to nearly a 160-fold greater mast cell content than was observed in normal skin and in several other cutaneous disorders. This technique also permitted the objective histologic stratification of mastocytosis skin lesions according to their mast cell density. Morphometric point counting in conjunction with conjugated avidin offers a simple and accurate method for establishing the diagnosis of mastocytosis. (Arch Dermatol 1987;123:1017-1021) References 1. Mikhail GR, Miller-Milinska A: Mast cell population in human skin . J Invest Dermatol 1964;43:249-254.Crossref 2. Cawley EP, Hoch-Ligeti C: Association of tissue mast cells and skin tumors . Arch Dermatol 1961;83:146-150.Crossref 3. Mihm MC Jr, Soter NA, Dvorak HF, et al: The structure of normal skin and the morphology of atopic eczema . J Invest Dermatol 1976;67:305-312.Crossref 4. Natbony SF, Phillips ME, Elias JM, et al: Histologic studies of chronic idiopathic urticaria . J Allergy Clin Immunol 1983; 73:177-183.Crossref 5. Hellstrom B, Holmgren HJ: Numerical distribution of mast cells in the human skin and heart . Acta Anat 1950;10:81-107.Crossref 6. Mills J, Strickland G, Paterson JC: The validity of tissue mast cell counts in postmortem material . Arch Pathol Lab Med 1958; 66:330-334. 7. Eady RAJ: The mast cells: Distribution and morphology . Clin Exp Dermatol 1976;1:313-321.Crossref 8. Devitt JE, Samuels PB, Pirozynski WJ, et al: Morphology of tissue mast cells: The frequency of artifacts and the influence of certain biologic agents . Am J Pathol 1954;30:391-401. 9. Kramer H, Windrum GM: The metachromatic staining reaction . J Histochem Cytochem 1955;3:227-237.Crossref 10. Montagna W, Melaragno HP: Histology and cytochemistry of human skin: III. Polymorphism and chromotrophy of mast cells . J Invest Dermatol 1953;20:257-261. 11. Aherne WA, Dunhill MS: Morphometry . Bath, England, Edward Arnold Publishers Ltd, 1980, pp 1-59. 12. Muntz KH, Hagler HK, Boulas HJ, et al: Redistribution of catecholamines in the ischemic zones of the dog heart . Am J Pathol 1984;114:64-78. 13. Bergstresser PR, Tigelaar RE, Tharp MD: Conjugated avidin identifies cutaneous rodent and human mast cells . J Invest Dermatol 1984;83:214-218.Crossref 14. Tharp MD, Seelig LL, Tigelaar RE, et al: Conjugated avidin binds to mast cell granules . J Histochem Cytochem 1985;33:27-32.Crossref 15. Kasper CS, Tharp MD: Quantification of cutaneous mast cells using morphometric point counting and a conjugated avidin stain . J Am Acad Dermatol 1986;16:326-331.Crossref 16. Roberts LJ, Fields JP, Oats JA: Mastocytosis without urticaria pigmentosa: A frequently unrecognized cause of recurrent syncope . Trans Assoc Am Physicians 1982;95:36-41. 17. Sahihi T, Easterly NB: Atypical diffuse cutaneous mastocytosis . AJDC 1972;124:133-135. 18. Kendall ME, Fields JP, King LE Jr: Cutaneous mastocytosis without clinically obvious skin lesions . J Am Acad Dermatol 1984; 10:903-905.Crossref 19. Mihm MC, Clark WH, Reed RJ, et al: Mast cell infiltrates of the skin and the mastocytosis syndrome . Hum Pathol 1973;4:231-239.Crossref 20. Sagher F, Even-Paz Z: Mastocytosis and the Mast Cell . Chicago, Year Book Medical Publishers Inc, 1967, pp 55-92. 21. Tharp MD: The spectrum of mastocytosis . Am J Med Sci 1985;289:119-132.Crossref 22. Olafsson JH, Roupe G, Enerbäck L: Dermal mast cells in mastocytosis: Fixation, distribution, and quantitation . Acta Derm Venereol 1986;66:16-22.
Archives of Dermatology – American Medical Association
Published: Aug 1, 1987