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Fine Structure and Histochemistry of Epithelioid Cells in Sarcoidosis Thorax: first published as 10.1136/thx.29.1.115 on 1 January 1974. Downloaded from Thorax (1974), 29, 115. Fine structure and histochemistry of epithelioid cells in sarcoidosis E. M. VALERIE JAMES and W. JONES WILLIAMS Pathology Department, Welsh National School of Medicine, The Heath, Cardiff James, E. M. Valerie and Jones Williams, W. (1974). Thorax, 29, 115-120. Fine structure and histochemistry of epithelioid cells in sarcoidosis. In this fine structure study of epithelioid cells in the granulomata of sarcoidosis we confirm our previous findings that they appear to be synthesizing rather than phagocytosing cells. The numerous characteristic intracyto- plasmic vesicles, 0 5 ,u in size, are shown to contain mucoglycoprotein and only rarely acid phosphatase activity. Epithelioid cells show varying quantities of extravesicular acid phos- phatase activity which is sometimes on the outer surface of the protein-containing vesicles. The possible role of secretory products of epithelioid cells in the formation and persistence ofgranulomata is discussed. It is suggested that epithelioid cells may be forming lymphokines. We have previously demonstrated that the fine that of Ericsson and Trump (1965) using the lead structure of granulomata in sarcoidosis and tuber- nitrate Gomori technique. Substrate-free and sodium culosis (Jones Williams, Erasmus, James, and fluoride control blocks were also prepared. After being Davies, 1970), in the Kveim test lesion (Jones washed in acetate buffer solutions the tissues were post-fixed in Millonig's osmium tetroxide, dehydrated, Williams, 1972), and in chronic beryllium disease and embedded in Araldite. Sections were cut on an (Jones Williams, Fry, and James, 1972a) are LKB ultramicrotome and 0.5 ,u sections were stained http://thorax.bmj.com/ similar. The constituent epithelioid and giant cells with toluidine blue for light microscopy identification show numerous intracytoplasmic vesicles, varying of epithelioid cell granulomata. Ultrathin sections were in size from 04 to 07 ,u in diameter, and contain examined, either unstained or stained with uranyl amorphous lightly granular material (Fig. 1). acetate only. Evidence of active or previous phagocytosis in In order to assess the methods used we examined epithelioid cells is uncommon, and we consider and demonstrated intravesicular acid phosphatase that the cells are essentially biosynthetic rather activity in macrophages from a number of tissues, than phagocytic. including inflammatory lymph nodes, hyperplastic spleen, and biochemically proven lysosomal fractions on October 2, 2021 by guest. Protected copyright. Our present histochemical study demonstrates from another hyperplastic spleen. that the majority of the vesicles contain muco- glycoproteins but not acid phosphatase. The sig- MUCOGLYCOPROTEINS Tissue blocks from two medi- nificance of these findings and the possible role astinal sarcoid lymph nodes and one positive Kveim of secretory substances in granuloma formation biopsy were fixed in 3% glutaraldehyde in 0-1 M are discussed. phosphate buffer pH 7-4 for two to four hours. After being washed ovemight in 0-1 M phosphate buffer the tissue was dehydrated, without postfixation in MATERIAL AND METHODS osmium tetroxide, and embedded in Araldite. Ultrathin sections of granulomatous areas were ACID PHOSPHATASE Tissue blocks of three sarcoid mounted on uncoated gold grids and were stained lymph nodes and one sarcoid skin biopsy were fixed for the detection of 1:2 glycol groups using the in 3% glutaraldehyde in 0-067 M cacodylate buffer, periodic acid, chromic acid silver methenamine (PA- pH 7-4 for two to four hours. After being washed CrA-silver) technique of Rambourg (1967) and overnight in 01 M cacodylate buffer the tissues were Rambourg, Hernandez, and Leblond (1969). Control incubated for 15 to 30 minutes in the acid phosphatase grids included those (a) unoxidized, and (b) blocked medium as either minute tissue blocks or 50 a Sorvall for four hours with a 2: 3 solution of acetic anhydride sections. The acid phosphatase technique used was and pyridine before oxidation. 115 Thorax: first published as 10.1136/thx.29.1.115 on 1 January 1974. Downloaded from 116 E. M. Valerie James and W. Jones Williams A.. 444~~~~~~~~~~~~~~~~~ ~~~ ~~~ ~~~ ~~~ ~~ ~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~; 4, ZAL http://thorax.bmj.com/ ~~~47~~~Mv~~~I-fl 9. 'A flG1Epithelicid cell shoIn(V)C abnatlgtysandveils()lreadnmeosGlicmlxsn (M) miohnra lcrnmirgah(E)x3,5 on October 2, 2021 by guest. Protected copyright. Thorax: first published as 10.1136/thx.29.1.115 on 1 January 1974. Downloaded from 4 4 -L & -9 4. t1 s. t r #> A,, .F* 4 t f .... O ..w .t t . -F ,. ;sw t § F .s *s S .. w I §. kl,. , :,N.V tI ,i. '.'O.. http://thorax.bmj.com/ on October 2, 2021 by guest. Protected copyright. :K w:. s - ll4n ::h~~~~-i- >^ M;6 .!St .S?s o s v~ < f~~~~~~~~4> ^ ^ s X s b bi X s. S~~~~~~~~~~~4 b " ^' a w !> r~~~~~~~~ FlG. 2. Extravesicular acidphosphatase activity in epithelioid cell. Modified Gomori technique. EM x 35,650. Thorax: first published as 10.1136/thx.29.1.115 on 1 January 1974. Downloaded from 118 E. M. Valerie James and W. Jones Willianms t S F 4 -11 V I ... OP *IF http://thorax.bmj.com/ on October 2, 2021 by guest. Protected copyright. FIG. 3. PA-CrA-silver stained vesicles illustrating the presence of 1: 2 glycol groups in an epithelioid cell. EMx 31,185. RESULTS pale vesicles which on light microscopy appeared foamy. Those with less heavy enzyme staining ACID PHOSPHATASE The localization of acid contained fewer, smaller, and more granular phosphatase, sodium ,3-glycerophosphatase in vesicles which were inconspicuous on light micro- epithelioid cells was similar when studied in 50 ,u scopy. Sorvall sections or tiny blocks. The epithelioid The enzyme staining was only rarely within the cells showed slight to heavy granular lead deposits characteristic vesicles but was sometimes attached free in the cytoplasm surrounding the mitochondria to their outer membrane. However, occasional and characteristic vesicles (Fig. 2). Those cells with cells showed a few small isolated vesicles with heavy enzyme staining contained abundant, large, heavy enzyme staining. Lymphocytes and non-epi- Thorax: first published as 10.1136/thx.29.1.115 on 1 January 1974. Downloaded from Fine structure and histochemistry of epithelioid cells in sarcoidosis 119 thelioid mononuclear cells also showed occasional phagocytic (macrophage type) cells. They rarely stained vesicles but no generalized cytoplasmic contain foreign material, residual bodies, phago- staining. cytic vesicles or acid phosphatase containing The majority of cell nuclei showed a varying vesicles. Our results also show that they do contain density of lead staining but this could not be numerous nmucoglycoprotein-containing vesicles, correlated with the cell type. Golgi complexes, and mitochondria. We cannot Both the substrate-free and sodium fluoride accept that the so-called 'epithelioid cells' pro- control technique resulted in completely negative duced under experimental conditions and develop- acid phosphatase staining in all epithelioid cells. ing from monocytes/macrophages (Papadimitriou and Spector, 1971 and 1972) are comparable to MUCOGLYCOPROTEINS The epithelioid and giant human epithelioid cells. These experimental cells cell vesicles gave a strong positive reaction with are rarely in closely packed foci, as in the human PA-CrA-silver technique (Fig. 3). The larger situation, are often described as containing lyso- vesicles gave a stronger reaction than the smaller somes, lipid droplets, and sometimes phagocytosed vesicles and the reaction product was most con- debris, and do not contain the characteristic 0-5 ,u spicuous on the inner aspect of the vesicle mem- diameter vesicles of human epithelioid cells. brane. Many of the vesicles showed a central On light microscopy we have previously demon- globular area of negative staining. Unoxidized strated (Williams, Jones Williams, and Williams, and blocking controls resulted in negative staining. 1969) with the Gomori technique the presence of These results demonstrate the presence of 1: 2 acid phosphatase in epithelioid cells and interpreted glycol-groups in the vesicles. the findings as indicating the presence of lyso- Both epithelioid and giant cells also show vary- somes. However, our present ul(trastructural ing numbers of electron dense, 222-296 A results do not confirm the above findings as the diameter, particles. These are randomly distributed enzyme activity when present was predominantly throughout the cytoplasm and are occasionally extravesicular and sometimes attached to the outer aggregated within membrane-bound vesicles. These membrane of the vesicles. We cannot explain the particles are considered to be glycogen as they difference merely on technique as within the same do not stain with the silver methenamine technique tissue we could show intravesicular staining in after periodic oxidation alone but are stained non-epithelioid cells and in macrophages in inflam- after treatment with both periodic and chronic matory lymph nodes. Further, we think it unlikely acids. This result is similar to that obtained in that intravesicular enzyme has leaked into the staining glycogen in liver. The particles are not cytoplasm because the dense activity which would http://thorax.bmj.com/ ribosomes, as ribosomes are difficult to visualize in have been expected on the inner surface of the
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