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病理醫(yī)生也要關(guān)注“富營養(yǎng)化”現(xiàn)象

Eutrophication in histopathology

組織病理學(xué)中的富營養(yǎng)化

Eutrophication is the term used to define the process by which some habitats such as lakes, reservoirs, streams or bays become overloaded with nutrient-rich water.

富營養(yǎng)化是用來定義某些棲息地，如湖泊、水庫、溪流或海灣，因富營養(yǎng)水而超載的過程。

360百科：富營養(yǎng)化是指湖泊、河流、水庫等水體中氮磷等植物營養(yǎng)物質(zhì)含量過多所引起的水質(zhì)污染現(xiàn)象。由于水體中氮磷營養(yǎng)物質(zhì)的富集，引起藻類及其他浮游生物的迅速繁殖，使水體溶解氧含量下降，造成藻類、浮游生物、植物、水生物和魚類衰亡甚至絕跡的污染現(xiàn)象。

This process can occur in both freshwater and saltwater habitats. When this occurs, large blooms of algae and aquatic plants grow as a result of an excess of nitrogen and phosphorus. Excess phosphorus often causes eutrophication in freshwater, whereas nitrogen is responsible for this phenomenon in saltwater. The sources of these excess nutrients in these habitats include agricultural runoff, overuse of synthetic fertilisers, and sewage leaks, among others. Additionally, certain climatic conditions such as high temperatures and low rain may also promote eutrophication.

這一過程可以發(fā)生在淡水和咸水棲息地。當(dāng)這種情況發(fā)生時，由于氮和磷的過量，藻類和水生植物大量繁殖。過量的磷常導(dǎo)致淡水富營養(yǎng)化，而氮則是造成這一現(xiàn)象的原因。這些棲息地中過量養(yǎng)分的來源包括農(nóng)業(yè)徑流、過度使用合成肥料、污水泄漏等。此外，某些氣候條件，如高溫和low rain，也可能促進(jìn)富營養(yǎng)化。

In histopathology laboratories, tap water is utilised for different purposes, such as tissue flotation baths, tissue processors, and certain staining techniques, such as staining with haematoxylin and eosin, Masson’s trichrome, Oil-red O, and Gomori methenamine-silver. However, tap water may be contaminated by freshwater algae and other microorganisms, owing to the eutrophication of the habitats that provide freshwater to the population.

在組織病理實驗室，自來水被用于不同的用途，例如組織漂浮浴、組織處理器和某些染色技術(shù)，例如HE染色、Masson三色染色、油紅O染色和Gomori甲胺銀染色。然而，由于為人類提供淡水的棲息地富營養(yǎng)化，自來水可能受到淡水藻類和其他微生物的污染。

In fact, algal contamination by a member of the Staurastrum genus of the Chlorophyta (a green alga) on histological sections stained with the periodic acid–Schiff reagent and the Grocott silver method has been reported, the most probable source being the main water supply common to both cytopathology and histopathology laboratories.

事實上已有報道，在用PAS和Grocott銀染色法染色的組織切片上出現(xiàn)綠藻污染現(xiàn)象，最可能的來源是細(xì)胞病理學(xué)和組織病理學(xué)實驗室共有的主要供水。

Herein, we report our experience with this form of contamination, and describe some examples of histological slides that were contaminated by freshwater algae because of their presence in the tap water used in the laboratory.

在此報告我們在這種形式的污染方面的經(jīng)驗，并描述一些組織切片的例子，這些切片是由于實驗室使用的自來水被淡水藻類污染。

Figure 1A shows the presence, in a kidney histological section, of a filamentous structure formed by a single row of several rectangular/cuboidal blue cells (Σ7 μm in width) arranged end to end. On the basis of the morphology, this structure was catalogued as a member of the Cyanobacteria (blue-green fresh algae), belonging to the genus Oscillatoria, family Oscillatoraceae, class Chroobacteria.

圖1A（左上）顯示在腎臟組織切片中，由一排首尾相連的單列數(shù)個矩形/立方藍(lán)色細(xì)胞形成的絲狀結(jié)構(gòu)。根據(jù)形態(tài)特征，該結(jié)構(gòu)被歸為藍(lán)藻（藍(lán)綠色新鮮藻類）一員，為Oscillatoria屬，Oscillatoraceae科，Chroobacteria綱。

Figure 1B shows the presence, in a skeletal muscle histological section, of a non-branched filamentous structure of a blackish hue formed by a chain of cylindrical barrel-shaped cells (4～6μm in length) with a gelatinous sheath of reddish hue. On the basis of the morphology, this structure was catalogued as a member of the Cyanobacteria, belonging to the genus Anabaena, order Nostocales, class Homogoneae.

圖1B（右上）顯示骨骼肌組織切片中存在一種黑色的非分枝絲狀結(jié)構(gòu)，由一系列圓柱形筒狀細(xì)胞（長4～6μm）形成，鞘呈紅色，膠狀。在形態(tài)學(xué)基礎(chǔ)上，將其歸為藍(lán)藻一員，為Anabaena屬，Nostocales目，Homogoneae綱。

Figure 1C shows the presence, in a uterine cervix histological section, of a non-branched elongated structure with thick walls, formed by numerous cuboidal cells (7～12μm in width). Each cell possesses one chloroplast located at the margin. Slight narrowings along the side walls can also be observed. On the basis of the morphology, this structure was catalogued as a green fresh alga, belonging to the genus Ulothrix, class Ulvophyceae, division Chlorophyta.

圖1C（左下）顯示子宮頸組織切片中存在由許多立方細(xì)胞（寬7～12μm）形成的壁厚的無分枝細(xì)長結(jié)構(gòu)。每個細(xì)胞邊緣有一個葉綠體。還可以觀察到沿側(cè)壁的輕微變窄。根據(jù)形態(tài)特征，該結(jié)構(gòu)被歸為一種綠色的淡水藻類，為Ulothrix屬，Ulvophyceae綱，division Chlorophyta。

Figure 1D shows the presence, in a brain histological section, of six non-branched filamentous structures, slightly twisted, of a darkish hue, each formed by a row of cuboidal cells (0.8～2μm in length) with clear cytoplasm and with narrow intercellular spaces. The cells are surrounded by a thin gelatinous sheath. On the basis of the morphology, this structure was catalogued as a member of the Cyanobacteria, belonging to the genus Phormidium, family Oscillatoraceae, class Cyanophyceae.

圖1D（右下）顯示，在腦組織切片中，存在六個微扭曲的暗色調(diào)的非分枝絲狀結(jié)構(gòu)，每一個結(jié)構(gòu)由一排胞質(zhì)清晰、細(xì)胞間隙狹窄的立方細(xì)胞（長0.8～2μm）組成。細(xì)胞被一層薄薄的膠狀鞘所包圍。根據(jù)其形態(tài)特征，歸為藍(lán)藻一員，為Phormidium屬，Oscillatoraceae科，Cyanophyceae綱。

Similarly, in cytological smears, the presence of diverse types of freshwater algae as contaminants has been reported, the cause also being contamination of tap water.

同樣，在細(xì)胞學(xué)涂片中，也有不同類型的淡水藻類作為污染物的報道，其原因也是自來水受到污染。

Eutrophication is one of the causes of the deterioration of water quality. Thus, the contamination of reservoirs by freshwater algae might explain the presence of these microorganisms in the tap water used not only in laboratories, but also in hospitals as drinking water. Consequently, the significance of this finding is two-fold.

富營養(yǎng)化是導(dǎo)致水質(zhì)惡化的原因之一。因此，淡水藻類對水庫的污染可能解釋了這些微生物在自來水中的存在，這些自來水不僅用作實驗室用水，也用作醫(yī)院的飲用水。因此，這一發(fā)現(xiàn)的意義是雙重的。

Some species of freshwater algae (mainly members of the Cyanobacteria) can produce powerful toxins, such as neurotoxic alkaloids (anatoxins), peptide hepatotoxins (microcystins), and cytotoxic alkaloids (cylindrospermopsins), which present a risk to human health. On the other hand, and because of their morphology, freshwater algae such as those described in this article may be misidentified as filamentous fungi or larvae of certain parasitic worms (e.g. filarial and rhabditiform nematodes).

一些淡水藻類（主要是藍(lán)藻的成員）能夠產(chǎn)生強大的毒素，如神經(jīng)毒性生物堿（毒傘肽）、肽類肝毒素（microcystins）和細(xì)胞毒性生物堿（cylindrospermopsins），這對人體健康構(gòu)成危險。另一方面，由于其形態(tài)，如本文所述的淡水藻類可能被誤認(rèn)為是絲狀真菌或某些寄生蠕蟲的幼蟲。（如絲蟲和rhabditiform nematodes）

As is the case with other types of contaminant (‘floaters’), that may arise during tissue processing and slide preparation and be a potential cause of misdiagnosis in surgical pathology, we think that the presence of freshwater algae in histopathological slides because of eutrophication and their consequent presence in laboratory tap water, should also be of concern to, and recognised by, cellular pathologists.

與其他類型的污染物（“漂浮物”）一樣，在組織處理和玻片制備過程中可能出現(xiàn)，并且可能是外科病理學(xué)誤診的潛在原因，我們認(rèn)為，由于富營養(yǎng)化，組織病理學(xué)玻片中存在淡水藻類，以及它們在實驗室自來水中的存在，也應(yīng)該引起細(xì)胞病理醫(yī)生的關(guān)注和認(rèn)可。

Figure 1. Histological sections showing the presence of diverse types of freshwater algae. A（左上）, Kidney, genus Oscillatoria [haematoxylin and eosin (HE)]. B（右上）, Skeletal muscle, Cyanobacteria (HE). C（左下）, Uterine cervix, Ulothrix (HE). D（右下）, Brain, Phormidium (H&E).

參考文獻(xiàn)：

[1] Eutrophication in histopathology.Histopathology,2019,75,137-138.

DOI: 10.1111/his.13852.