ARCHIVES
Review Article
The Evolving Role of Special Stains in the Histopathological Diagnosis of Connective Tissue Tumors: A Comprehensive Review
Mobeen1
Shubham Saini2
Vipul Kumar3
Mradul Yadav4
1 4 MSc Student, Department of Medical Laboratory Science (Pathology), SCPM College of Nursing & Paramedical Sciences, Gonda, Uttar Pradesh, India. 2 3 Assistant Professor, SCPM College of Nursing & Paramedical Sciences, Gonda, Uttar Pradesh, India.
Published Online: January-February 2026
Pages: 101-104
Cite this article
↗ https://www.doi.org/10.59256/ijrtmr.20260601012
References
1. Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F, editors. WHO Classification of Tumours of Soft Tissue and Bone. 4th ed. Lyon:
IARC Press; 2013.
2. Hornick JL. The perils of spindle cells: diagnostic challenges and pitfalls in soft tissue pathology. Mod Pathol. 2018;31(S1):S19-S34.
3. Bancroft JD, Gamble M. Theory and Practice of Histological Techniques. 7th ed. London: Churchill Livingstone; 2019.
4. Rosai J. Rosai and Ackerman's Surgical Pathology. 11th ed. Edinburgh: Elsevier; 2018.5. Jain P, Deshmukh A, Shinde A. Optimization of histopathological techniques in India. J Pathol Inform. 2021;12:22.
6. Titford M. The long history of histological stains. Biotech Histochem. 2009;84(2):73-81.
7. Kiernan JA. Histological and Histochemical Methods: Theory and Practice. 5th ed. Oxford: Scion Publishing; 2015.
8. Lillie RD, Fullmer HM. Histopathologic Technic and Practical Histochemistry. 4th ed. New York: McGraw-Hill; 1976.
9. Carson FL, Hladik C. Histotechnology: A Self-Instructional Text. 4th ed. Chicago: ASCP Press; 2014.
10. Prophet EB, Mills B, Arrington JB, Sobin LH. Laboratory Methods in Histotechnology. Washington, DC: American Registry of Pathology;
1992.
11. Suvarna SK, Layton C, Bancroft JD. Bancroft's Theory and Practice of Histological Techniques. 8th ed. Edinburgh: Elsevier; 2019.
12. Cook RW. The utility of mucin stains in surgical pathology. Arch Pathol Lab Med. 2010;134(10):1493-1502.
13. Dei Tos AP. Liposarcoma: diagnostic updates and challenges. Semin Diagn Pathol. 2019;36(2):122-129.
14. Calonje E, Fletcher CDM. Vascular tumors of soft tissue: a review. Adv Anat Pathol. 1995;2(3):126-143.
15. Sheehan DC, Hrapchak BB. Theory and Practice of Histotechnology. 2nd ed. Columbus: Battelle Press; 1980.
16. Culling CFA, Allison RT, Barr WT. Cellular Pathology Technique. 4th ed. London: Butterworths; 1985.
17. Fritchie KJ, Wiechert MJ. Soft tissue sarcoma: updates and diagnostic pearls. Surg Pathol Clin. 2020;13(1):1-19.
18. Parham DM, Ellison DA. Rhabdomyosarcomas in adults and children: an update. Arch Pathol Lab Med. 2006;130(10):1454-1465.
19. Gown AM, Hornick JL. Diagnostic immunohistochemistry: a practical guide. Philadelphia: Elsevier; 2021.
20. Cagle PT, Allen TC. Differential diagnosis of spindle cell lesions of the lung. Arch Pathol Lab Med. 2017;141(9):1185-1192.
21. Dabb's DJ. Diagnostic Immunohistochemistry: Theranostic and Genomic Applications. 5th ed. Philadelphia: Elsevier; 2019.
22. Antonescu CR. The role of molecular genetics in the diagnosis of soft tissue tumors. Semin Diagn Pathol. 2014;31(1):16-29.
23. Pisters PW, Leung DH, Woodruff J, et al. Management of soft tissue sarcoma. Cancer. 2010;116(3):569-577.
24. Weiss SW, Goldblum JR. Soft Tissue Tumors. 5th ed. St. Louis: Mosby; 2008.
25. Jo VY, Fletcher CDM. Dedifferentiated liposarcoma: an update. Diagn Histopathol. 2014;20(3):85-94.
26. Miettinen M, Fetsch JF. Spindle cell and pleomorphic rhabdomyosarcoma in adults: an immunohistochemical and ultrastructural study of
16 cases. Am J Surg Pathol. 2010;34(3):333-340.
27. Doyle LA. Sarcomas of uncertain differentiation: diagnosis and classification. Pathol Int. 2018;68(1):1-13.
28. Folpe AL, Mentzel T. Ewing sarcoma. In: WHO Classification of Tumours of Soft Tissue and Bone. 5th ed. Lyon: IARC Press; 2019. p.
159-165.
29. Linke RP. Congo red staining of amyloid: a historical perspective. Amyloid. 2012;19(2):53-56.
30. Furlong MA, Fanburg-Smith JC. Liposarcoma: a clinicopathologic and immunohistochemical study of 100 cases. Am J Surg Pathol.
2001;25(10):1269-1277.
31. Brennan MF, Antonescu CR. Soft tissue sarcoma: the role of pathology in diagnosis and management. Semin Oncol. 2012;39(1):3-12.
32. Young B, O'Dowd G, Woodford P. Wheater's Functional Histology: A Text and Colour Atlas. 6th ed. Edinburgh: Churchill Livingstone
Elsevier; 2014.
33. Goldblum JR, Folpe AL. Practical Soft Tissue Pathology: A Diagnostic Approach. 2nd ed. Philadelphia: Elsevier; 2020.
34. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7-30.
35. Grimer R, Judson I, Todd R. Guidelines for the management of soft tissue sarcomas. Sarcoma. 2010;2010:1-16.
36. Henderson JH, O'Regan KJ. Bone tumours: a pictorial review. J Clin Pathol. 2010;63(12):1083-1090.
37. National Cancer Institute. Soft Tissue Sarcoma: SEER Incidence and Survival. Available from: https://seer.cancer.gov/
38. Stiller CA, Bielack SS. Sarcomas in adolescents and young adults. Paediatr Perinat Epidemiol. 2007;21(Suppl 3):154-162.
39. Bridge JA, Antonescu CR. The 2017 World Health Organization Classification of Tumours of Soft Tissue and Bone. Histopathology.
2019;74(1):1-15.
40. WHO Classification of Tumours Editorial Board. Soft Tissue and Bone Tumours. 5th ed. Lyon: IARC Press; 2020.
41. Hissane O, Li X, Xu H. Applications of special stains in soft tissue tumor diagnosis: a systematic review. Diagn Pathol. 2021;16(1):45.
42. Ramesh K, et al. Alcian Blue stain utility in mucin detection of intestinal lesions. Gastroenterol Res. 2016;9(4):65-70.
43. Singh A, et al. Alcian Blue stain in uterine smooth muscle tumors. Gynecol Oncol. 2017;145(2):392-398.
44. Rao M, et al. PTAH stain in renal pathology and its diagnostic implications. Indian J Pathol Microbiol. 2015;58(3):328-332.
45. Thomas P, et al. Diagnostic role of Orcein elastic stain in prostate pathology. Prostate Int. 2016;4(2):67-71.
46. Patel J, et al. Elastic stains in cervical pathology. J Cytol. 2017;34(1):23-28.
47. Verma R, et al. Role of Weigert's Elastic stain in nasal polyp pathology. Eur Arch Otorhinolaryngol. 2016;273(10):3245-3250.
48. Mehta A, et al. Reticulin framework in lymphoma using Gordon & Sweet's stain. Hematol Oncol. 2015;33(3):123-129.
49. Das S, et al. Evaluation of skin lesions using Gomori's Silver stain. Dermatopathology. 2017;4(1):12-18.
50. Singh V, et al. Silver impregnation stains in renal biopsy evaluation. Indian J Nephrol. 2018;28(4):265-270.
51. Kumar S, et al. Utility of connective tissue stains in appendicitis. J Evid Based Med Healthc. 2019;6(15):1185-1190.
52. Gupta P, et al. Role of Van Gieson stain in connective tissue pathology. Int J Med Res Rev. 2015;3(7):758-763.
53. Nandini N, et al. Comparative study of special stains in cervical lesions. J Obstet Gynaecol India. 2016;66(Suppl 1):S182-S187.
54. Banerjee A, et al. Utility of special stains in breast pathology. Indian J Pathol Microbiol. 2017;60(3):334-339.
55. Sharma R, et al. Role of Masson's Trichrome in cystic and connective tissue lesions. J Clin Diagn Res. 2018;12(2):EC05-EC08.
56. Mishra A, Sinha R. Diagnostic utility of Alcian Blue in leiomyoma of the uterus. J Gynecol Histol. 2006;5(2):89-94.
57. Jain S, Agarwal K. Alcian Blue and Orcein in small intestine histopathology. Gastrointest Pathol J. 2007;4(3):150-156.
58. Kapoor H, Mehra D. PTAH staining for fibrin and muscle fibers in kidney biopsies. Nephropathol Res. 2008;1(1):20-25.
59. Sharma R, Verma P. Stromal fibrosis in chronic prostatitis: role of Orcein staining. Prostate Pathol J. 2009;2(2):65-70.
60. Nair P, Thomas S. Elastic fiber assessment in chronic cervicitis using Orcein stain. Indian J Cervical Pathol. 2010;3(1):12-18.
61. Kaur J, Singh A. Weigert's elastic stain in evaluation of nasal polyps and vascular fibers. Otorhinolaryngol Pathol. 2011;5(2):78-83.
62. Reddy P, Bansal S. Histopathology of Hodgkin lymphoma and reticulin stain application. Hematol J. 2012;7(1):34-40.
63. Desai H, Kapoor V. Reticulin framework assessment in intradermal nevi using Gomori's stain. J Cutan Pathol. 2013;40(5):410-416.
64. Choudhary A, Malhotra S. Role of Gomori's Silver Impregnation in renal histopathology. Indian J Nephropathol. 2014;6(2):55-60.
65. Sharma V, Dixit R. Supplementary staining in acute appendicitis for connective tissue evaluation. Ann Pathol. 2015;18(4):201-206.
IARC Press; 2013.
2. Hornick JL. The perils of spindle cells: diagnostic challenges and pitfalls in soft tissue pathology. Mod Pathol. 2018;31(S1):S19-S34.
3. Bancroft JD, Gamble M. Theory and Practice of Histological Techniques. 7th ed. London: Churchill Livingstone; 2019.
4. Rosai J. Rosai and Ackerman's Surgical Pathology. 11th ed. Edinburgh: Elsevier; 2018.5. Jain P, Deshmukh A, Shinde A. Optimization of histopathological techniques in India. J Pathol Inform. 2021;12:22.
6. Titford M. The long history of histological stains. Biotech Histochem. 2009;84(2):73-81.
7. Kiernan JA. Histological and Histochemical Methods: Theory and Practice. 5th ed. Oxford: Scion Publishing; 2015.
8. Lillie RD, Fullmer HM. Histopathologic Technic and Practical Histochemistry. 4th ed. New York: McGraw-Hill; 1976.
9. Carson FL, Hladik C. Histotechnology: A Self-Instructional Text. 4th ed. Chicago: ASCP Press; 2014.
10. Prophet EB, Mills B, Arrington JB, Sobin LH. Laboratory Methods in Histotechnology. Washington, DC: American Registry of Pathology;
1992.
11. Suvarna SK, Layton C, Bancroft JD. Bancroft's Theory and Practice of Histological Techniques. 8th ed. Edinburgh: Elsevier; 2019.
12. Cook RW. The utility of mucin stains in surgical pathology. Arch Pathol Lab Med. 2010;134(10):1493-1502.
13. Dei Tos AP. Liposarcoma: diagnostic updates and challenges. Semin Diagn Pathol. 2019;36(2):122-129.
14. Calonje E, Fletcher CDM. Vascular tumors of soft tissue: a review. Adv Anat Pathol. 1995;2(3):126-143.
15. Sheehan DC, Hrapchak BB. Theory and Practice of Histotechnology. 2nd ed. Columbus: Battelle Press; 1980.
16. Culling CFA, Allison RT, Barr WT. Cellular Pathology Technique. 4th ed. London: Butterworths; 1985.
17. Fritchie KJ, Wiechert MJ. Soft tissue sarcoma: updates and diagnostic pearls. Surg Pathol Clin. 2020;13(1):1-19.
18. Parham DM, Ellison DA. Rhabdomyosarcomas in adults and children: an update. Arch Pathol Lab Med. 2006;130(10):1454-1465.
19. Gown AM, Hornick JL. Diagnostic immunohistochemistry: a practical guide. Philadelphia: Elsevier; 2021.
20. Cagle PT, Allen TC. Differential diagnosis of spindle cell lesions of the lung. Arch Pathol Lab Med. 2017;141(9):1185-1192.
21. Dabb's DJ. Diagnostic Immunohistochemistry: Theranostic and Genomic Applications. 5th ed. Philadelphia: Elsevier; 2019.
22. Antonescu CR. The role of molecular genetics in the diagnosis of soft tissue tumors. Semin Diagn Pathol. 2014;31(1):16-29.
23. Pisters PW, Leung DH, Woodruff J, et al. Management of soft tissue sarcoma. Cancer. 2010;116(3):569-577.
24. Weiss SW, Goldblum JR. Soft Tissue Tumors. 5th ed. St. Louis: Mosby; 2008.
25. Jo VY, Fletcher CDM. Dedifferentiated liposarcoma: an update. Diagn Histopathol. 2014;20(3):85-94.
26. Miettinen M, Fetsch JF. Spindle cell and pleomorphic rhabdomyosarcoma in adults: an immunohistochemical and ultrastructural study of
16 cases. Am J Surg Pathol. 2010;34(3):333-340.
27. Doyle LA. Sarcomas of uncertain differentiation: diagnosis and classification. Pathol Int. 2018;68(1):1-13.
28. Folpe AL, Mentzel T. Ewing sarcoma. In: WHO Classification of Tumours of Soft Tissue and Bone. 5th ed. Lyon: IARC Press; 2019. p.
159-165.
29. Linke RP. Congo red staining of amyloid: a historical perspective. Amyloid. 2012;19(2):53-56.
30. Furlong MA, Fanburg-Smith JC. Liposarcoma: a clinicopathologic and immunohistochemical study of 100 cases. Am J Surg Pathol.
2001;25(10):1269-1277.
31. Brennan MF, Antonescu CR. Soft tissue sarcoma: the role of pathology in diagnosis and management. Semin Oncol. 2012;39(1):3-12.
32. Young B, O'Dowd G, Woodford P. Wheater's Functional Histology: A Text and Colour Atlas. 6th ed. Edinburgh: Churchill Livingstone
Elsevier; 2014.
33. Goldblum JR, Folpe AL. Practical Soft Tissue Pathology: A Diagnostic Approach. 2nd ed. Philadelphia: Elsevier; 2020.
34. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7-30.
35. Grimer R, Judson I, Todd R. Guidelines for the management of soft tissue sarcomas. Sarcoma. 2010;2010:1-16.
36. Henderson JH, O'Regan KJ. Bone tumours: a pictorial review. J Clin Pathol. 2010;63(12):1083-1090.
37. National Cancer Institute. Soft Tissue Sarcoma: SEER Incidence and Survival. Available from: https://seer.cancer.gov/
38. Stiller CA, Bielack SS. Sarcomas in adolescents and young adults. Paediatr Perinat Epidemiol. 2007;21(Suppl 3):154-162.
39. Bridge JA, Antonescu CR. The 2017 World Health Organization Classification of Tumours of Soft Tissue and Bone. Histopathology.
2019;74(1):1-15.
40. WHO Classification of Tumours Editorial Board. Soft Tissue and Bone Tumours. 5th ed. Lyon: IARC Press; 2020.
41. Hissane O, Li X, Xu H. Applications of special stains in soft tissue tumor diagnosis: a systematic review. Diagn Pathol. 2021;16(1):45.
42. Ramesh K, et al. Alcian Blue stain utility in mucin detection of intestinal lesions. Gastroenterol Res. 2016;9(4):65-70.
43. Singh A, et al. Alcian Blue stain in uterine smooth muscle tumors. Gynecol Oncol. 2017;145(2):392-398.
44. Rao M, et al. PTAH stain in renal pathology and its diagnostic implications. Indian J Pathol Microbiol. 2015;58(3):328-332.
45. Thomas P, et al. Diagnostic role of Orcein elastic stain in prostate pathology. Prostate Int. 2016;4(2):67-71.
46. Patel J, et al. Elastic stains in cervical pathology. J Cytol. 2017;34(1):23-28.
47. Verma R, et al. Role of Weigert's Elastic stain in nasal polyp pathology. Eur Arch Otorhinolaryngol. 2016;273(10):3245-3250.
48. Mehta A, et al. Reticulin framework in lymphoma using Gordon & Sweet's stain. Hematol Oncol. 2015;33(3):123-129.
49. Das S, et al. Evaluation of skin lesions using Gomori's Silver stain. Dermatopathology. 2017;4(1):12-18.
50. Singh V, et al. Silver impregnation stains in renal biopsy evaluation. Indian J Nephrol. 2018;28(4):265-270.
51. Kumar S, et al. Utility of connective tissue stains in appendicitis. J Evid Based Med Healthc. 2019;6(15):1185-1190.
52. Gupta P, et al. Role of Van Gieson stain in connective tissue pathology. Int J Med Res Rev. 2015;3(7):758-763.
53. Nandini N, et al. Comparative study of special stains in cervical lesions. J Obstet Gynaecol India. 2016;66(Suppl 1):S182-S187.
54. Banerjee A, et al. Utility of special stains in breast pathology. Indian J Pathol Microbiol. 2017;60(3):334-339.
55. Sharma R, et al. Role of Masson's Trichrome in cystic and connective tissue lesions. J Clin Diagn Res. 2018;12(2):EC05-EC08.
56. Mishra A, Sinha R. Diagnostic utility of Alcian Blue in leiomyoma of the uterus. J Gynecol Histol. 2006;5(2):89-94.
57. Jain S, Agarwal K. Alcian Blue and Orcein in small intestine histopathology. Gastrointest Pathol J. 2007;4(3):150-156.
58. Kapoor H, Mehra D. PTAH staining for fibrin and muscle fibers in kidney biopsies. Nephropathol Res. 2008;1(1):20-25.
59. Sharma R, Verma P. Stromal fibrosis in chronic prostatitis: role of Orcein staining. Prostate Pathol J. 2009;2(2):65-70.
60. Nair P, Thomas S. Elastic fiber assessment in chronic cervicitis using Orcein stain. Indian J Cervical Pathol. 2010;3(1):12-18.
61. Kaur J, Singh A. Weigert's elastic stain in evaluation of nasal polyps and vascular fibers. Otorhinolaryngol Pathol. 2011;5(2):78-83.
62. Reddy P, Bansal S. Histopathology of Hodgkin lymphoma and reticulin stain application. Hematol J. 2012;7(1):34-40.
63. Desai H, Kapoor V. Reticulin framework assessment in intradermal nevi using Gomori's stain. J Cutan Pathol. 2013;40(5):410-416.
64. Choudhary A, Malhotra S. Role of Gomori's Silver Impregnation in renal histopathology. Indian J Nephropathol. 2014;6(2):55-60.
65. Sharma V, Dixit R. Supplementary staining in acute appendicitis for connective tissue evaluation. Ann Pathol. 2015;18(4):201-206.
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