Comparative light microscopical and X-ray microanalysis study of barium granuloma

Barium Sulfate Deposition in the Gastrointestinal Tract: Review of the literature

BACKGROUND

Barium sulfate is utilized for imaging of the gastrointestinal tract and is usually not deposited within the wall of the intestine. It is thought that mucosal injury may allow barium sulfate to traverse the mucosa, and allow deposition to occur uncommonly. Most pathology textbooks describe the typical barium sulfate deposition pattern as small granular accumulation in macrophages, and do not describe the presence of larger rhomboid crystals. This review will summarize the clinical background, radiographic, gross, and microscopic features of barium sulfate deposition in the gastrointestinal tract. A review of the PubMed database was performed to identify all published cases of barium sulfate deposition in the gastrointestinal tract that have been confirmed by pathologic examination.

CONCLUSIONS

A review of the literature shows that the most common barium sulfate deposition pattern in the gastrointestinal tract is finely granular deposition (30 previously described cases), and less commonly large rhomboid crystals are seen (19 cases) with or without finely granular deposition. The fine granules are typically located in macrophages, while rhomboid crystals are usually extracellular. There are various methods to support that the foreign material is indeed barium sulfate, however, only a minority of studies perform ancillary testing. Scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM/EDS) can be useful for definitive confirmation. This review emphasizes the importance of recognizing both patterns of barium sulfate deposition, and the histologic differential diagnosis.

Xanthogranulomatous gastritis: association with xanthogranulomatous cholecystitis

A case of xanthogranulomatous inflammation of the gastric wall is reported. The lesion was associated with adherent xanthogranulomatous cholecystitis and simulated, clinically, a malignant neoplasm. Histologically, foamy histiocytes, multi-nucleated giant cells, other inflammatory cells, fibrous reaction with spindle cells and cholesterol clefts were found.

Unusual histological appearances of barium sulphate--a case report with scanning electron microscopy and energy dispersive x ray analysis

Multiple birefringent rhomboidal crystals seen on histological examination of a resected oesophagus were subsequently found to contain elemental barium and sulphur on energy dispersive x ray ( EDX ) analysis. Scanning electron microscopy and EDX analysis of readily available commercial barium sulphate suspensions suggested that the two forms of barium sulphate previously described in tissue sections may be a result of the method of preparation of the commercial suspension used. With increased use of barium sulphate prepared by crushing the natural compound, birefringent rhomboidal crystals should be found with increasing frequency in endoscopic biopsy samples and resected specimens.

Observations on the histochemistry of barium

The histochemistry of barium was investigated with particular reference to the use of sodium rhodizonate. It was found that not all batches of sodium rhodizonate were able to effect satisfactory visualisation of barium deposits. None of the other histological parameters considered gave a consistent indication of the presence of barium.