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Mastocytosis : Toluidine Blue

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Metachromatic Staining: The mast cell burden in mastocytosis can be assessed with Giemsa or Toluidine Blue stains. The mast cell granules are metachromatic i.e. they stain a different color (purple to red) than the color of the dye used (toluidine blue).

Mast cells appear as medium-sized round to oval cells with abundant cytoplasm containing densely packed metachromatic granules. Mast cells also stain with chloroacetate esterase and are negative for myeloperoxidase.

Irrespective of the subtype of mastocytosis, the mast cell burden in the skin, bone marrow, gastrointestinal tract, lymph nodes, liver, and spleen increases with time. Patients with indolent systemic mastocytosis and aggressive forms such as aggressive systemic mastocytosis and mast cell leukemia have significant mast cell burdens.

Image courtesy of: Miguel Guzman, MD, St. Louis, Missouri, USA; used with permission.

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