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Formalin alternatives in diagnostic pathology

L Benerini Gatta, M Cadei, P Balzarini, S Castriciano, R Paroni, A Verzeletti, V Cortellini, F De Ferrari, P Grigolato

European Journal of Histochemistry


Formalin alternatives have been found in diagnostic pathology where fixation is a critical step in the preparation of tissues for histopathology.

The objective of this study was to investigate the effects of different fixatives vs formalin on proteins and DNA, and to evaluate alternative fixation for morphological diagnosis and nucleic acid preservation for molecular methods.

Forty tissues were fixed for 24 h with six different fixatives: the gold standard fixative formalin, the historical fixatives Bouin and Hollande, and the alternative fixatives Greenfix, UPM and CyMol.

Tissues were stained (Haematoxylin-Eosin, Periodic Acid Schiff, Trichromic, Alcian-blue, High Iron Diamine), and their antigenicity was determined by immunohistochemistry (performed with PAN-CK, CD31, Ki-67, S100, CD68, AML antibodies).

DNA extraction, KRAS sequencing, FISH for CEP-17, and flow cytometry analysis of nuclear DNA content were applied. For cell morphology the alternative fixatives (Greenfix, UPM, CyMol) were equivalent to formalin. As expected, Hollande proved the best fixative for morphology.

The morphology obtained with Bouin was comparable to that with the first material. Hollande was the best fixative for histochemistry.

The alternative fixatives were equivalent to formalin, although with greater variability in haematoxylin-eosin staining.

It proved possible to obtain immunohistochemical staining largely equivalent to that following formalin-fixation with the following fixatives: Greenfix, Hollande, UPM and CyMol.

The DNA extracted from samples fixed with alternative fixatives was found to be suitable for molecular analysis.


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