Nucleolar (AC9)

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The page below is a sample from the LabCE course Autoimmune Diseases and Antinuclear Antibody Testing: Methods and Staining Patterns. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

Learn more about Autoimmune Diseases and Antinuclear Antibody Testing: Methods and Staining Patterns (online CE course)
Nucleolar (AC9)

This is an example of a Nucleolar ANA pattern.
This pattern is characterized by staining in the nucleoli of the interphase cells (a). The nucleolar staining can display subtle variations in staining inside the nucleoli including smooth, speckled and clumpy. All are reported as "ANA positive, Nucleolar."
In sample (b) staining is present in the chromosomal area of the metaphase mitotic cells along with some staining in the area outside of the chromosomal area. The staining of the mitotics can be different with different anti-nucleolar antibodies. Remember, the ANA pattern is determined by staining in the interphase cells, and the mitotics are used to assist in interpretation.
Follow-up testing for anti-nucleolar antibodies is very limited and, in most cases, not done. There are assays for identification of anti-RNP polymerase antibodies. Anti-nucleolar antibodies are primarily seen in patients with systemic sclerosis.
This pattern is reported as "ANA positive, Nucleolar; titering is necessary."
Interphase cells
  • Staining only of the nucleoli
    • Clumpy
    • Smooth
    • Speckled
Metaphase mitotic cells
  • Can demonstrate variable staining depending on the antigen involved