Speckled ANA pattern called Nuclear Matrix
This pattern is characterized by coarse granular speckled staining in the nucleus of the interphase cells. The nucleoli do not stain and the speckles tend to outline the nucleoli. Follow-up testing is recommended to rule out antibodies to the extractable nuclear antigens (ENAs) such as Sm or U1-RNP. Nuclear matrix antibodies are not specific for a single SARD. In the ICAP recommendations, this pattern is grouped with the large coarse speckled pattern AC-5.
This pattern is reported as "ANA positive, Speckled; titering is necessary."
Midbody ANA pattern (AC-27)
In this pattern, there is no staining in the early interphase cells; however, fine speckling is present by late interphase. In metaphase, the speckling is located in the chromosomal area and is very similar to centromere staining. As the cells progress into anaphase and telophase, staining is seen in the intercellular bridge. No follow-up testing is necessary. This pattern has low predictive value for any disease.
This pattern is reported as "ANA positive, Midbody; titering is optional."
Other unusual speckled ANA patterns
Unusual speckled ANAs are not limited to the few mentioned here. Over 150 different autoantigens have been identified in SLE patients alone. When an unusual pattern is encountered, remember to go back to basics, positive or negative, and, if positive, what major group best describes it: Homogeneous, Speckled, Nucleolar, et al.
Unusual other speckled ANA patterns are commonly reported as "unusual speckled, include titer with no follow-up recommendation."
