In this mixed pattern, one observes the Speckled ANA pattern; granular/speckled staining in the nucleus of the interphase cells (b); no staining in nucleoli; the absence of staining in the chromosomal area of the metaphase mitotic cells; and some speckling in the area outside of the chromosomal area (a) along with the hyperexpressing cells demonstrating the SS-A/Ro pattern.
In cases of mixed speckled and SS-A/Ro, follow-up testing for anti-ENA antibodies is necessary.
This pattern is reported as "ANA positive, Speckled and SS-A/Ro pattern, anti-SS-A/Ro antibodies present; titering is necessary."
