Neuromuscular

Home, Search, Index, Links, Pathology, Molecules, Syndromes,
Muscle, NMJ, Nerve, Spinal, Ataxia, Antibody & Biopsy, Patient Info


MUSCLE BIOPSY

Methods
  Selection of muscle to biopsy
  Biopsy freezing
  Biopsy procedures
  Stains
  Biopsy request form: PDF

Clinical
  How to read a muscle biopsy
  Indications
  Results: Differential diagnosis
  Pathology: Index
  Unknowns

Nerve biopsy

Vesalius

Gowers

GENERAL INDICATIONS FOR MUSCLE BIOPSIES

SELECTION OF MUSCLE TO BIOPSY

BIOPSY PROCEDURES


HOW TO READ A MUSCLE BIOPSY

General questions to keep in mind

MUSCLE BIOPSY STAINS

Category Method Utility
Morphology Hematoxylin and eosin Muscle fiber pathology; Nuclei
Verhof van Giesson (VvG)Connective tissue; Vessel structure
Intramuscular nerve
Gomori trichrome Connective tissue; Nemaline rods
Fiber Type Enzymes Myofibrillar ATPase Muscle fiber type grouping or Atrophy
  ATPase pH 9.4 Myosin loss; Type 1 or 2 fiber atrophy
  ATPase pH 4.6Type 2B muscle fibers
  ATPase pH 4.3Type 2C (Immature) muscle fibers
Blood vessels
Oxidative Enzymes NADH-TR Muscle fiber internal architecture;
Tubular aggregates; Cores
Succinate dehydrogenase Mitochondrial pathology
  Nuclear DNA encoded complex
Cytochrome oxidase Mitochondrial pathology
  Mitochondrial & Nuclear DNA encoded
Glycolytic Enzymes Phosphorylase Phosphorylase deficiency
Phosphofructokinase (PFK) PFK deficiency
Hydrolytic Enzymes Acid phosphatase Macrophages; Lysosomes; Lipofuscin
Non-specific esterase Macrophages; Lysosomes;
Neuromuscular & Myotendinous junctions
Denervated (small angular) muscle fibers
Acetylcholinesterase Neuromuscular & Myotendinous junctions
Alkaline phosphatase Regenerating or immature muscle fibers;
Immune disease of connective tissue
  or capillaries;
Muscle fiber necrosis
Storage material PAS Glycogen & Carbohydrate disorders
Alcian blue Mucopolysaccharide
Sudan black BLipid storage
Oil red O Lipid storage
Other Congo red Amyloid; Inflammation; Vacuoles
Myoadenylate deaminase AMPDA deficiency
Methyl green pyronine RNA
Acridine orangeRNA
Von Kossa Calcium
Alizarin red Calcium
Fixed muscle Toluidine blue Muscle fibers; Capillaries


MUSCLE BIOPSY RESULTS: Differential diagnosis

Muscle fiber
  Damage
  Internal architecture
  Mitochondrial
  Necrosis
  Size changes
    Atrophy
    Hypertrophy
  Storage
  Type disorders
  Vacuoles
Amyloid
Capillary pathology
Complement
Endomysial fibrosis
Inflammation
Inherited myopathies
  Cytoplasmic proteins
  Extracellular proteins
  Nuclear proteins
  Sarcolemmal proteins
Nuclear pathology

Focal invasion of muscle fiber


Muscle Fiber Pathology

Other Muscle Features

Molecular Pathology: Immunohistochemistry for Inherited Myopathies 1

Cytoplasmic proteins
Extracellular proteins
Nuclear proteins
Sarcolemmal proteins
See: Pathology index
Return to Neuromuscular Home Page
Return to Neuromuscular Evaluations

References
1. J Neuropath Exp Neurol 2005;64:181-193
2. Neuromuscul Disord 2008;18:934-941

4/21/2014