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
  Biochemistry
  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
NORMAL MUSCLE
Mean fiber diameter
Age
(Years)
Diameter
(μM)
Birth 12 to 15
1 18
3 20
6 27
8 35
10 40
12 45
15 50
Adult 50 to 60


MUSCLE BIOPSY STAINS & PROCEDURES

Category Method Utility
Morphology Hematoxylin and eosin Muscle fiber pathology; Nuclei
Verhoeff van Gieson (VvG) Elastin; Connective tissue;
Vessel structure; Intramuscular nerve
Gomori trichrome Connective tissue; Nemaline rods
Cytoplasmic bodies
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 Histiocytes; Lysosomes; Lipofuscin
Non-specific esterase Histiocytes (Cytoplasm); 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
Cytoplasmic aggregates
Methyl green pyronine RNA
Acridine orangeRNA
Von Kossa Calcium
Alizarin red Calcium
Fixed muscle Toluidine blue Muscle fibers; Capillaries


VvG stain
Mitochondrial Oxidative Enzyme Activities: Methods

MUSCLE BIOPSY RESULTS: Differential diagnosis

Muscle fiber
  Damage
  Internal architecture
  Mitochondrial
  Necrosis
  Size changes
    With age
    Atrophy
    Hypertrophy
  Storage
  Type disorders
  Vacuoles
Amyloid
Capillary pathology
Complement
Endomysial fibrosis
Inflammation
  MHC-I
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
3. Molecular Aspects of Medicine 2015; Online Aug

8/21/2015