Neuromuscular

Graft vs Host Disease (GVHD)

General
Myopathy
Neuropathy


Graft vs Host Disease: Neuromuscular, General


GVH: Neuropathy


Toluidine blue stain
Differential Fascicular Involvement: More axon loss in some regions than others

VvG stain

Neurofilament stain

ATPase pH 4.3 stain

Wallerian Degeneration: Intrafascicular variation


Toluidine blue stain

Toluidine blue stain

Acid phosphatase stain


Gomori trichrome stain
Immune damage: Connective tissue
  Perineurium (Arrow) & Epineurium: Damaged structure (Above)
  Epineurium: Alkaline phosphatase staining (Below)
  Perineurium: CD4 cells (Right)


Alkaline phosphatase stain

CD4 stain


Gomori trichrome stain
GVH Muscle Denervation
  Pyknotic Nuclear Clumps

NADH stain

GVH: Myopathy

Perimysial pathology

H&E stain

Gomori trichrome stain
Perimysium: Fragmented and damaged; Contains scattered large cells.
Muscle fibers neighboring abnormal perimysium: Mildly small.

H&E stain

Gomori trichrome stain


H&E stain
Fragmented perimysium: Contains large histiocytic cells

VvG stain

Muscle fibers at the edge of fascicles, near perimysium, tend to be smaller

NADH stain


Acid phosphatase stain
Perimysium: Acid phosphatase positive cells

Acid phosphatase stain

Acid phosphatase stain

Acid phosphatase stain
Histiocytic cells in perimysium



Esterase stain

Histiocytic cells in endomysium
  Often accompany upregulated MHC I by muscle fibers

Acid phosphatase stain

GVH: C5b-9 deposits
  On perimysium, in some areas extending into endomysium


C5b-9 stain

GVH: C5b-9 deposits
  On perimysium
  On surface of some muscle fibers, more often near perimysium


C5b-9 stain

GVH: Muscle Fibers
  MHC Class I: Upregulated on all muscle fibers

MHC Class I stain

GVH: Muscle Fibers, Unusual features
  Abnormal myonuclei

Congo red stain

Congo red stain


Acid phosphatase stain
Cytoplasmic granules: Acid phosphatase positive

Acid phosphatase stain

Capillary Pathology

UEA I stain
GVH: Capillaries
  Pale stained by UEA I
  Number: Reduced; Many muscle fibers with no neighboring capillary
  Size: Mildly large

UEA I stain
Control muscle: Capillaries
  Abundant: Capillaries neighboring most muscle fibers
  Dark stained by UEA I


UEA I stain

UEA I stain

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4/24/2017