Capillary Pathology: Muscle
Capillary Pathology with Minimal Myopathy:
Systemic Sclerosis
1 & Other
Clinical associations
- Muscle
- Less weakness
- Serum CK: High but lower than myopathy patients
- Systemic: Less frequent
- Pulmonary: Interstitial lung disease; Arterial hypertension
- Renal crises
- Skin: Diffuse involvement
Pathology: Endomysial Capillaries
- Histochemistry
- Ultrastructure
- Basement membrane: Thick & Reduplicated
- Endothelium: Activation
- Pericytes (PDGFR-β stain): Proliferation
Capillary Features: Stain Analysis
Basal Lamina |
Endothelium |
Immune |
Morphology
H&E
GT/VvG
Ultrastructure
Molecular
Decorin/Col IV
PAS: + or -
Pericytes
PDGFRβ
|
H&E: Morphology
Ulex: Distribution;
#; Size; Stain intensity
ATPase pH 4.3: #+
Alkaline phosphatase: #+
NADH: + or -
|
Humoral
C5b-9
Cellular
Acid phosphatase
HAM56
Cell involvement
Muscle: MHC I
Capillary: MxA
|
Systemic Immune Disorders: Capillary ± Muscle Pathology
SLE
Patient Features
38 yo female
Clinical diagnoses:
Systemic Lupus Erythematosis; ILD
Serum Antibodies: Ro52; ANA 1:640, Speckled; ± NT5C1a, PL-12 & MGT-30
Treatment: Prednisone
Capillary pathology
Morphology: Basal lamina mildly to moderately thick
Basal lamina: PAS+; Decorin mildly thick
Endothelium: Ulex large & reduced #; Alkaline phosphatase -; ATPase +; NADH ++
Immune: C
5b-9 scattered capillaries; MxA & Acid phosphatase cells
Muscle: MHC1+
Endomysial Capillaries: Morphology
![](../pics/biopsy/inflammation/muscmicrovasc/muscmicvaschelpar.jpg)
H&E stain
|
Endomysial Capillaries (Arrow)
Moderately enlarged
Muscle fibers
Fiber sizes: Moderately varied
![](../pics/biopsy/inflammation/muscmicrovasc/muscmicvaschehp.jpg)
H&E stain
|
![](../pics/biopsy/inflammation/muscmicrovasc/muscmicvascgtmp.jpg)
Gomori trichrome stain
|
Endomysial Capillaries
Moderately enlarged
Some have thick basal lamina
![](../pics/biopsy/inflammation/muscmicrovasc/muscmicvascgthp.jpg)
Gomori trichrome stain
|
Endomysial Capillaries
Moderately enlarged
![](../pics/biopsy/inflammation/muscmicrovasc/muscmicvasccrmp.jpg)
Congo red stain
|
![](../pics/biopsy/inflammation/muscmicrovasc/muscmicvascvvghp.jpg)
VvG stain
|
Endomysial Capillaries: Basal lamina
PAS stains capillary basal lamina
![](../pics/biopsy/inflammation/muscmicrovasc/muscmicvascpashp.jpg)
PAS stain
|
![](../pics/biopsy/inflammation/muscmicrovasc/cappathsledeclp.jpg)
Decorin stain
|
Endomysial Capillaries
Moderately enlarged
Basal lamina: Commonly thick
![](../pics/biopsy/inflammation/muscmicrovasc/cappathsledec.jpg)
Decorin stain
|
Endomysial capillaries: Endothelium
![](../pics/biopsy/inflammation/muscmicrovasc/cappathsleulex.jpg)
UEA I stain
|
![](../pics/biopsy/inflammation/muscmicrovasc/cappathslealp.jpg)
Alkaline phosphatase phosphatase stain
|
![](../pics/biopsy/inflammation/muscmicrovasc/muscmicvascatp43lpar.jpg)
ATPase pH 4.3 stain
|
Endomysial Capillaries
ATPase positive (Arrow)
![](../pics/biopsy/inflammation/muscmicrovasc/muscmicvascatp43hp.jpg)
ATPase pH 4.3 stain
|
![](../pics/biopsy/inflammation/muscmicrovasc/muscmicvascnadhmp.jpg)
NADH stain
|
Endomysial Capillaries
NADH positive
![](../pics/biopsy/inflammation/muscmicrovasc/muscmicvascnadhhp.jpg)
NADH stain
|
![](../pics/biopsy/inflammation/muscmicrovasc/muscmicvascnadhhp2.jpg)
NADH stain
|
Endomysial Capillaries: Immune
![](../pics/biopsy/inflammation/muscmicrovasc/cappathslec5b9.jpg)
C5b-9 stain
|
![](../pics/biopsy/inflammation/muscmicrovasc/cappathmxalp.jpg)
MxA stain
|
MxA
Stains cells in & around endomysial capillary walls
![](../pics/biopsy/inflammation/muscmicrovasc/cappathmxahp.jpg)
MxA stain
|
![](../pics/biopsy/inflammation/muscmicrovasc/muscmicvascacpmpar.jpg)
Acid phosphatase stain
|
Endomysial Capillaries: Immune
Acid phosphatase: Stains cells in & around (Arrows) endomysial capillary walls
![](../pics/biopsy/inflammation/muscmicrovasc/muscmicvascacphp.jpg)
Acid phosphatase stain
|
Histiocyte neighbors Endomysial capillary
Muscle fiber pathology
MHC I up regulated on muscle fibers
![](../pics/biopsy/inflammation/muscmicrovasc/cappathslemhc1.jpg)
MHC Class I stain
|
Patient features
52 yo female
Clinical diagnosis:
Systemic Sclerosis; ILD
Serum Antibodies: ANA 1:1280, Speckled; Ro52; AChR binding
Capillary pathology
Morphology: Basal lamina very thick
Basal lamina: PAS-; Decorin dark & moderately thick
Endothelium: Ulex large & reduced #; Alkaline phosphatase -; ATPase +; NADH ++
Immune: C
5b-9 scattered capillaries; Acid phosphatase cells & endothelium
Muscle: MHC1+
![](../pics/biopsy/inflammation/sscler/ssclmyophe.jpg)
H&E stain
|
Myopathy
Muscle Fiber sizes: Varied
Small, Immature fibers: Scattered
Internal nuclei: Some muscle fibers
Endomysial Capillary Pathology
Capillary sizes: Large
Capillary basal lamina: Thick
Endothelial cells: Large in enlarged capillaries
![](../pics/biopsy/inflammation/sscler/ssclgt.jpg)
Gomori trichrome stain
|
Systemic Sclerosis
Endomysial capillaries: Large
![](../pics/biopsy/inflammation/sscler/ssclvvglp.jpg)
VvG stain
|
Myopathy
Muscle Fiber sizes: Varied
Small, Immature fibers: Scattered
Endomysial Capillary Pathology
Capillary sizes: Large
Capillary basal lamina: Thick
Endothelial cells: Large in enlarged capillaries
![](../pics/biopsy/inflammation/sscler/ssclvvghp.jpg)
VvG stain
|
![](../pics/biopsy/inflammation/sscler/ssclvvghp2.jpg)
VvG stain
|
Endomysial Capillary Pathology
Capillary sizes: Large
Capillary basal lamina: Thick
Endothelial cells: Large in enlarged capillaries
![](../pics/biopsy/inflammation/sscler/ssclcrhp.jpg)
Congo red stain
|
Capillary pathology: Basal lamina
![](../pics/biopsy/inflammation/muscmicrovasc/cappath2cpas.jpg)
PAS stain
|
![](../pics/biopsy/inflammation/muscmicrovasc/cappath2cdec.jpg)
Decorin stain
|
Capillary pathology: Endothelium
![](../pics/biopsy/inflammation/muscmicrovasc/cappath2culex2.jpg)
UEA I stain
|
Endomysial Capillaries
Number: Reduced; Many fibers with no adjacent capillary
Endothelial cells
Location: Inside thick basal lamina
Size: Large
![](../pics/biopsy/inflammation/muscmicrovasc/cappath2culex.jpg)
UEA I stain
|
![](../pics/biopsy/inflammation/sscler/ssclulexhp.jpg)
UEA I stain
|
Endomysial Capillaries
Size: Often large
Endothelial cells
Stain for UEAI & MHC I
Location: Inside thick basal lamina
Size: Large
Basal lamina (Unstained): Thick
![](../pics/biopsy/inflammation/sscler/ssclmhc1hp1.jpg)
MHC I stain
|
Endomysial Capillaries
Size: Often large
Endothelial cells
Stain for MHC Class I
Enlarged inside thick basal lamina
Basal lamina (Unstained): Thick
![](../pics/biopsy/inflammation/sscler/ssclmhc1hp2.jpg)
MHC I stain
|
![](../pics/biopsy/inflammation/muscmicrovasc/cappath2calp.jpg)
Alkaline phosphatase stain
|
Endomysial capillaries: Normal numbers stained
![](../pics/biopsy/inflammation/sscler/ssclnadhhp.jpg)
NADH stain
|
Endomysial Capillary Pathology
Capillary sizes: Large
Capillary basal lamina: Thick
Endothelial cells: Large; NADH positive
![](../pics/biopsy/inflammation/sscler/sscapsatp43.jpg)
ATPase pH 4.3 stain
|
Systemic Sclerosis
Endomysial Capillaries: Large (Arrows)
![](../pics/biopsy/inflammation/sscler/ssclatp43lpar.jpg)
ATPase pH 4.3 stain
|
Endomysial Capillaries
Endothelial cells: ATPase positive
Capillary basal lamina: Often thick around endothelial cells
![](../pics/biopsy/inflammation/sscler/ssclatp43mp.jpg)
ATPase pH 4.3 stain
|
![](../pics/biopsy/inflammation/sscler/ssclatp43hp.jpg)
ATPase pH 4.3 stain
|
C5b-9 stain: Endomysial Capillaries
![](../pics/biopsy/inflammation/muscmicrovasc/cappath2cc5b9.jpg)
C5b-9 stain
|
Endomysial Capillaries
Endothelial cells: Acid phosphatase positive
![](../pics/biopsy/inflammation/sscler/ssclacphp.jpg)
Acid phosphatase stain
|
Systemic Sclerosis: Myopathy
![](../pics/biopsy/inflammation/muscmicrovasc/cappath2cmhc1lp.jpg)
MHC Class I stain
|
Systemic Sclerosis: Myopathy
Muscle fibers
Varied sizes
MHC1: Patchy upregulation
![](../pics/biopsy/inflammation/sscler/ssclmhc1lp.jpg)
MHC Class I stain
|
![](../pics/biopsy/inflammation/sscler/sslc3.jpg)
LC3 stain
|
Systemic Sclerosis
Clusters of muscle fibers have multiple, irregular collectons of LC3 aggregates
![](../pics/biopsy/inflammation/muscmicrovasc/cappath2clc3.jpg)
LC3 stain
|
Patient features
Clinical diagnosis:
Systemic Sclerosis
Serum Antibodies: ANA high; Ro; NT5C1a
Capillary pathology
Morphology: Some capillaries large
Basal lamina: PAS-; Decorin mildly thick walls
Endothelium: Ulex large; Alkaline phosphatase -; ATPase +; NADH -
Immune: C
5b-9 scattered capillaries; Acid phosphatase cells & endothelium
Muscle: MHC1+; Endomysial inflammation; Sarcoplasmic pads; Atrophy; LC3 -
Systemic Sclerosis Myopathy: Morphology
![](../pics/biopsy/inflammation/sscler/cappath7chelp.jpg)
H&E stain
|
Endomysial Capillaries
Mildly large
Often diffficult to visualize
Muscle fibers
Sizes: Bimodal distribution
All fibers are small
Some fibers: Very small, Round, Large nuclei
![](../pics/biopsy/inflammation/sscler/cappath7chehp.jpg)
H&E stain
|
![](../pics/biopsy/inflammation/sscler/cappath7cgt.jpg)
GT stain
|
Endomysial Capillaries
Mildly large
Often diffficult to visualize
Muscle fibers
Sizes: Bimodal distribution
All fibers are small
Some fibers: Very small, Round, Large nuclei
![](../pics/biopsy/inflammation/sscler/cappath7cvvg.jpg)
VvG stain
|
![](../pics/biopsy/inflammation/sscler/cappath7cpas.jpg)
PAS stain
|
PAS: Endomysial capillaries not well stained
Decorin: Endomysial capillaries have thick walls
![](../pics/biopsy/inflammation/sscler/cappath7cdec.jpg)
Decorin stain
|
![](../pics/biopsy/inflammation/sscler/cappath7culex.jpg)
UEA I stain
|
UEA I: Endomysial capillary endothelium large vs vs control (Below)
Control
![](../pics/biopsy/inflammation/sscler/cappath7culexcont.jpg)
UEA I stain
|
![](../pics/biopsy/inflammation/sscler/cappath7calp.jpg)
Alkaline Phosphatase stain
|
Alkaline Phosphatase: No increase in capillary staining
ATPase pH 4.3: Stains larger endomysial capillaries
![](../pics/biopsy/inflammation/sscler/cappath7catp43.jpg)
ATPase pH 4.3 stain
|
![](../pics/biopsy/inflammation/sscler/cappath7cnadh1.jpg)
NADH stain
|
NADH
Capillaries: No prominent staining
Muscle fibers
Internal architecture: Coarse
Scattered fibers: Rings or Sarcoplasmic pads
![](../pics/biopsy/inflammation/sscler/cappath7cnadhlp.jpg)
NADH stain
|
![](../pics/biopsy/inflammation/sscler/cappath7cc5b9lp.jpg)
C5b-9 stain
|
![](../pics/biopsy/inflammation/sscler/cappath7cc5b9hp.jpg)
C5b-9 stain
|
![](../pics/biopsy/inflammation/sscler/cappath7cacplp.jpg)
Acid phosphatase stain
|
![](../pics/biopsy/inflammation/sscler/cappath7cacphp1.jpg)
Acid phosphatase stain
|
![](../pics/biopsy/inflammation/sscler/cappath7cacphp2.jpg)
Acid phosphatase stain
|
![](../pics/biopsy/inflammation/sscler/cappath7cest.jpg)
Esterase stain
|
![](../pics/biopsy/inflammation/sscler/cappath7cmxa.jpg)
MxA stain
|
![](../pics/biopsy/inflammation/sscler/cappath7cmhc1lp.jpg)
MHC I stain
|
![](../pics/biopsy/inflammation/sscler/cappath7cmhc1mp.jpg)
MHC I stain
|
![](../pics/biopsy/inflammation/sscler/cappath7cinflhehp.jpg)
H&E stain
|
![](../pics/biopsy/inflammation/sscler/cappath7cinflhehp2.jpg)
H&E stain
|
![](../pics/biopsy/inflammation/sscler/cappath7cinflhehp3.jpg)
H&E stain
|
Systemic Sclerosis
Serum Antibody: Th/To
Capillary pathology
Morphology: Capillary sizes normal to slightly large
Basal lamina: PAS-; Decorin small size, dark staining & moderately thick
Endothelium: Ulex & MHC I reduced intensity of staining; Alkaline phosphatase +; ATPase +; NADH -
Immune: C
5b-9 -; Acid phosphatase minor staining of few endomysial capillaries; MxA -
Muscle: MHC1-
![](../pics/biopsy/inflammation/muscmicrovasc/cappath4che.jpg)
H&E stain
|
Systemic sclerosis, Th/To antibody
Muscle fibers: Scattered intermediate sized fibers
Capillaries: Normal to Mildly large sizes
![](../pics/biopsy/inflammation/muscmicrovasc/cappath4chehp.jpg)
H&E stain
|
Systemic sclerosis + Th/To: Basal Lamina
![](../pics/biopsy/inflammation/muscmicrovasc/cappath4cpas.jpg)
PAS stain
|
Capillary Basal lamina: No PAS staining
![](../pics/biopsy/inflammation/muscmicrovasc/cappath4cdec.jpg)
Decorin stain
Capillary Basal lamina: Small size endomysial capillaries with mildly thick, dark-stained walls
|
Systemic sclerosis + Th/To: Endomysial Capillary Endothelium
![](../pics/biopsy/inflammation/muscmicrovasc/cappath4culex.jpg)
UEA I stain
|
Endothelium: Reduced intensity of UEA I staining (Above) compared to control (Below)
![](../pics/biopsy/inflammation/muscmicrovasc/cappath4culexcont.jpg)
UEA I stain
|
![](../pics/biopsy/inflammation/muscmicrovasc/cappath4cmhc1.jpg)
MHC Class I stain
|
Capillaries: Very pale staining for MHC Class I (Above) compared to controls (Below)
Muscle: No upregulation of MHC class I
![](../pics/biopsy/inflammation/muscmicrovasc/cappath4cmhc1cont.jpg)
MHC Class I stain
|
![](../pics/biopsy/inflammation/muscmicrovasc/cappath4calplp.jpg)
Alkaline phosphatase stain
|
Endomysial capillaries: Increased # stained by alkaline phosphatase
![](../pics/biopsy/inflammation/muscmicrovasc/cappath4calpmp.jpg)
>Alkaline phosphatase stain
|
![](../pics/biopsy/inflammation/muscmicrovasc/cappath4catp43.jpg)
ATPase pH 4.3 stain
|
Endomysial capillaries: Increased # stained by ATPase pH 4.3
![](../pics/biopsy/inflammation/muscmicrovasc/cappath4cnadh.jpg)
NADH stain
|
Endomysial capillaries: No staining by NADH
Systemic sclerosis + Th/To: Immune
![](../pics/biopsy/inflammation/muscmicrovasc/cappath4cacplp.jpg)
Acid phosphatase stain
|
Endomysial capillaries: Mild staining of a few endomysial capillaries by acid phosphatase
![](../pics/biopsy/inflammation/muscmicrovasc/cappath4cacphp.jpg)
Acid phosphatase stain
|
![](../pics/biopsy/inflammation/muscmicrovasc/cappath4cmxa.jpg)
MxA stain
|
Systemic Sclerosis
Serum Antibody: RUV B1/2
Capillary pathology
Morphology: Capillary sizes mildly large
Basal lamina: PAS-; Decorin capillaries moderately thick wall, Normal size to slightly large
Endothelium: Ulex mildly large capillaries; Alkaline phosphatase -; ATPase +- few capillaries; NADH mild +
Immune: C
5b-9 no capillary staining; Acid phosphatase +; MxA +-
Muscle: MHC1-; C
5b-9 on endomysium; UEA I on muscle fiber surfaces
Systemic Sclerosis + RUV B1/2: Morphology
![](../pics/biopsy/inflammation/muscmicrovasc/cappath5chelp.jpg)
H&E stain
|
![](../pics/biopsy/inflammation/muscmicrovasc/cappath5chehp.jpg)
H&E stain
|
![](../pics/biopsy/inflammation/muscmicrovasc/cappath5cgt.jpg)
Gomori trichrome stain
|
![](../pics/biopsy/inflammation/muscmicrovasc/cappath5cvvg.jpg)
VvG stain
|
Systemic Sclerosis + RUV B1/2: Endomysial Capillary Basal Lamina
![](../pics/biopsy/inflammation/muscmicrovasc/cappath5cpas.jpg)
PAS stain
|
Endomysial capillaries: No PAS staining
![](../pics/biopsy/inflammation/muscmicrovasc/cappath5cdec.jpg)
Decorin stain
|
Endomysial capillaries: Decorin thick walls; Smaller sizes
Systemic Sclerosis + RUV B1/2: Capillary endothelium
![](../pics/biopsy/inflammation/muscmicrovasc/cappath5culex2.jpg)
UEA I stain
|
Endomysial capillary endothelium: UEA I stain
Moderately large sizes
Borderline reduced #: Scattered small muscle fibers with no associated capillary
Muscle fibers: UEA I stain on fiber surfaces
![](../pics/biopsy/inflammation/muscmicrovasc/cappath5culex.jpg)
UEA I stain
|
![](../pics/biopsy/inflammation/muscmicrovasc/cappath5cmhc1.jpg)
MHC class I stain
|
Endomysial capillary endothelium: MHC I stain
Pale (Above) compared to
Control (Below)
Muscle fibers: Mostly Normal
![](../pics/biopsy/inflammation/muscmicrovasc/cappath5cmhc1cont.jpg)
MHC class I stain
|
![](../pics/biopsy/inflammation/muscmicrovasc/cappath5alp.jpg)
Alkaline phosphatase stain
|
Endomysial capillaries: Normal stain
![](../pics/biopsy/inflammation/muscmicrovasc/cappath5catp43.jpg)
ATPase pH 4.3 stain
|
Endomysial capillaries: Minor scattered staining
![](../pics/biopsy/inflammation/muscmicrovasc/cappath5cnadh.jpg)
NADH stain
|
Endomysial capillaries: Mild staining of most vessels
Systemic Sclerosis + RUV B1/2: Immune features
![](../pics/biopsy/inflammation/muscmicrovasc/cappath5cc5b9.jpg)
C5b-9 stain
|
C
5b-9
Endomysial capillaries: No staining
Muscle fiber surface membranes: Patchy beaded staining
![](../pics/biopsy/inflammation/muscmicrovasc/cappath5cacp.jpg)
Acid phosphatase stain
|
Acid phosphatase
Stains capillary endothelial cells & few neighboring histiocytes
![](../pics/biopsy/inflammation/muscmicrovasc/cappath5cmxa.jpg)
MxA stain
|
MxA
Stains capillary endothelial cells & few neighboring histiocytes
CREST
Patient 1 features
75 yo female
Clinical Diagnosis:
CREST
Serum antibodies: Ro-52; Tif1γ; NT5C1a
Capillary pathology
Morphology: Basal lamina normal; Lymphocytes surround small vessels
Basal lamina: PAS+; Decorin small size, dark staining & moderately thick
Endothelium: Ulex large & reduced #; Alkaline phosphatase +; ATPase +; NADH -
Immune: C
5b-9 most capillaries; Acid phosphatase cells & endothelium, scattered; MxA +
Muscle: MHC1+
CREST: Endomysial Capillary Morphology
![](../pics/biopsy/inflammation/sscler/ssmorphhe.jpg)
H&E stain
|
Endomysial capillaries
Morphology: Normal to Slightly large size
Lymphocytes: Surround a small vessel
![](../pics/biopsy/inflammation/sscler/ssmorphhehp.jpg)
H&E stain
|
![](../pics/biopsy/inflammation/muscmicrovasc/cappath3cgt.jpg)
Gomori trichrome stain
|
CREST: Endomysial Capillary Basal Lamina
![](../pics/biopsy/inflammation/muscmicrovasc/cappath3cpas.jpg)
PAS stain
|
Basal Lamina
PAS: Mild staining
![](../pics/biopsy/inflammation/muscmicrovasc/cappath3cdec.jpg)
Decorin stain
|
Basal Lamina
Decorin: Dark stained walls
CREST: Endomysial Capillary Endothelium
![](../pics/biopsy/inflammation/sscler/ssulex.jpg)
UEA I (Ulex) stain
|
Capillaries
Reduced numbers: Many muscle fibers have no adjacent capillary
![](../pics/biopsy/inflammation/sscler/ssmyopalp.jpg)
Alkaline phosphatase stain
|
Endomysial Capillaries
Alkaline phosphatase stain: Increased numbers, especially large capillaries, are positive (Above)
ATPase pH 4.3 stain: Larger capillaries are positive (Below)
![](../pics/biopsy/inflammation/muscmicrovasc/cappath3catp43.jpg)
ATPase pH 4.3 stain
|
Endomysial Capillaries: No NADH stain
![](../pics/biopsy/inflammation/muscmicrovasc/cappath3cnadh.jpg)
NADH stain
|
CREST capillaries: Immune
C5b-9 staining
Capillaries: Present on many endomysial capillaries
Muscle fibers: Punctate on some fiber surfaces
![](../pics/biopsy/inflammation/sscler/ssc5b9.jpg)
C5b-9 stain
|
Endomysial Capillaries
MxA stained cells are present near endomysial capillaries & in perimysium
![](../pics/biopsy/inflammation/muscmicrovasc/cappath3cmxa.jpg)
MxA stain
|
Endomysial Capillaries
Endothelial cells & some surrounding cells: Acid phosphatase positive
![](../pics/biopsy/inflammation/muscmicrovasc/cappath3cacp.jpg)
Acid phosphatase stain
|
CREST: Muscle fibers
![](../pics/biopsy/inflammation/sscler/ssmhc1lp.jpg)
MHC Class I stain
|
CREST: Myopathy
Muscle fibers
Varied sizes
MHC1: Patchy upregulation, especially by fibers with
Small size
Location near perimysium
Capillaries: Reduced numbers in some regions
![](../pics/biopsy/inflammation/sscler/ssmhc1hp.jpg)
MHC Class I stain
|
CREST
Patient 2 features
30 yo Male
Clinical Diagnosis:
CREST
Serum antibodies: Sm; ANA 1:2560
Capillary pathology
Morphology: Basal lamina normal to mildly thick
Basal lamina: PAS +-; Decorin large, dark staining & moderately thick
Endothelium: Ulex large & reduced #; Alkaline phosphatase +; ATPase +; NADH -
Immune: C
5b-9 few capillaries; Acid phosphatase cells & endothelium, scattered; MxA ++
Muscle: MHC1 -
![](../pics/biopsy/inflammation/muscmicrovasc/cappath6chelp.jpg)
H&E stain
|
Endomysial capillaries
Morphology
Size: Large
Basal lamina: Mildly thick
![](../pics/biopsy/inflammation/muscmicrovasc/cappath6chemp.jpg)
H&E stain
|
![](../pics/biopsy/inflammation/muscmicrovasc/cappath6cgt.jpg)
Gomori trichrome stain
|
Endomysial capillaries
Morphology
Size: Large
Basal lamina: Mildly thick
![](../pics/biopsy/inflammation/muscmicrovasc/cappath6cvvg.jpg)
VvG stain
|
CREST: Endomysial Capillary Basal Lamina
![](../pics/biopsy/inflammation/muscmicrovasc/cappath6cpas.jpg)
PAS stain
|
Basal Lamina
PAS: Mild staining of larger vessels
![](../pics/biopsy/inflammation/muscmicrovasc/cappath6cdeclp.jpg)
Decorin stain
|
Basal Lamina
Decorin: Dark stained walls; Large size
![](../pics/biopsy/inflammation/muscmicrovasc/cappath6cdechp.jpg)
Decorin stain
|
![](../pics/biopsy/inflammation/muscmicrovasc/cappath6cuea2.jpg)
UEA1 stain
|
Capillaries
Reduced numbers
Many muscle fibers have no adjacent capillary
![](../pics/biopsy/inflammation/muscmicrovasc/cappath6cuea1.jpg)
UEA1 stain
|
Capillaries (Control)
All muscle fibers have adjacent capillary
Endomysial capillary size: Mildly large
![](../pics/biopsy/inflammation/muscmicrovasc/cappath6culexcont.jpg)
UEA1 stain
|
![](../pics/biopsy/inflammation/muscmicrovasc/cappath6calp.jpg)
Alkaline phosphatase stain
|
Endomysial Capillaries
Alkaline phosphatase stain: Increased numbers, especially large capillaries, are positive (Above)
ATPase pH 4.3 stain: Larger capillaries are positive (Below)
![](../pics/biopsy/inflammation/muscmicrovasc/cappath6catp43.jpg)
ATPase pH 4.3 stain
|
Endomysial Capillaries: NADH stains endothelium in larger capillaries
![](../pics/biopsy/inflammation/muscmicrovasc/cappath6cnadh.jpg)
NADH stain
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![](../pics/biopsy/inflammation/muscmicrovasc/cappath6cc5b9.jpg)
C5b-9 stain
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CREST capillaries: Immune
C5b-9 staining
Capillaries: Present on a few, scattered endomysial capillaries
![](../pics/biopsy/inflammation/muscmicrovasc/cappath6cmxalp.jpg)
MxA stain
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Endomysial Capillaries
MxA stains endothelial cells & cells around endomysial capillaries
![](../pics/biopsy/inflammation/muscmicrovasc/cappath6cmxahp.jpg)
MxA stain
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![](../pics/biopsy/inflammation/muscmicrovasc/cappath6cacplp.jpg)
Acid phosphatase stain
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Endomysial Capillaries
Endothelial cells & some surrounding cells: Acid phosphatase positive
![](../pics/biopsy/inflammation/muscmicrovasc/cappath6cacphp.jpg)
Acid phosphatase stain
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CREST: Muscle fibers
![](../pics/biopsy/inflammation/muscmicrovasc/cappath6cmhc1.jpg)
MHC Class I stain
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MHC Class I: No staining on muscle fiber surfaces
Endomysial Capillaries: Basal Lamina
Irregular increase in basal lamina layers around capillaries (Arrows)
Capillary Basal Lamina: Multiple circumferential layers
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Capillary pathology
References
1.
Acta Neuropathol 2021;141:917-927
2.
Rheumatology (Oxford) 2023;62(SI):SI82-SI90,
Curr Opin Rheumatol. 2023 Aug 23
12/9/2023