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POEMS

Muscle   Capillary pathology   Denervation   Glycogen Nerve   Axons     Wallerian Degeneration   Edema   Endoneurial Microvessels     Hemosiderin   Uncompacted Myelin   Vessels

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POEMS: Subperineurial & Endoneurial Edema

Gomori trichrome stain

Axon Loss: Moderate

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H&E stain

Subperineurial & Endoneurial Edema
  Pale regions under perieurium & in endoneurial septae
  Subperineurial edema stains with Alcian blue (Below)

Alcian blue stain

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H&E stain

Subperineurial & Endoneurial Edema
  Pale regions under perieurium & in endoneurial septae

H&E stain

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H&E stain

Hemosiderin
  Brown pigment granules near endoneurial microvessels

Gomori trichrome stain

VvG stain

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Epineurial Veins

VvG stain

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Some epineurial vessels have
  Surrounding histiocytes
  Prominent endothelium

HAM56 stain

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Epineurial vessel has normal smooth muscle in wall

ATPase pH 4.3 stain

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Ulex stain

Small Vessels
  Increased numbers in epineurium & endoneurium

ATPase pH 4.3 stain

MHC Class I stain

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POEMS: Axon loss, Mild

Toluidine blue stain

Toluidine blue stain

Neurofilament stain

POEMS: Axon loss, Mild

Neurofilament stain

Neurofilament stain

POEMS
  Mild loss of myelinated axons

Neurofilament (Green) + P0 (Red)

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POEMS: Wallerian Degeneration

VvG stain

Scattered myelin sheaths have reduced VvG and Gomori trichrome staining

Gomori trichrome stain

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Acid phosphatase stain

Acid phosphatase + cells
  Endoneurial histiocytes, Scattered
  Some myelin sheaths

Acid phosphatase stain

Acid phosphatase stain

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C_5b-9 stains around myelin sheaths

C5b-9 stain

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NCAM stain

Myelin remains mature: No NCAM expression

NCAM stain

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Büngner band cells
  Scattered endioneurial cells costain (Yellow) for NCAM & P0

NCAM (Green) + P0 (Red)

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From: R Schmidt

Endoneurial Cell: Degeneration
  Neighboring Schwann cell process
  Another small Schwann cell (Right) has collagen pockets

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From: R Schmidt

Endoneurial Cells: Degeneration

From: R Schmidt

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POEMS: Muscle

Denervation
  Small angular fibers, individually or in small groups

H&E stain

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H&E stain

Endomysial Capillaries
  Large size
  Increased numbers
Denervation
  Small angular fibers, individually or in small groups

H&E stain

H&E stain

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Ulex stain

Endomysial Capillaries
  Large size
  Increased numbers

Ulex stain

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Ulex stain

C5b-9 stain

Endomysial Capillaries
  C_5b-9 stains most endomysial capillaries

C5b-9 stain

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Acid phosphatase stain

Endomysial Capillaries
  Acid phosphatase stains endothelium in most capillaries

Acid phosphatase stain

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ATPase pH 4.3 stain

Endomysial Capillaries
  ATPase pH 4.3 stains many capillaries

ATPase pH 4.3 stain

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POEMS: Muscle Denervation

VvG stain

Small angular muscle fibers: Scattered & grouped
Endomysial capillaries: Large size

VvG stain

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ATPase pH 9.4 stain

Denervation
  Small angular muscle fibers
    Types I & II
    Dark stain for esterase

Esterase stain

Esterase stain

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NADH stain

Targetoid changes: Irregular, rounded clear regions

NADH stain

COX stain

SDH stain

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PAS stain

Glycogen: Increased PAS staining in muscle fiber cytoplasm

PAS stain

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Perimysial Artery & Vein: Normal

VvG stain

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6/17/2024