Neuromuscular

Statin Myopathy: Toxic

Muscle pathology
  Necrosis
    Early
      Membrane damage
      Cytoplasm pathology
    Ongoing
  Muscle fiber properties


NADH stain
Necrotic Muscle Fibers: Cytoplasm
  Pale stained by NADH (Arrow)
  Dark-stained on H&E & Gomori trichrome


Gomori Trichrome stain
Necrotic Muscle Fibers: Cytoplasm
  Pale stained by NADH
  Dark-stained on Gomori trichrome & H&E (Arrows)
  Few necrotic fibers are pale-stained

H&E stain


Acid phosphatase stain
Necrosis, Early
  Few histiocytes associated with necrotic muscle fibers

Esterase stain

Necrosis: Active

H&E stain
Sub-acute myopathy, Very active:
Muscle fibers in varying stages of necrosis (Dark arrow), phagocytosis & regeneration (Light arrow)

H&E stain


Gomori trichrome stain
Sub-acute myopathy, Very active:
Muscle fibers in varying stages of necrosis, phagocytosis & regeneration


NADH stain
Sub-acute myopathy, Very active:
Large muscle fibers: Coarse internal architecture
Small, regenerating muscle fibers: Dark-stained


Acid phosphatase stain
Sub-acute myopathy, Very active:
Muscle fibers invaded, or replaced, by phagocytic cells
Histiocytic cells are also scattered in the endomysium near capillaries (Arrow)

Acid phosphatase stain

Statin myopathy: Muscle fiber properties

Alkaline phosphatase stain
Sub-acute myopathy, Very active:
Muscle fibers are surrounded by alkaline phosphatase stain


ATPase pH 4.3 stain
Sub-acute myopathy, Very active:
Scattered intermediate stained muscle fibers: Type 2C or Necrotic


PAS stain
Sub-acute myopathy, Very active:
Unlike some other patterns of rhabdomyolysis, glycogen is still present in muscle fiber cytoplasm

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10/18/2018