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Archive: December 2020

Glomerular Capillary Loops with Advanced Membranous Glomerulonephritis

Advanced Membranous Glomerulonephritis, stage IV, renal pathology, Bonsib, eyescandy, arkana laboratories
Today’s eyeSCANdy image shows acellular scanning EM of glomerular capillary loops from a biopsy with advanced membranous glomerulonephritis stage IV with shallow depressions and larger "craters" representing a second layer of basement membrane response on top of completely bridged GBM spikes.   Image courtesy of Dr. Stephen Bonsib.  

Twitter Poll (December 23, 2020)

anti-brush border antibody disease, ABBA, renal pathology, Twitter Poll, arkana labs
Answer: D The histologic features of a thrombotic microangiopathy (TMA) are non-specific as to etiology and include both acute and chronic changes. Acute changes of TMA include glomeruli demonstrating mesangiolysis, endothelial swelling, as well as intracapillary fibrin thrombi, and fragmented red blood cells. Blood vessels in the acute phase will also classically show endothelial swelling along with intimal mucoid edema and entrapped schistocytes. Chronic TMA changes include glomerular basement duplication with double contour formation and arterial/arteriolar intimal fibrosis with concentric lamination (onion skinning), to name a few. All of the above are known to lead to TMA except for anti-brush...

Contraction Band Artifact

Contraction Band Artifact , Neuro Notes, neuropathology
Contraction band artifact (Hematoxylin and Eosin stained section from formalin fixed paraffin embedded tissue 400x magnification)   This skeletal muscle biopsy shows contraction band artifact.  This artifact is caused by prolonged ischemic time prior to fixation.  To avoid this artifact, the best practice is to triage and submit the skeletal muscle tissue into it's appropriate "fixative" as soon as possible (i.e. snap freeze, formalin, or glutaraldehyde).   Contraction band artifact (electron microscopy 500x magnification)

Diagnose This (December 21, 2020)

renal argyria, arkana laboratories, renal pathology, kidney
What is your diagnosis in a patient with a particular “gray” appearance to their complexion?       ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​...

Sarcoid Myopathy and Vasculopathy

myopathy, Sarcoid Myopathy and Vasculopathy, Neuro Notes, neuropathology, arkana laboratories
What is your diagnosis and how would you characterize the designated lesions in Figures 1 & 2? (Black Arrows)   Hematoxylin and eosin stained FFPE tissue section (200x original magnification Granulomatous myopathy, most consistent with Sarcoidosis (so-called "Sarcoid Myopathy"). The granulomatous inflammation of Sarcoidosis may show a perivascular distribution and may cause vascular compromise (vasculopathy or vasculitis). Of note, Sarcoidosis is a diagnosis of exclusion (i.e. other causes of granulomatous inflammation must be excluded).  See references. References: Cohen Aubart F, Abbara S, Maisonobe T, et al. Symptomatic muscular sarcoidosis: Lessons from a nationwide multicenter study. Neurol Neuroimmunol Neuroinflamm. 2018 Mar...