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Archive: August 2021

Tissue Gram Stain

Tissue Gram stain, inflamed skeletal muscle
This 50-year-old female presents with progressively worsening swelling and pain involving her left hip and buttock of four days duration. CPK levels are in the 900 to 1200 range [normal 20-200 IU/L]. A muscle biopsy was performed. A. Esterase enzyme histochemical stain B. Grocott Methenamine Silver stain (GMS) C. Tissue Gram stain D. Modified Gomori Trichrome stain   Answer: Tissue Gram stain Figure 1 demonstrates inflamed skeletal muscle; Figure 2 shows bacterial cocci in clusters. Tissue Gram stain is useful for attempting to further characterize the bacterial organisms, and demonstrates numerous Gram positive cocci (Image 3). Why were the other...

Wednesday Relaxation

wednesday relaxation
Wednesday relaxation!   Today, Tanesha Forrest led us in a mindfulness class that focused on stretching and meditation. This was definitely what our team needed!  

Glomerular Basement Membranes

Glomerular Basement Membranes, Subepithelial deposits
This eyeSCANdy image shows an acellular scanning EM of glomerular basement membranes from a biopsy with membranous glomerulonephritis, stage II showing a reticular pattern of the subepithelial GBM. The extracted deposits previously resided in the dark spaces. The lighter GBM corresponds to “spikes” on silver stain.   Photo credits to Dr. Stephen Bonsib.

Diagnose This (August 24, 2021)

Amyloidosis, AA amyloid, IV drug, proteinuria
This is the biopsy of a 32yo IV drug user who has nephrotic range proteinuria and MSSA bacteremia secondary to a skin abscess. What is this stain and what is your diagnosis?     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​  ...

Critical Illness Myopathy

critical illness myopathy
Skeletal muscle biopsy demonstrating changes of critical illness myopathy.  (Figure 1) Hematoxylin and eosin (H&E)-stained section prepared from snap frozen skeletal muscle shows atrophic muscle with a subset of atrophic pale staining type 2 muscle fibers (fiber typing stains not shown), and relatively rare scattered mild nonspecific myopathic changes are seen through the specimen.  (Figure 2) Muscle fibers have a blue tinctorial quality change on staining with Modified Gomori Trichrome (MGT).  (Figure 3) Ultrastructural examination by electron microscopy (EM) shows loss of the myosin thick filaments and preservation of thin filaments and Z-lines.  Original Magnifications:  A. Frozen H&E, 100x; B....

Episode 27: What’s So Special About Renal Pathology

What's So Special About Renal Pathology, first impressions, Keep Good Company, Stick to Your Knowledge, Never Be Afraid To Ask Questions, Making Time, How to Build A Reputation, Doing the Best You Can, Know Who Is In the Audience, Expanding the Differential Diagnosis, Knowing What Is Normal, Answer the Question, Knowing What You Know, Looking At Every Component, gestalt diagnosis, going deep, examining all the material, Lumping or Splitting, Focus, Using Therapy to Guide a Diagnosis, knowing the therapy, Severity of Change, principles of pathology, representativeness, arkana labs, renal path
In his final episode of Principles of Pathology, Dr. Silva explains why renal pathology is special.   Many thanks to Dr. Silva for always teaching and sharing knowledge of renal pathology. While being a pillar in this industry, his wisdom has advanced the understanding of renal disease throughout many decades. As numerous as the accolades in his career, so are the physicians he has taught and inspired.  

Hereditary Amyloid Neuropathy

TTR gene
Elderly female with amyloid neuropathy of the sural nerve. Cross-sections of the left sural nerve prepared from formalin-fixed paraffin-embedded (FFPE) tissue stained with Congo red show dense salmon-orange material (i.e. congophilic) predominantly around endoneurial blood vessels (Figure 1), as well as a few small accumulations within nerve fascicles, diagnostic of amyloid deposition.  The material shows apple-green birefringence with compensated polarized light microscopy (not shown), and also shows an intense bright red glow (Figure 2) against a dull background under UV light fluorescence microscopy with a Texas red excitation filter (i.e. rhodamine optics).  Co-localization to the same nerve fascicle, original magnifications: ...