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Archive: November 2021

Diagnose This (November 22, 2021)

fibrillary glomerulopathy (FGN)
In a non-diabetic patient, with positive IgG, kappa and lambda staining by immunofluorescence, what is your diagnosis?     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​...

Happy birthday, Dr. Ambruzs!

Happy birthday, Dr. Ambruzs
Dr. Ambruzs’ husband decided to sneak in this weekend and surprise her with an office full of balloons for her birthday. We don’t know who was more excited, Dr. Ambruzs or Connor!     Happy birthday, Dr. Ambruzs!   

Vacuolar Myopathy

Figure 1: Frozen section hematoxylin and eosin, 400x original magnification Multiple vacuolar change toward the periphery of the muscle fiber that are variably optically clear to containing finely granular basophilic material (for example see black arrows).   This 60-year-old patient noticed slowly progressive difficulty getting into and out of their chair at work over the past year, and increased tripping and falling. Family history was negative for neuromuscular disorder.   What is your diagnosis based on Figures 1-5? A. Inclusion Body Myositis B. Mitochondrial myopathy C. Pompe disease D. Lipid storage myopathy   Figure 2: Frozen section modified Gomori Trichrome,...

Diagnose This (November 15, 2021)

medullary infarct in transplant kidney
This patient received a kidney transplant 10 days prior and is currently anuric, with delayed graft function. What is your diagnosis?     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​  ...

EMG Needle Site

EMG Needle Site
Figure 1: Frozen section hematoxylin and eosin; 200x original magnification Note the increased cellularity within the perimysium due to the presence of foamy macrophages (large arrow). The adjacent muscle fibers show some variation in least mean diameter and a few atrophic regenerating fibers are present.   This middle-aged patient presented with a two year history of bilateral lower extremity pain and weakness predominately involving anterior thighs. Electrodiagnostic studies one month prior to muscle biopsy showed minimal myopathic features without evidence for neurogenic change. Lower extremity (3/5) and upper extremity (4/5) weakness and waddling gait were noted on physical examination.  Muscle...

Diagnose This (November 8, 2021)

lupus nephritis
In a patient with SLE, deposits in this location are typically seen in which class(es) of lupus nephritis?     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​  ...

Vascular Changes On Thick Sections

vasculitis
Low power image: The small arteriole (large arrow) shows thickening and hypercellularity of its wall.  The hypercellularity is in part due to the presence of chronic cells. Note the marked loss of myelinated axons in the two nerve fascicles (small arrows)   This 50-year-old patient presented with microscopic hematuria, weight loss, and difficulty with gait. Electrodiagnostic studies are reported to have demonstrated features of a multifocal sensorimotor neuropathy. Laboratory studies showed positive cANCA, elevated ESR and CRP, and normal CPK. The patient was treated with steroid and azathioprine prior to nerve biopsy.   Which of the following morphologic features in...