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Diagnose This (April 5, 2021)

ACNA or Anti-GBM
In a patient with these findings, which serological exams results would you be interested to know?     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​...

Tubular Aggregates

Tubular aggregates in H&E stain of muscle/nerve biopsy
Considering the clinical vignette from the prior week (elderly male with proximal muscle weakness). Staining the skeletal muscle biopsy with Hematoxylin and Eosin (H&E) in combination with frozen sections evaluated with Modified Gomori Trichrome (MGT) and oxidative stains can provide the neuropathologist with much information, including clues as to the ultrastructural abnormality of this myopathy. Electron microscopy was pursued. Using the images, what is the ultrastructural abnormality shown below in this skeletal muscle biopsy?   Formalin-fixed paraffin-embedding (FFPE) tissue section of skeletal muscle with Tubular Aggregate Myopathy (TAM) demonstrating four nearby muscle fibers with round to ovoid eccentric and subsarcolemmal...

Twitter Poll (April 1, 2021)

Granulomatous TIN, twitter poll, arkana laboratories
Answer: Granulomatous TIN   The classic finding for renal sarcoidosis is that of a non-necrotizing granulomatous tubulointerstitial nephritis (Granulomatous TIN). However, on biopsy this finding is non-specific and thus the differential diagnosis would also include drug/hypersensitivity reaction, infections (i.e. mycobacterial, fungal), and autoimmune disease. Sarcoidosis is considered a diagnosis of exclusion and thus clinical correlation is required.      

Membranous Glomerulonephritis Stage II

Membranous Glomerulonephritis Stage II
This eyeSCANdy image shows acellular scanning EM from a biopsy with membranous glomerulonephritis, stage II. The extracted deposits previously resided in the dark spaces. The lighter GBM corresponds to “spikes” on silver stai.   Photo courtesy of Dr. Stephen Bonsib.  

Diagnose This (March 29, 2021)

Light Chain Deposition Disease
What would be your leading diagnosis given the glomerular changes in a patient with an abnormal SPEP? (Hint: Congo red and DNAJB9 stains are negative, powdery deposits by EM)     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​...