Clinical History:
This 45-year-old patient underwent sural nerve biopsy to evaluate for potential etiologies of their progressive sensorimotor predominantly axonal polyneuropathy. An extensive clinical workup did not identify a clinical cause for the patient’s neuropathy (i.e. idiopathic).
What descriptive pathologic diagnosis would you use for the provided toluidine blue-stained thick section (prepared from glutaraldehyde-fixed EPON embedded tissue block)?
An image of more normal appearing nerve fascicles is also provided.
Answer:
- “End-stage nerve”
- The image shows diffuse near complete loss of large diameter and smaller diameter myelinated axons. There is diffuse mild thickening of the perineurium.
- It is frequently difficult to impossible to determine the etiology for a patient’s neuropathy in end-stage nerve biopsy samples.
Reference(s) / Additional Reading:
- Chkheidze R, Pytel P. What Every Neuropathologist Needs to Know: Peripheral Nerve Biopsy. J Neuropathol Exp Neurol. 2020 Apr 1;79(4):355-364. doi: 10.1093/jnen/nlaa012. PMID: 32167544.
- Jackson LJ, Serhal M, Omar IM, Garg A, Michalek J, Serhal A. Sural nerve: imaging anatomy and pathology. Br J Radiol. 2023 Jan 1;96(1141):20220336. doi: 10.1259/bjr.20220336. Epub 2022 Sep 12. PMID: 36039944; PMCID: PMC10997020.
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