Clinical History:
- This 50-year-old patient presented with generalized muscle weakness and elevated CPK levels. Muscle biopsy was performed to evaluate for myopathy.
- The biopsy tissue is divided into three portions: fresh, formalin-fixed and glutaraldehyde fixed. The formalin-fixed and glutaraldehyde-fixed tissue containers were transported in the frozen state (dry-ice filled cooler) along with the fresh tissue.
What do the changes seen in the two provided images of H&E stained FFPE sections represent?
Answer:
- Freezing artifact
- Freezing artifact in fresh frozen tissue can be partially remedied by briefly thawing the tissue and then re-snap freezing the tissue in liquid nitrogen cooled isobutane. However, the ice crystals that form in formalin-fixed tissue and glutaraldehyde-fixed tissue subject to freezing cannot be resolved.
- Freezing artifact in muscle biopsy hampers morphologic evaluation.
Reference(s) / Additional Reading:
- Nix JS, Moore SA. What Every Neuropathologist Needs to Know: The Muscle Biopsy. J Neuropathol Exp Neurol. 2020 Jul 1;79(7):719-733. doi: 10.1093/jnen/nlaa046. Erratum in: J Neuropathol Exp Neurol. 2021 Mar 22;80(4):387. doi: 10.1093/jnen/nlaa096. PMID: 32529201; PMCID: PMC7304986.
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