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Currently filtering by tag: myopathy

Muscle Inclusions

Polyglucosan bodies, Some of the muscle fibers in this image contain multiple refractile angular/rhomboid shaped well-circumscribed structures within the sarcoplasm
Figure 1: H&E frozen section 400x original magnification Some of the muscle fibers in this image contain multiple refractile angular/rhomboid shaped well-circumscribed structures within the sarcoplasm.    This 50-year-old patient presented with complaints of progressive leg weakness and dysesthesia (burning sensation) in a sock and glove distribution. Laboratory studies showed normal CPK and aldolase levels, negative ANA, normal vitamin B12, and folate levels. On physical examination, the patient was noted to have a wide-based gait. What are the inclusions seen in Figures #1 - #5? A. Polyglucosan bodies B. Russell bodies C. Lewy bodies D. Marinesco bodies   Figure 2:...

Mycobacterial Infection

Mycobacterial Infection
Hematoxylin and eosin FFPE 100x original magnification Hematoxylin and eosin FFPE 100x original magnification   Acid Fast Stain (Kinyoun) FFPE 1000x oil immersion   This 45-year-old patient presented to the emergency department with left thigh and buttock pain of four months’ duration, and two weeks of fever (105oF) and chills. The patient's past medical history is significant for autoantibody-positive rheumatoid arthritis treated with mycophenolate mofetil and steroid, and recent findings of focal central disc herniation at L5-S1. The patient is reported to have traveled to Asia and India. Chest X-ray showed mild bibasilar atelectasis. MRI showed avascular necrosis of the...

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...

Acquired Etiologies of Myopathy with Lobulated Muscle Fibers

Myopathy with Lobulated Muscle Fibers
An elderly male patient presents with a chief complaint of “dull achy pain.” The patient relates that the pain is predominantly in his thighs and hip girdle region, most intense in his left lateral thigh. He says the pain has ongoing and progressive for several months but has significantly worsened over the last few days.  The patient had been recently admitted for “rhabdomyolysis” thought due to his statin medication, which was discontinued; however, no muscle biopsy was performed at that time and his muscle enzymes showed CPK 934.  Other past medical history includes diabetes mellitus, hyperlipidemia, hypertension, hypercalcemia, and vitamin...

Fibrous Body

Fibrous Body, neuro path, arkana laboratories, Muscle biopsy
A 75-year-old female patient presents with proximal muscle weakness, characteristic skin rash, and dysphagia. Laboratory workup reveals elevated CPK 3500. A skeletal muscle biopsy is performed from the right thigh and shows findings diagnostic of dermatomyositis.  The muscle biopsy also shows rare vacuolated muscle fibers with Modified Gomori Trichrome stain.  Electron microscopy is pursued.  What is the ultrastructural finding seen in the electron photomicrograph shown below?   Answer: The electron photomicrograph shows a Fibrous (filamentous) body, which is a nonspecific finding that may be seen in a variety of clinical settings, including inflammatory myopathies, such as dermatomyositis, as well as...