SOFT TISSUE PATHOLOGY

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" rowspan="2" width=210 BGCOLOR="#99CC99" TEXT="#080000" bgproperties="fixed" background="0408dfc3.jpg"> <div> <B> <img src="HTMLobj-161/aniGif.gif" border="0" align="bottom" width="162" height="127">  </B></div> </td> <td valign="top" colspan=2 height=82 BGCOLOR="#CCCC99" TEXT="#080000" bgproperties="fixed" background="0418dfe1esnpes.jpg"> <div> <FONT SIZE="5" COLOR="#336666" FACE="Arial" ><B>BONE PATHOLOGY</B></FONT><B>     </B><B>|</B><B>     </B><A HREF="index.htm" TARGET="_top" TITLE="BONE PATHOLOGY"><U><B>home</B></U></A></div> <div> <A HREF="id22.htm" TARGET="_top" TITLE="bone formation review"><U>bone formation review</U></A>   |   <A HREF="id24.htm" TARGET="_top" TITLE="anatomy"><U>anatomy</U></A>   |   <A HREF="id18.htm" TARGET="_top" TITLE="BONE PATHOLOGY"><U>BONE PATHOLOGY</U></A>   |   <A HREF="id25.htm" TARGET="_top" TITLE="fractures"><U>fractures</U></A>   |   <A HREF="id27.htm" TARGET="_top" TITLE="musculoskeletal pathology index"><U>musculoskeletal pathology index</U></A>   |   <B>SOFT TISSUE PATHOLOGY</B>   |   <A HREF="id23.htm" TARGET="_top" TITLE="bone tumors listing"><U>bone tumors listing</U></A>   |   <A HREF="id20.htm" TARGET="_top" TITLE="bone quiz answered"><U>bone quiz answered</U></A>   |   <A HREF="id21.htm" TARGET="_top" TITLE="some pictures"><U>some pictures</U></A>   |   <A HREF="id17.htm" TARGET="_top" TITLE="Contact Me"><U>Contact Me</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" height=398 colspan=2 BGCOLOR="#CCCC99" TEXT="#080000" bgproperties="fixed" background="0418dfc3.jpg"> <div> <I>SOFT TISSUE PATHOLOGY</I></div> <div> <B>SOFT TISSUE PATHOLOGY</B></div> <div> <B>Biopsy Site</B></div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="995" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 76 WIDTH="985"><div> The muscle with maximal clinical signs should NOT be selected since it would likely produce an uninformative 'end-stage' biopsy comprising mainly fat and connective tissue. Muscles showing minimum clinical signs are helpful in elucidating pathological aetiology. Also avoid muscles which have recently suffered trauma - including EMG or BIOPSY needles! Common sampling sites (for which there is much normal data) include:- </div> </tD> </tR> </TABLE></div> <div> <B> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="726" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 20 WIDTH="716"><div> <B>Quadriceps femoris (lateral aspect) </B></div> </tD> </tR> </TABLE></B></div> <div> <B> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="725" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 20 WIDTH="715"><div> <B>Deltoid </B></div> </tD> </tR> </TABLE></B></div> <div> <B> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="723" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 20 WIDTH="713"><div> <B>Biceps brachii </B></div> </tD> </tR> </TABLE></B></div> <div> <B> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="688" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 20 WIDTH="678"><div> <B>Tibialis anterior </B></div> </tD> </tR> </TABLE></B></div> <div> <B>histological and histochemistry procedures</B></div> <div> <B> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="998" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" BGCOLOR=#003300 > <tR> <tD VALIGN=CENTER HEIGHT= 20 WIDTH="133"><div> <B>Category</B></div> </tD> <tD VALIGN=CENTER WIDTH="174"><div> <B>Method</B></div> </tD> <tD VALIGN=CENTER><NOBR><div> <B>Enzyme</B></div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="590"><div> <B>Use</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 20 WIDTH="133"><div> <B>Morphology</B></div> </tD> <tD VALIGN=CENTER WIDTH="174"><div> <B>Toluidine blue</B></div> </tD> <tD VALIGN=CENTER WIDTH="76"><div> <B> </B></div> </tD> <tD VALIGN=CENTER WIDTH="590"><div> <B>General appearance and orientation</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 39 WIDTH="133"><div> <B> </B></div> </tD> <tD VALIGN=CENTER WIDTH="174"><div> <B>Haematoxylin and eosin*</B></div> </tD> <tD VALIGN=CENTER WIDTH="76"><div> <B> </B></div> </tD> <tD VALIGN=CENTER WIDTH="590"><div> <B>Muscle fibre architecture, nuclear position and number, degeneration and regeneration, hyaline fibres, fibrosis.</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 20 WIDTH="133"><div> <B> </B></div> </tD> <tD VALIGN=CENTER WIDTH="174"><div> <B>Van Giesson</B></div> </tD> <tD VALIGN=CENTER WIDTH="76"><div> <B> </B></div> </tD> <tD VALIGN=CENTER WIDTH="590"><div> <B>Fibrosis</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 20 WIDTH="133"><div> <B> </B></div> </tD> <tD VALIGN=CENTER><NOBR><div> <B>Masson's trichrome</B></div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="76"><div> <B> </B></div> </tD> <tD VALIGN=CENTER WIDTH="590"><div> <B>Fibrosis</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 39 WIDTH="133"><div> <B> </B></div> </tD> <tD VALIGN=CENTER WIDTH="174"><div> <B>Modified Gomori trichrome</B></div> </tD> <tD VALIGN=CENTER WIDTH="76"><div> <B> </B></div> </tD> <tD VALIGN=CENTER WIDTH="590"><div> <B>Nemaline rods and 'ragged-red' fibres</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 39 WIDTH="133"><div> <B>Fibre Typing</B></div> </tD> <tD VALIGN=CENTER><NOBR><div> <B>Myofibrillar ATPase*</B></div> <div> <B>(pH 4.3, 4.6, 10.2)</B></div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="76"><div> <B> </B></div> </tD> <tD VALIGN=CENTER WIDTH="590"><div> <B>Types I, IIa, IIb, IIc</B></div> <div> <B>Type grouping</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 39 WIDTH="133"><div> <B>Enzymes - Oxidative</B></div> </tD> <tD VALIGN=CENTER WIDTH="174"><div> <B>NADH-Tr*</B></div> </tD> <tD VALIGN=CENTER><NOBR><div> <B>EC 1.6.4.3 </B></div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="590"><div> <B>Mitochondrial and tubular aggregates</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 39 WIDTH="133"><div> <B> </B></div> </tD> <tD VALIGN=CENTER WIDTH="174"><div> <B>Succinate dehydrogenase</B></div> </tD> <tD VALIGN=CENTER WIDTH="76"><div> <B> </B></div> </tD> <tD VALIGN=CENTER WIDTH="590"><div> <B>Mitochondria</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 20 WIDTH="133"><div> <B> </B></div> </tD> <tD VALIGN=CENTER><NOBR><div> <B>Cytochrome oxidase</B></div> </NOBR></tD> <tD VALIGN=CENTER><NOBR><div> <B>EC 1.9.3.1 </B></div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="590"><div> <B>Mitochondria, enzyme deficiency</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 39 WIDTH="133"><div> <B>Enzymes - Glycolytic</B></div> </tD> <tD VALIGN=CENTER WIDTH="174"><div> <B>Phosphorylase*</B></div> </tD> <tD VALIGN=CENTER><NOBR><div> <B>EC 2.4.1.1 </B></div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="590"><div> <B>Enzyme deficiency</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 39 WIDTH="133"><div> <B> </B></div> </tD> <tD VALIGN=CENTER><NOBR><div> <B>Phosphofructokinase</B></div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="76"><div> <B>EC 2.7.1.11 </B></div> </tD> <tD VALIGN=CENTER WIDTH="590"><div> <B>Enzyme deficiency</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 39 WIDTH="133"><div> <B>Enzymes - Hydrolytic</B></div> </tD> <tD VALIGN=CENTER><NOBR><div> <B>Acid phosphatase</B></div> </NOBR></tD> <tD VALIGN=CENTER><NOBR><div> <B>EC 3.1.3.2 </B></div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="590"><div> <B>Inflammation, lysosomes</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 20 WIDTH="133"><div> <B> </B></div> </tD> <tD VALIGN=CENTER><NOBR><div> <B>Non-specific esterase*</B></div> </NOBR></tD> <tD VALIGN=CENTER><NOBR><div> <B>EC 3.1.1.8 </B></div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="590"><div> <B>Inflammation, lysosomes</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 20 WIDTH="133"><div> <B> </B></div> </tD> <tD VALIGN=CENTER><NOBR><div> <B>Acetylcholinesterase</B></div> </NOBR></tD> <tD VALIGN=CENTER><NOBR><div> <B>EC 3.1.1.7 </B></div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="590"><div> <B>Neuromuscular and myotendinous junctions</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 20 WIDTH="133"><div> <B>Storage</B></div> </tD> <tD VALIGN=CENTER WIDTH="174"><div> <B>PAS*</B></div> </tD> <tD VALIGN=CENTER WIDTH="76"><div> <B> </B></div> </tD> <tD VALIGN=CENTER WIDTH="590"><div> <B>Glycogen, carbohydrate</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 20 WIDTH="133"><div> <B> </B></div> </tD> <tD VALIGN=CENTER WIDTH="174"><div> <B>Alcian blue</B></div> </tD> <tD VALIGN=CENTER WIDTH="76"><div> <B> </B></div> </tD> <tD VALIGN=CENTER WIDTH="590"><div> <B>Mucopolysaccharide</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 20 WIDTH="133"><div> <B> </B></div> </tD> <tD VALIGN=CENTER WIDTH="174"><div> <B>Sudan black B</B></div> </tD> <tD VALIGN=CENTER WIDTH="76"><div> <B> </B></div> </tD> <tD VALIGN=CENTER WIDTH="590"><div> <B>Lipid</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 20 WIDTH="133"><div> <B> </B></div> </tD> <tD VALIGN=CENTER WIDTH="174"><div> <B>Oil red O*</B></div> </tD> <tD VALIGN=CENTER WIDTH="76"><div> <B> </B></div> </tD> <tD VALIGN=CENTER WIDTH="590"><div> <B>Lipid</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 20 WIDTH="133"><div> <B>Other</B></div> </tD> <tD VALIGN=CENTER><NOBR><div> <B>Methyl green pyronine</B></div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="76"><div> <B> </B></div> </tD> <tD VALIGN=CENTER WIDTH="590"><div> <B>RNA</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 20 WIDTH="133"><div> <B> </B></div> </tD> <tD VALIGN=CENTER WIDTH="174"><div> <B>Acridine orange</B></div> </tD> <tD VALIGN=CENTER WIDTH="76"><div> <B> </B></div> </tD> <tD VALIGN=CENTER WIDTH="590"><div> <B>RNA</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 20 WIDTH="133"><div> <B> </B></div> </tD> <tD VALIGN=CENTER WIDTH="174"><div> <B>Von Kossa</B></div> </tD> <tD VALIGN=CENTER WIDTH="76"><div> <B> </B></div> </tD> <tD VALIGN=CENTER WIDTH="590"><div> <B>Calcium</B></div> </tD> </tR> </TABLE></B></div> <bR> <div> <B>Investigation of the Patient with a suspected Neuromuscular Disorder </B></div> <div> <B> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="947" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 20 WIDTH="937"><div> <B>Family History:</B> acquired or genetic disorder? </div> </tD> </tR> </TABLE></B></div> <div> <B> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="947" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 38 WIDTH="937"><div> <B>Clinical History and Examination:</B> acute or chronic, age of onset, rate of progression, anatomical distribution of weakness (MRC ratings), wasting or pain </div> </tD> </tR> </TABLE></B></div> <div> <B> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="947" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 20 WIDTH="937"><div> <B>Muscle Biopsy:</B> myopathic or neurogenic? </div> </tD> </tR> </TABLE></B></div> <div> <B> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="947" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 20 WIDTH="937"><div> <B>Imaging:</B> CT or MRI scans </div> </tD> </tR> </TABLE></B></div> <div> <B> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="947" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 20 ><NOBR><div> <B>Haematology/ Biochemistry/ Molecular Genetics:</B> CK levels, lactate levels, leucocyte counts, gene defects </div> </NOBR></tD> </tR> </TABLE></B></div> <div> <B> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="947" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 20 WIDTH="937"><div> <B>Electrophysiology:</B> EMG, nerve conduction velocities </div> </tD> </tR> </TABLE></B></div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="1017" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER BGCOLOR=#800000 HEIGHT= 43 WIDTH="115"><div> <I><B>Pathological features</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000><NOBR><div> <I><B>Normal</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="91"><div> <IMG SRC="04c10100.png" border=0 width="16" height="16" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="74"><div> <I><B>-----</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000><NOBR><div> <I><B>Myopathic</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="108"><div> <I><B>-----</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="93"><div> <I><B><IMG SRC="04d10100.png" border=0 width="16" height="16" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="73"><div> <I><B>?</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="73"><div> <I><B><IMG SRC="04c10100.png" border=0 width="16" height="16" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#800000><NOBR><div> <I><B>Neurogenic</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#800000 WIDTH="74"><div> <I><B><IMG SRC="04d10100.png" border=0 width="16" height="16" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></I></div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 ><NOBR><div> <I><B>CT: fibrosis</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="73"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="91"><div> +/+</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="74"><div> ++/+++</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="92"><div> -/+</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="108"><div> -/+++</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="93"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="73"><div> -/+</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="73"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="91"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="74"><div> -/++</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 ><NOBR><div> <I><B>Inflammation</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="73"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="91"><div> ++/++++</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="74"><div> -/+</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="92"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="108"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="93"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="73"><div> -/+</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="73"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="91"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="74"><div> -</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 WIDTH="115"><div> <I><B>Fibre Size variation</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> CV<25%</div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="91"><div> +/+++</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="74"><div> ++/++++</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="92"><div> -/++</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="108"><div> -/++++</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="93"><div> -/++</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="73"><div> -/+</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="73"><div> +/++++</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="91"><div> -/+</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="74"><div> +/+++</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 19 ><NOBR><div> <I><B>Regeneration</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="73"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="91"><div> ++/+++</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="74"><div> ++/++++</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="92"><div> -/+</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="108"><div> -/+</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="93"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="73"><div> -/+</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="73"><div> -/+</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="91"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="74"><div> -</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 57 WIDTH="115"><div> <I><B>Morphological abnormalities</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="73"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="91"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="74"><div> Hyaline fibres</div> <div> Fibrosis</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="92"><div> Vacuoles</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Cores</div> <div> Nemaline,</div> <div> Internal nuclei</div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="93"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="73"><div> -/+</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="73"><div> Angular</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="91"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="74"><div> Grouped atrophy</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 ><NOBR><div> <I><B>Enzymes/storage</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="73"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="91"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="74"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="92"><div> ++/+++</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Undifferentiated</div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="93"><div> Excess Type I fibres</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="73"><div> -/+</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="73"><div> FTG</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="91"><div> AChE</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="74"><div> -</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 ><NOBR><div> <I><B>Other Features</B></I></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="73"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="91"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="74"><div> Absent dystrophin</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Ragged red</div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="108"><div> Variable</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="93"><div> NADH distribution</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="73"><div> -/+</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="73"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="91"><div> -</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="74"><div> -</div> </tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 125 WIDTH="115"><div> <I><B> </B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <IMG SRC="05145770.png" border=0 width="69" height="119" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <IMG SRC="05345770.png" border=0 width="69" height="119" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <IMG SRC="05545770.png" border=0 width="69" height="119" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <IMG SRC="05745770.png" border=0 width="69" height="119" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="108"><div> <IMG SRC="05945770.png" border=0 width="69" height="119" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <IMG SRC="05b45770.png" border=0 width="69" height="119" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <IMG SRC="05d45770.png" border=0 width="69" height="119" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <IMG SRC="05f45770.png" border=0 width="69" height="119" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <IMG SRC="06145770.png" border=0 width="69" height="119" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> <IMG SRC="06345770.png" border=0 width="69" height="119" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 38 WIDTH="115"><div> <I><B>Pathological group</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="73"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Inflammatory</div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Dystrophic</div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="92"><div> Metabolic</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="108"><div> Congenital</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="93"><div> Secondary / miscellaneous</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="73"><div> ? </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="73"><div> Central</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Junctional</div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Peripheral</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER BGCOLOR=#FFFFCC HEIGHT= 57 WIDTH="115"><div> <I><B>Differential diagnoses (examples)</B></I></div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="73"><div> Normal</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="91"><div> PM</div> <div> DM</div> <div> IBM</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> DMD</div> <div> BMD</div> <div> SCARMD</div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> McArdle's</div> <div> Pompe's</div> <div> Mitochondrial</div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> CFTD,</div> <div> Central core,</div> <div> Nemaline</div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC><NOBR><div> Hypothyroid</div> <div> Steroid</div> </NOBR></tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="73"><div>  </div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="73"><div> MND</div> <div> SMA</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="91"><div> MyG</div> <div> LEMS</div> </tD> <tD VALIGN=CENTER BGCOLOR=#FFFFCC WIDTH="74"><div> HMSN</div> </tD> </tR> </TABLE></B></div> <div> <A HREF="http://www.biomed.man.ac.uk/ns/mm/musdiag.html" TARGET="_top" TITLE="http://www.biomed.man.ac.uk/ns/mm/musdia"><U><U>http://www.biomed.man.ac.uk/ns/mm/musdiag.html</U></U></A></div> <bR> <bR> <div> <B>pathology of cardiac muscle</B></div> <div> <B> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="998" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" BGCOLOR=#990000 > <tR> <tD VALIGN=TOP HEIGHT= 276 ><NOBR><div> <B>·</B><FONT SIZE="3" COLOR="#FFFF00" FACE="Arial" ><B>  Myocardial hypertrophy </B></FONT></div> </NOBR></tD> <tD VALIGN=TOP WIDTH="750"><div> <B><IMG BORDER="0" SRC="Symb075c00b700c8ffff0000.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">occurs in response to increased pressure overload. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8ffff0000.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">At autopsy, an assessment of ventricular hypertrophy can be made by measuring the thickness of the ventricular walls. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8ffff0000.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">This measurement is traditionally made 2 cm below the mitral or tricuspid valve, taking care not to include any papillary muscle(s).</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8ffff0000.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Upper limits of normal are 0.4 cm for the right ventricle and 1.4 cm for the left ventricle. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8ffff0000.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Ventricular dilatation (as seen in failing hearts, or in volume overload as in valvular incompetence) can make a hypertrophic ventricular wall appear to be of normal thickness because the wall thins as the ventricular cavity dilates. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8ffff0000.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Right ventricular hypertrophy is commonly due to chronic lung disease ("chronic cor pulmonale"). </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8ffff0000.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Common causes of left ventricular hypertrophy are systemic hypertension (an increase in the peripheral resistance of the vasculature) and stenosis (narrowing) of the aortic valve (due to degenerative calcific aortic valve stenosis, chronic rheumatic valvular disease or a congenital bicuspid valve). </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8ffff0000.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">At a light microscopic level, hypertrophy can be recognized as in increase in the diameter of the cardiac muscle cells from a normal of about 15 um to 25 um or more. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8ffff0000.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The myocardium does not become </B><A HREF="http://www.smd.kcl.ac.uk/kcsmd/hist/chap1.htm#Hyperplasia" TARGET="_top" TITLE="http://www.smd.kcl.ac.uk/kcsmd/hist/chap"><U><B><U>hyperplastic</U></B></U></A><B> because the cardiac muscle cells are one the permanent cell populations of the body (like the CNS neurones) and, in the adult, they have no replicative ability.</B></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 130 ><NOBR><div> <B>·</B><FONT SIZE="3" COLOR="#FFFF00" FACE="Arial" ><B>  Myocardial infarction </B></FONT></div> </NOBR></tD> <tD VALIGN=TOP WIDTH="750"><div> <B><IMG BORDER="0" SRC="Symb075c00b700c8ffff0000.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">An infarct is an altered area of tissue which has lost its blood supply (ischaemia).</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8ffff0000.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Infarction usually implies that the tissue has undergone ischaemic necrosis but this is not true for all infarcts e.g. a "red infarct" of the liver is not a true infarct but is due to sinusoidal engorgement and atrophy of liver cells. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8ffff0000.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Myocardial infarcts are true infarcts because each of the three main coronary arteries acts as an end artery (arteries of internal organs having imperfect anastomoses).</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8ffff0000.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Because there are little or no anastomoses, little blood enters the dying myocardium, and so myocardial infarcts are pale infarcts. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700c8ffff0000.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Two types of myocardial infarction are recognized: transmural and subendocardial.</B></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 49 WIDTH="233"><div> <B>·</B><FONT SIZE="3" COLOR="#FFFF00" FACE="Arial" ><B>  Myocarditis</B></FONT></div> </tD> <tD VALIGN=TOP WIDTH="750"><div> Inflammatory reactions within the myocardium are due to viruses and other infective agents, drugs, and autoimmune injury (hypersensitivity). </div> <div> The histological appearances are variable but mononuclear infiltrates (lymphocytes, macrophages) are usually present</div> </tD> </tR> </TABLE></B></div> <bR> <bR> <bR> <bR> <div> <B>Myopathy: Congenital</B></div> <bR> <div> <B> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="995" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 722 ><NOBR><div> <A HREF="http://www.neuro.wustl.edu/neuromuscular/pathol/centcore.htm" TARGET="_top" TITLE="http://www.neuro.wustl.edu/neuromuscular"><U><U>Central core</U></U></A></div> </NOBR></tD> <tD VALIGN=TOP><NOBR><div> Myopathic changes in central core disease: Adult (left) & Child (Right) </div> <div> Fiber size: Variability </div> <div> Connective tissue: Increased </div> <div> Internal nuclei </div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="873" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=BOTTOM HEIGHT= 421 ><NOBR><div> <IMG SRC="065af860.jpg" border=0 width="175" height="134" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </NOBR></tD> <tD VALIGN=BOTTOM><NOBR><div> <IMG SRC="067ae820.jpg" border=0 width="174" height="130" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </NOBR></tD> <tD VALIGN=BOTTOM><NOBR><div> <IMG SRC="06937ee0.jpg" border=0 width="311" height="238" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> NADH stain<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </NOBR></tD> <tD VALIGN=BOTTOM><NOBR><div> <IMG SRC="06b318c0.jpg" border=0 width="561" height="396" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> ATPase, pH 9.4<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </NOBR></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 170 WIDTH="243"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="170" ALIGN="bottom" WIDTH="243" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=BOTTOM WIDTH="240"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="170" ALIGN="bottom" WIDTH="240" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="188"><div> <B>Cores</B></div> <bR> <div> Central zone, "core", in muscle fibers</div> <div>  <FONT SIZE="3" COLOR="#000000" FACE="Wingdings" >ê</FONT> Oxidative enzyme activity</div> <div>  <FONT SIZE="3" COLOR="#000000" FACE="Wingdings" >ê</FONT> Mitochondria</div> <div> Cores run whole length of muscle fiber</div> </tD> <tD VALIGN=TOP WIDTH="189"><div> <B>Muscle fibers</B></div> <bR> <div> Marked type I muscle fiber predominence</div> <div> Some cores have loss of central myofibrillar structure</div> </tD> </tR> </TABLE></div> <bR> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 2055 ><NOBR><div> <A HREF="http://www.neuro.wustl.edu/neuromuscular/pathol/centcore.htm" TARGET="_top" TITLE="http://www.neuro.wustl.edu/neuromuscular"><U><U>Central core</U></U></A></div> </NOBR></tD> <tD VALIGN=TOP><NOBR><div> <B>CENTRONUCLEAR (MYOTUBULAR) MYOPATHY</B></div> <div> <B> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="533" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=BOTTOM HEIGHT= 240 ><NOBR><div> <B>Infantile</B></div> <div> <IMG SRC="06d03c80.jpg" border=0 width="259" height="200" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> H&E stain<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </NOBR></tD> <tD VALIGN=BOTTOM><NOBR><div> <IMG SRC="06f0ccc0.jpg" border=0 width="268" height="204" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> ATPase stain, pH 9.4<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 75 ><NOBR><div> Note central nuclei in</div> <div> several small muscle fibers.</div> </NOBR></tD> <tD VALIGN=TOP><NOBR><div> Type I (light) muscle fibers tend </div> <div> to be smaller than type II.</div> <div> Note clear regions in center of</div> <div> some fibers.</div> </NOBR></tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 200 ><NOBR><div> <IMG SRC="071e3af0.jpg" border=0 width="227" height="175" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> NADH stain<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </NOBR></tD> <tD VALIGN=BOTTOM WIDTH="259"><div> <IMG SRC="07396700.jpg" border=0 width="150" height="112" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> VvG stain<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 95 WIDTH="267"><div> Abnormal internal architecture.</div> <div> Some fibers have central dark staining.</div> <div> Others have coarse internal architecture.</div> </tD> <tD VALIGN=TOP><NOBR><div> Abnormal internal architecture.</div> <div> Note clear rim around edge of</div> <div> many fibers.</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 HEIGHT= 19 WIDTH="527"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="527" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></B></div> <bR> <div> <B> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="533" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=BOTTOM HEIGHT= 292 ><NOBR><div> <B>Childhood</B></div> <div> <IMG SRC="07553fc0.jpg" border=0 width="339" height="252" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> H&E stain<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </NOBR></tD> <tD VALIGN=BOTTOM><NOBR><div> <IMG SRC="077c79c0.jpg" border=0 width="199" height="156" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> H&E stain<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP COLSPAN=2 HEIGHT= 54 WIDTH="527"><div> Note central nuclei in several smaller muscle fibers.</div> <div> Central regions in other fibers are basophilic.</div> </tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 391 ><NOBR><div> <IMG SRC="079ec6e0.jpg" border=0 width="492" height="366" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> NADH stain<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </NOBR></tD> <tD VALIGN=BOTTOM><NOBR><div> <IMG SRC="07be66c0.jpg" border=0 width="486" height="364" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> ATPase stain, pH 9.4<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 95 WIDTH="267"><div> Abnormal internal architecture.</div> <div> Some fibers have central dark staining.</div> <div> Others have coarse internal architecture.</div> </tD> <tD VALIGN=TOP><NOBR><div> Type I (light) muscle fibers tend</div> <div> to be smaller than type II.</div> <div> Note clear regions in center of</div> <div> some fibers.</div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER COLSPAN=2 HEIGHT= 19 WIDTH="527"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="527" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></B></div> <bR> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="681" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER COLSPAN=3 HEIGHT= 20 WIDTH="673"><div> <B>Juvenile</B></div> </tD> </tR> <tR> <tD VALIGN=BOTTOM HEIGHT= 276 ><NOBR><div> <IMG SRC="07d17bf0.jpg" border=0 width="279" height="191" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> H&E stain<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </NOBR></tD> <tD VALIGN=BOTTOM><NOBR><div> <IMG SRC="07f36c20.jpg" border=0 width="310" height="194" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> ATPase stain, pH 9.4<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </NOBR></tD> <tD VALIGN=BOTTOM><NOBR><div> <IMG SRC="0814afb0.jpg" border=0 width="330" height="251" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> NADH stain<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 132 WIDTH="212"><div> Central nuclei in several smaller</div> <div> muscle fibers.</div> </tD> <tD VALIGN=TOP WIDTH="204"><div> Type I (light) muscle fibers are</div> <div> generally smaller than type II</div> <div> (dark) fibers.</div> <div> Note clear regions in center of</div> <div> type I fibers.</div> </tD> <tD VALIGN=TOP><NOBR><div> Abnormal internal architecture</div> <div> in smaller (type I) muscle fibers.</div> </NOBR></tD> </tR> </TABLE></div> <bR> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 684 WIDTH="99"><div> <A HREF="http://www.neuro.wustl.edu/neuromuscular/pathol/congmd.htm" TARGET="_top" TITLE="http://www.neuro.wustl.edu/neuromuscular"><U><U>Congenital muscular dystrophy</U></U></A></div> </tD> <tD VALIGN=TOP><NOBR><div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="570" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=BOTTOM HEIGHT= 212 ><NOBR><div> <IMG SRC="08390bb0.jpg" border=0 width="144" height="187" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="0858abb0.jpg" border=0 width="138" height="187" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="08787bb0.jpg" border=0 width="135" height="187" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> H&E stain<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </NOBR></tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > </TABLE></div> <div> <B>Myopathic changes in congenital muscular dystrophy</B> </div> <div> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > </TABLE></div> <div> Fiber size: Variability </div> <div> Immature muscle fibers (Center): Internal nuclei; Basophilia </div> <div> Connective tissue (Right): Increased </div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="575" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="571"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="571" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <bR> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="814" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=BOTTOM HEIGHT= 149 ><NOBR><div> <IMG SRC="089bb850.jpg" border=0 width="187" height="133" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </NOBR></tD> <tD VALIGN=BOTTOM WIDTH="548"><div> <IMG SRC="08bbb8f0.jpg" border=0 width="187" height="143" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 94 ><NOBR><div> <B>Merosin: Normal muscle</B></div> <bR> <div> Merosin is normally located in:</div> <div>  Basal lamina: Muscle fiber surface</div> <div>  Intramuscular nerves</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="548"><div> <B>Merosin: Congenital muscular dystrophy</B></div> <bR> <div>  Merosin staining is absent from</div> <div>  the muscle fiber surface </div> </tD> </tR> </TABLE></div> <bR> </NOBR></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 2410 WIDTH="99"><div> <A HREF="http://www.neuro.wustl.edu/neuromuscular/pathol/1small.htm" TARGET="_top" TITLE="http://www.neuro.wustl.edu/neuromuscular"><U><U>Fiber type size disproportion</U></U></A></div> </tD> <tD VALIGN=TOP WIDTH="881"><div> <B>Congenital Fiber Type Size Disproportion:</B></div> <div> <B> Small type 1 Muscle fibers</B></div> <div> <B>INFANT</B> </div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="547" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 263 ><NOBR><div> <IMG SRC="08d3dee0.jpg" border=0 width="317" height="238" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> H&E stain<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </NOBR></tD> <tD VALIGN=TOP><NOBR><div> <IMG SRC="08f19d30.jpg" border=0 width="281" height="211" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> ATPase pH 9.4 stain<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> </NOBR></tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > </TABLE></div> <div> Congenital fiber type size disproportion in an infant. </div> <div> Type 1 muscle fibers (pale on ATPase) are much smaller than type 2 fibers. </div> <div> This change may also be found in more well defined <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><A HREF="http://www.neuro.wustl.edu/neuromuscular/syncm.html" TARGET="_top" TITLE="http://www.neuro.wustl.edu/neuromuscular"><U><U>congenital myopathies</U></U></A></FONT></div> <div> including <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><A HREF="http://www.neuro.wustl.edu/neuromuscular/syncm.html#cnm" TARGET="_top" TITLE="http://www.neuro.wustl.edu/neuromuscular"><U><U>centronuclear</U></U></A></FONT>, <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><A HREF="http://www.neuro.wustl.edu/neuromuscular/syncm.html#rod" TARGET="_top" TITLE="http://www.neuro.wustl.edu/neuromuscular"><U><U>nemaline rod</U></U></A></FONT> and <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><A HREF="http://www.neuro.wustl.edu/neuromuscular/syncm.html#multicore" TARGET="_top" TITLE="http://www.neuro.wustl.edu/neuromuscular"><U><U>multicore</U></U></A></FONT>.</div> <div> The large disparity in sizes of the 2 fiber types (> 50%) correlates</div> <div> with a clinical picture of hypotonia and nonprogressive weakness. </div> <div> See <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><A HREF="http://www.neuro.wustl.edu/neuromuscular/lab/mbiopsy.htm#fibertype" TARGET="_top" TITLE="http://www.neuro.wustl.edu/neuromuscular"><U><U>Fiber type disorders</U></U></A></FONT> </div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="547" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="543"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="543" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <div> <B>CHILD</B></div> <div> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > </TABLE></div> <div> <IMG SRC="09152180.jpg" border=0 width="594" height="792" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="0935e290.jpg" border=0 width="606" height="809" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> ATPase pH 4.3 stain<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="657" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 44 WIDTH="653"><div> Type 1 muscle fibers (Dark) are small </div> <bR> </tD> </tR> </TABLE></div> <div> <B>Type 1 Fiber Smallness: Diffferential Diagnosis</B> </div> <div> Dystrophy: <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><A HREF="http://www.neuro.wustl.edu/neuromuscular/pathol/edmdpath2.htm" TARGET="_top" TITLE="http://www.neuro.wustl.edu/neuromuscular"><U><U>Emery-Dreifuss</U></U></A></FONT>; ?Myotonic </div> <div> Congenital myopathies:<A HREF="http://" TARGET="_top" TITLE="http://"><U> </U></A><FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><A HREF="http://" TARGET="_top" TITLE="http://"><U><U>Centronuclear</U></U></A></FONT><A HREF="http://" TARGET="_top" TITLE="http://"><U>; </U></A><FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><A HREF="http://" TARGET="_top" TITLE="http://"><U><U>Nemaline rod</U></U></A></FONT><A HREF="http://" TARGET="_top" TITLE="http://"><U>; </U></A><FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><A HREF="http://" TARGET="_top" TITLE="http://"><U><U>Fiber type disproportion</U></U></A></FONT><A HREF="http://" TARGET="_top" TITLE="http://"><U> </U></A></div> <div> Exercise training </div> <bR> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 1283 WIDTH="99"><div>  <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><A HREF="http://www.neuro.wustl.edu/neuromuscular/pathol/rod.htm" TARGET="_top" TITLE="http://www.neuro.wustl.edu/neuromuscular"><U><U>Nemaline rod myopathy</U></U></A></FONT></div> </tD> <tD VALIGN=TOP><NOBR><div> <B>NEMALINE RODS</B></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="862" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 151 WIDTH="172"><div> <IMG SRC="0955b430.jpg" border=0 width="91" height="67" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> Gomori trichrome</div> </tD> <tD VALIGN=CENTER WIDTH="683"><div> <IMG SRC="0979c6d0.jpg" border=0 width="156" height="109" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> Electron microscopy of rods from Z-lines</div> <div> in Met9Arg <FONT SIZE="2" COLOR="#000000" FACE="Symbol" >a</FONT>TM<FONT SIZE="1" COLOR="#000000" FACE="Arial" >slow</FONT> mouse: From <FONT SIZE="2" COLOR="#0000FF" FACE="Arial" ><A HREF="mailto:ehardeman@cimri.usyd.edu.au" TARGET="_top" TITLE="mailto:ehardeman@cimri.usyd.edu.au"><U><U>E Hardeman</U></U></A></FONT> </div> </tD> </tR> </TABLE></div> <bR> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="861" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 697 WIDTH="857"><div> <IMG SRC="099dc720.jpg" border=0 width="476" height="370" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="09b823d0.jpg" border=0 width="386" height="317" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </tD> </tR> </TABLE></div> <bR> <div> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > </TABLE></div> <div> <B>Pathology</B> </div> <div> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > </TABLE></div> <div> Light microscopy: Rods best visualized with Gomori trichrome stain (Upper Left) </div> <div> Dark red-blue structures in muscle fiber cytoplasm </div> <div> Composed of Z-line like material (Upper Right) </div> <div> Contain <FONT SIZE="3" COLOR="#000000" FACE="Symbol" >a</FONT>-actinin & tropomyosin ± desmin at the periphery </div> <div> Located in sarcoplasm: Often in regions with disrupted sarcomere structure </div> <div> Occur in </div> <div> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > </TABLE></div> <div> Congenital myopathies </div> <div> Adult onset nemaline myopathies </div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="861" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="857"><div> Muscle fibers with targets </div> </tD> </tR> </TABLE></div> <bR> </NOBR></tD> </tR> </TABLE></B></div> <bR> <bR> <div> pathology of skeletal muscle</div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="990" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 678 ><NOBR><div> <FONT SIZE="3" COLOR="#000000" FACE="Symbol" >·</FONT>  <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><A HREF="http://www.smd.kcl.ac.uk/kcsmd/hist/#Congenital" TARGET="_top" TITLE="http://www.smd.kcl.ac.uk/kcsmd/hist/#Con"><U><U>Congenital myopathies</U></U></A></FONT> </div> </NOBR></tD> <tD VALIGN=TOP WIDTH="778"><bR> <div> These patients usually present as floppy infants; the disease course is variable but most are non-progressive and some patients will have normal life expectancies. This is a heterogeneous group of diseases of which an example would be nemaline myopathy. Here rod-shaped inclusions are seen on longitudinal semithin sections or on sections stained with Gomori's trichrome method (a modified collagen stain). <FONT SIZE="2" COLOR="#000000" FACE="Arial" ><IMG SRC="09c40f00.png" border=0 width="320" height="240" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></FONT>The photomicrograph shows a Gomori's trichrome-stained tranverse section of quadriceps femoris from a 58-year-old woman with a 7 year history of gradual onset of muscle weakness. The myofilaments are stained green and the abnormal nemaline inclusions are stained deep red. <FONT SIZE="2" COLOR="#000000" FACE="Arial" ><IMG SRC="09d40f00.png" border=0 width="320" height="240" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></FONT>The electron photomicrograph shows the ultrastructure appearance of the nemaline inclusions. Immunohistochemical staining with a monoclonal antibody which recognizes alpha-actinin (the substance that forms the Z-lines where the actin filaments are anchored) shows that the nemaline inclusions are formed of alpha-actinin</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 437 ><NOBR><div> <FONT SIZE="3" COLOR="#000000" FACE="Symbol" >·</FONT>  <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><A HREF="http://www.smd.kcl.ac.uk/kcsmd/hist/#Inflammatory" TARGET="_top" TITLE="http://www.smd.kcl.ac.uk/kcsmd/hist/#Inf"><U><U>Inflammatory myopathies</U></U></A></FONT> </div> </NOBR></tD> <tD VALIGN=TOP WIDTH="778"><div> <FONT SIZE="2" COLOR="#000000" FACE="Arial" ><IMG SRC="09e40f00.png" border=0 width="320" height="240" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></FONT>This is also a heterogeneous group of diseases of which the most important is the polymyositis/dermatomyositis group. They are characterized by inflammatory infiltrates of lymphocytes and macrophages. Immunohistochemical staining shows most of the lymphocytes are CD8 +ve T cells. There is rhabdomyolysis and rhabdomyophagia in the acute phase with a raised serum creatine phosphokinase level. Later stages show regenerating fibres with central nuclear chains and basophilic sarcoplasm. There is usually a perifascicular atrophy present. The disease can be quite focal within a muscle and so sampling can be a problem. A normal biopsy does not exclude polymyositis. Treatment is with <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><A HREF="http://www.smd.kcl.ac.uk/kcsmd/hist/#steroids" TARGET="_top" TITLE="http://www.smd.kcl.ac.uk/kcsmd/hist/#ste"><U><U>steroids</U></U></A></FONT> such as prednisolone. This photomicrograph of a quadriceps femoris biopsy shows transversely sectioned skeletal muscle fibres with those in the centre surrounded and infiltrated by a chronic inflammatory cell infiltrate composed mostly of lymphocytes. The infiltrate in this example is a fairly intense and many cases are more subtle then this. Immunohistochemical staining using anti-lymphoid antibodies can be very useful in borderline cases.</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 437 WIDTH="197"><div> <FONT SIZE="3" COLOR="#000000" FACE="Symbol" >·</FONT>  <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><A HREF="http://www.smd.kcl.ac.uk/kcsmd/hist/#Metabolic" TARGET="_top" TITLE="http://www.smd.kcl.ac.uk/kcsmd/hist/#Met"><U><U>Metabolic and endocrine myopathies</U></U></A></FONT> </div> </tD> <tD VALIGN=TOP WIDTH="778"><div> <IMG SRC="09f40f00.png" border=0 width="320" height="240" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><FONT SIZE="3" COLOR="#000000" FACE="Arial" >A number of specific metabolic abnormalities can cause muscle disorders. Examples would include periodic paralysis, glycogen and lipid storage diseases, and the mitochondrial myopathies (these are a large and heterogeneous group of diseases where there are abnormally large numbers of ultrastructurally abnormal mitochondria present within the sarcoplasm. Mitochondria can be seen on the oxidative enzyme stains [NADH and SDH] and more clearly by electron microscopy). Myopathies have also been described in association with several endocrine disorders, notably thyroid, parathyroid and pituitary disorders. Hyperadrenalism (Cushing's syndrome) and prolonged therapy with steroids (steroid myopathy) are both seen histologically as type II fibre atrophy. Type II atrophy is a fairly non-specific change seen in many chronic myopathies e.g. alcoholic myopathy. The photomicrograph shows a PAS-stained section of a quadriceps femoris skeletal muscle biopsy from a patient with a glycogen storage disease. Abnormal accumulations of glycogen can be seen within the sarcoplasm of many of the skeletal muscle fibres</FONT></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 437 WIDTH="197"><div> <FONT SIZE="3" COLOR="#000000" FACE="Symbol" >·</FONT>  <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><A HREF="http://www.smd.kcl.ac.uk/kcsmd/hist/#Lower" TARGET="_top" TITLE="http://www.smd.kcl.ac.uk/kcsmd/hist/#Low"><U><U>Lower motor neurone diseases</U></U></A></FONT> </div> </tD> <tD VALIGN=TOP WIDTH="778"><div> <IMG SRC="0a040f00.png" border=0 width="320" height="240" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><FONT SIZE="3" COLOR="#000000" FACE="Arial" >Lower motor neurone diseases include peripheral neuropathies (most commonly caused by diabetes mellitus although there are many other causes), poliomyelitis, amyotrophic lateral sclerosis and spinal muscular atrophy. Lower motor neurone diseases cause a neurogenic atrophy characterized by random atrophy of type II skeletal muscle fibres that are angulated on transverse sections. "Target" skeletal muscle fibres, resembling the pattern on a dartboard, are commonly revealed by oxidative enzyme staining (NADH, SDH). If it occurs, reinnervation of the skeletal muscle leads to fibre type grouping which contrasts with the chequer-board mosaic seen in normal skeletal muscle biopsies. The photomicrograph shows a transverse section of a quadriceps femoris skeletal muscle biopsy stained for NADH. Fibre type grouping is evident (the type I skeletal muscle fibres are darkly stained and type II skeletal muscle fibres lightly stained in this preparation) and the normal chequer-board mosiac pattern is lost. Fibre type grouping is said to have occured when groups of 6 or more fibres of the same type can be found in the skeletal muscle biopsy.</FONT></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 57 ><NOBR><div> ·<FONT SIZE="3" COLOR="#000000" FACE="Arial" >  </FONT><FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><A HREF="http://www.smd.kcl.ac.uk/kcsmd/hist/#Muscular" TARGET="_top" TITLE="http://www.smd.kcl.ac.uk/kcsmd/hist/#Mus"><U><U>Muscular dystrophies</U></U></A></FONT></div> </NOBR></tD> <tD VALIGN=TOP WIDTH="778"><div> This is a group of hereditary primary myopathies. They show a chronic and progressive clinical course. The commonest forms are Duchenne muscular dystrophy, Becker dystrophy, limb girdle dystrophy, and myotonic dytrophy. Muscle biopsies show scattered necrotic fibres and hypertrophied fibres.</div> </tD> </tR> </TABLE></div> <div> Dr Jon Salisbury, http://www.smd.kcl.ac.uk/kcsmd/hist/chap3.htm#cardiac%20muscle</div> <bR> </td> </tr></table></body>