Difference between revisions of "Neuromuscular pathology"

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+granulomatous myositis & others....
(+granulomatous myositis & others....)
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[[Image:Vasculitic neuropathy - plastics - low mag.jpg|thumb|right|[[Micrograph]] of a muscle biopsy. [[Toluidine blue stain]].]]
[[Image:Vasculitic neuropathy - plastics - low mag.jpg|thumb|right|[[Micrograph]] of a nerve biopsy. [[Toluidine blue stain]].]]
'''Neuromuscular pathology''' is the study of muscle and neurologic disease associated with muscle dysfunction.  It is a part of [[neuropathology]].   
'''Neuromuscular pathology''' is the study of muscle and neurologic disease associated with muscle dysfunction.  It is a part of [[neuropathology]].   


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*Groups of small fibres.
*Groups of small fibres.
*Apparent increase of nuclei.
*Apparent increase of nuclei.
<gallery>
File:Muscle angular atrophic fibers.jpg | Angulated atrophic fibers (HE)
File:ATPase targetoid fibers neurogenic muscle atrophy.jpg Fiber type grouping and targetoid fibers in neurogenic atrophy (ATPase)
</gallery>


Myogenic:
Myogenic:
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*Endomysial fibrosis.
*Endomysial fibrosis.
*Hypercontracted fibres (large muscle fibres).
*Hypercontracted fibres (large muscle fibres).
<gallery>
File:BMD histology.jpg | Becker's muscular dystrophy ([[H&E]))
File:Dys1 Dystrophinopathy carrier.jpg | Carrier status in dystrophinophathy (Dystrophin)
</gallery>


Images:
Images:
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Notes:
Notes:
*Can be demonstrated with [[IHC]].
*Can be demonstrated with [[IHC]].


===DDx===
===DDx===
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*[[Inclusion body myositis]].
*[[Inclusion body myositis]].
*[[Dermatomyositis]].
*[[Dermatomyositis]].
<gallery>
File:Neuropathology case XII 01.jpg | Polymoysitis ([[H&E]])
File:Neuropathology case XII 02.jpg | Polymoysitis ([[H&E]])
File:Neuropathology case XII 03.jpg | Polymoysitis (CD45)
File:Neuropathology case XII 04.jpg | Polymoysitis (MHC-I)
File:Polymyositis_HE.jpg | Polymoysitis ([[H&E]])
</gallery>


Images:
Images:
*[http://commons.wikimedia.org/wiki/File:Polymyositis_HE.jpg Polymyositis (WC)].
*[http://neuromuscular.wustl.edu/pathol/inflammation.htm#cellinv Focal invasion of lymphocytes (wustl.edu)].
*[http://neuromuscular.wustl.edu/pathol/inflammation.htm#cellinv Focal invasion of lymphocytes (wustl.edu)].


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**Endomysial - T cells.
**Endomysial - T cells.
**Perimysial - B cells.
**Perimysial - B cells.
==Inclusion body myositis==
<gallery>
File:IBM rimmed vacuoles HE x200.jpg | Rimmed vacuoles in inclusion body myositis (HE).
</gallery>
==Granulomatous myositis==
===General===
Etiology:<ref>{{Cite journal  | last1 = Prieto-González | first1 = S. | last2 = Grau | first2 = JM. | title = Diagnosis and classification of granulomatous myositis. | journal = Autoimmun Rev | volume = 13 | issue = 4-5 | pages = 372-4 | month =  | year =  | doi = 10.1016/j.autrev.2014.01.017 | PMID = 24424169 }}</ref>
* [[Sarcoidosis]]
* Idiopathic
* Infectious ([[Tuberculosis]], Syphillis, Brucellosis
* Foreign-body reaction
* [[Thymoma]] - myasthenia gravis
* [[Lymphoma]] - paraneoplastic
* [[Primary biliary cirrhosis]]
<gallery>
File:Sarkoidosis muscle.jpg | Sarcoidosis ([[H&E]])
File:Granulomatous myositis.jpg | Granulomatous myositis ([[H&E]])
</gallery>
==Metabolic myopathy==
===Microscopic===
Fetures:
*Intramuscular storage deposits.
** PAS positive stain in glycogen storage disease.
<gallery>
File:PAS glycogen storage disease intermed mag.jpg | Glycogen storage (PAS).
File:Trichrom glycogen storage disease intermed mag..jpg | Glycogen storage (Trichrom).
File:Vacuolar myopathy mcArdle type V glcogenosis.jpg | Type V glocogenosis (McArdle, HE).
</gallery>


==Myotonic dystrophy==
==Myotonic dystrophy==
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*A type of congenital myopathy.
*A type of congenital myopathy.
*Paediatric thingy.
*Paediatric thingy.
==Centronuclear myopathy==
*AKA myotubular myopathy
*Several types
** X-chromosomal recessive: floppy infant
** austosmal dominant: late onset with proximal involvement, ptosis, opthalmoplegia
<gallery>
File:Biopsy centronuclear myopathy HE.jpg
</gallery>
Image centronuclear myopathy<ref>URL: [http://www.igbmc.fr/recherche/Dep_NG/Eq_JLaporte/JL3.html http://www.igbmc.fr/recherche/Dep_NG/Eq_JLaporte/JL3.html]. Accessed on: 26 October 2010.</ref>).


==Drug-induced rhabdomyolysis==
==Drug-induced rhabdomyolysis==
*AKA ''drug-induced acute necrotizing myopathy''.
*AKA ''drug-induced acute necrotizing myopathy''.
===General===
===General===
Clinical:<ref name=pmid15021204>{{Cite journal  | last1 = Coco | first1 = TJ. | last2 = Klasner | first2 = AE. | title = Drug-induced rhabdomyolysis. | journal = Curr Opin Pediatr | volume = 16 | issue = 2 | pages = 206-10 | month = Apr | year = 2004 | doi =  | PMID = 15021204 }}</ref>
Clinical:<ref name=pmid15021204>{{Cite journal  | last1 = Coco | first1 = TJ. | last2 = Klasner | first2 = AE. | title = Drug-induced rhabdomyolysis. | journal = Curr Opin Pediatr | volume = 16 | issue = 2 | pages = 206-10 | month = Apr | year = 2004 | doi =  | PMID = 15021204 }}</ref>
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