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What Do These Preliminary Muscle Biopsy Results Indicate?
Question: Hello - my preliminary muscle biopsy results were just posted to my patient portal. They are sending the samples for additional his to chemical testing. Please help me understand what these preliminary findings might mean (see arrayed screen shot photo) You can read more of my medical history by looking at previous inquiries. Thank you for any assistance you can give.
Brief Answer:
Indicates mild myopathy but not the cause.
Detailed Answer:
I read the report carefully and I understand your concern.
The report doesn't indicate any specific active process going on in your muscles, there is no sign of inflammation/vasculitis and atrophy. There is some adipose/fatty depositions between your muscle fibers which could indicate some mild myopathy, but it is not a specific finding, shows only there is some mild suffering of the muscle not the cause. Histochemical stains might give more data by applying special stains to look for the implication of certain enzymes, structural proteins or glucogen.
The fact that it is a case of only mild changes is also confirmed by the fact that your EMG and neurological exam showed no findings and the creatine kinase (CK) elevation is only mild as well.
Myopathy can have many causes and at times even after extensive investigations the cause remains idiopathic, meaning unidentifiable.
Some of the causes are hormonal (Cushing syndrome, thyroid function alterations, hyperparathyroidism), medications or toxins, infections etc. I see that thyroid function and Vitamin B12 has already been evaluated, also some common inflammatory tests with no findings.
So until now the only factor which could be a cause is your use of Prednisone (mentioned on another query), depending on how long have you been using it, if you have been using it for a long time that could cause myopathy. Other drugs you are taking should be considered as well.
For now no particular treatment is recommended unless a specific cause is confirmed which should then be addressed.
I remain at your disposal for further questions.
Indicates mild myopathy but not the cause.
Detailed Answer:
I read the report carefully and I understand your concern.
The report doesn't indicate any specific active process going on in your muscles, there is no sign of inflammation/vasculitis and atrophy. There is some adipose/fatty depositions between your muscle fibers which could indicate some mild myopathy, but it is not a specific finding, shows only there is some mild suffering of the muscle not the cause. Histochemical stains might give more data by applying special stains to look for the implication of certain enzymes, structural proteins or glucogen.
The fact that it is a case of only mild changes is also confirmed by the fact that your EMG and neurological exam showed no findings and the creatine kinase (CK) elevation is only mild as well.
Myopathy can have many causes and at times even after extensive investigations the cause remains idiopathic, meaning unidentifiable.
Some of the causes are hormonal (Cushing syndrome, thyroid function alterations, hyperparathyroidism), medications or toxins, infections etc. I see that thyroid function and Vitamin B12 has already been evaluated, also some common inflammatory tests with no findings.
So until now the only factor which could be a cause is your use of Prednisone (mentioned on another query), depending on how long have you been using it, if you have been using it for a long time that could cause myopathy. Other drugs you are taking should be considered as well.
For now no particular treatment is recommended unless a specific cause is confirmed which should then be addressed.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Thank you for your answer and your careful review of my medical records. Can you explain to me the significance of the following in.the muscle biopsy report;
"Angulated atrophic fibers and pyknotic nuclear clumps".
Thank you!
"Angulated atrophic fibers and pyknotic nuclear clumps".
Thank you!
Brief Answer:
Indicates disuse/corticosteroid use myopathy or denervation.
Detailed Answer:
I had a feeling you might ask about that. I limited myself in my answer to addressing the main diagnosis of the pathologist because I feared that if I went in more detail I might end up confusing you rather then being helpful.
Usually that description "Angulated atrophic fibers and pyknotic nuclear clumps" is found in the case of denervation injuries, from conditions affecting the peripheral nerves or motor neuron disease, meaning the damage to the muscle is related to involvement of the nerves which supply the muscles (apart from taking commands to the muscle the nerves have also trophic properties and the lack of signal causes atrophy of the nerve). However these changes are described as occasional in your report. Also pathology of the nerves usually would be accompanied with changes in neurological exam as well as in EMG studies which according to the report are both normal. For that reason I thought that as a less likely cause and mentioned only myopathy.
One type of muscle involvement which could manifest with a similar report of angulated atrophic fibers, is type II muscle fiber atrophy which is usually linked to disuse of the muscle as well as prolonged corticosteroid use, so in your case with your many medical conditions which I assume have limited you activity as well as the previously mentioned prednisone use, that could well be the case.
I hope to have been of help. Feel free to ask further questions, I'll be happy to answer them to the best of my abilities. (If/when on the other hand you have no other questions you can close the query and rate it as you see fit).
Indicates disuse/corticosteroid use myopathy or denervation.
Detailed Answer:
I had a feeling you might ask about that. I limited myself in my answer to addressing the main diagnosis of the pathologist because I feared that if I went in more detail I might end up confusing you rather then being helpful.
Usually that description "Angulated atrophic fibers and pyknotic nuclear clumps" is found in the case of denervation injuries, from conditions affecting the peripheral nerves or motor neuron disease, meaning the damage to the muscle is related to involvement of the nerves which supply the muscles (apart from taking commands to the muscle the nerves have also trophic properties and the lack of signal causes atrophy of the nerve). However these changes are described as occasional in your report. Also pathology of the nerves usually would be accompanied with changes in neurological exam as well as in EMG studies which according to the report are both normal. For that reason I thought that as a less likely cause and mentioned only myopathy.
One type of muscle involvement which could manifest with a similar report of angulated atrophic fibers, is type II muscle fiber atrophy which is usually linked to disuse of the muscle as well as prolonged corticosteroid use, so in your case with your many medical conditions which I assume have limited you activity as well as the previously mentioned prednisone use, that could well be the case.
I hope to have been of help. Feel free to ask further questions, I'll be happy to answer them to the best of my abilities. (If/when on the other hand you have no other questions you can close the query and rate it as you see fit).
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thank you. Yes, I have a few more questions. First of all, my most recent EMG in November showed sensory neuropathy in both legs. Along with the elevated CK and Aldolase my most recent B12 was elevated at 1200. I've been running elevated WBC and Neutrophils for more than a year which have never returned to normal levels despite several courses of antiobiotics. I have been on short courses of prednisone probably 4-5 times in the past year (for bronchitis) but have never been on long-term prednisone (most recently I was on it for about 2 weeks when I had pneumonia). Does any of that information affect your opinion?
Finally, is the damage to the nerves/muscles permanent or is there something that can be done to reverse it?
I will probably have some additional questions. Thank you.
Finally, is the damage to the nerves/muscles permanent or is there something that can be done to reverse it?
I will probably have some additional questions. Thank you.
Brief Answer:
Steroid treatment myopathy unlikely.
Detailed Answer:
The report mentioned only a normal earlier EMG. However this most recent one doesn't seem to add much regarding the motor nerves and muscle involvement, sensory neuropathy is common considering your history of diabetes.
Vitamin B12 causes neurological complications only when deficient, elevated levels are not related to neurological consequences. Elevated levels are associated with several of your conditions like diabetes, obesity and elevated WBC.
If you have never had long term courses of steroids then it is unlikely that those are to blame for your neuropathy, usually in the setting of long-term use. Of course elevation of corticosteroids could be due to their endogenous production in pituitary gland or adrenal gland conditions, but I suspect that as well as other hormonal disorders must have been excluded by your neurologist before reaching to the stage of an exam like muscle biopsy.
The previously mentioned possibility of disuse muscular involvement remains though. Your long standing recurrences of bronchitis and asthma indicate a chronic obstructive pulmonary condition. That is thought to involve skeletal muscles not only because of inactivity and disuse but possibly also due to other contributing factors like hypoxemia and oxidative stress, and inflammation.
Regarding the question on the damage, first of all I should repeat that while it is unlikely to reverse, the damage is a mild one, which is enforced by the fact that your neurological testing is normal, no diminished muscle strength. The fatigue you experience could be related mostly to your concomitant pulmonary condition, obesity, diabetes, rather than attributed to this muscle change itself. Whether there is some specific intervention to do to stop progression depends also on the results of the histochemical studies, if there is some specific metabolic origin (which I don't consider very likely because many of those conditions manifest themselves at an earlier age) some dietary measures should be taken.
If nothing is found the treatment is directed to controlling your other previously mentioned conditions, losing weight and appropriate exercise programs.
Steroid treatment myopathy unlikely.
Detailed Answer:
The report mentioned only a normal earlier EMG. However this most recent one doesn't seem to add much regarding the motor nerves and muscle involvement, sensory neuropathy is common considering your history of diabetes.
Vitamin B12 causes neurological complications only when deficient, elevated levels are not related to neurological consequences. Elevated levels are associated with several of your conditions like diabetes, obesity and elevated WBC.
If you have never had long term courses of steroids then it is unlikely that those are to blame for your neuropathy, usually in the setting of long-term use. Of course elevation of corticosteroids could be due to their endogenous production in pituitary gland or adrenal gland conditions, but I suspect that as well as other hormonal disorders must have been excluded by your neurologist before reaching to the stage of an exam like muscle biopsy.
The previously mentioned possibility of disuse muscular involvement remains though. Your long standing recurrences of bronchitis and asthma indicate a chronic obstructive pulmonary condition. That is thought to involve skeletal muscles not only because of inactivity and disuse but possibly also due to other contributing factors like hypoxemia and oxidative stress, and inflammation.
Regarding the question on the damage, first of all I should repeat that while it is unlikely to reverse, the damage is a mild one, which is enforced by the fact that your neurological testing is normal, no diminished muscle strength. The fatigue you experience could be related mostly to your concomitant pulmonary condition, obesity, diabetes, rather than attributed to this muscle change itself. Whether there is some specific intervention to do to stop progression depends also on the results of the histochemical studies, if there is some specific metabolic origin (which I don't consider very likely because many of those conditions manifest themselves at an earlier age) some dietary measures should be taken.
If nothing is found the treatment is directed to controlling your other previously mentioned conditions, losing weight and appropriate exercise programs.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
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