PMC9943687_01
(A) Sural nerve biopsy semithin section shows a moderate decrease in large, myelinated fiber density for the patient's age, axonal degeneration (black arrows), and regeneration profiles (white arrows). (B) Semithin section of a normal sural nerve biopsy processed at our laboratory. Bar = 40 mum.
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F1
The former showed a moderately decreased density of myelinated fibers, increased rates of axonal degeneration, and rare regeneration profiles, which is consistent with a non-specific chronic axonal neuropathy (Figure 1).
Tibialis anterior muscle biopsy. H&E stained section (A) shows different myopathic features including marked variability in muscle fiber diameters and muscle fiber necrosis, regeneration, and splitting. Muscle fibers are harboring internalized nuclei and rimmed vacuoles (black arrows). Modified Gomori trichrome stained section (C) shows rimmed vacuoles (black arrows). Congo red stained section (E) shows prominent fiber splitting (white arrows). No inflammatory changes were noticed throughout the sample. (B, D, F) represent normal control muscle biopsy-stained sections by H&E, modified Gomori trichrome, and Congo red, respectively, processed at our laboratory. Bar = 80 mum.
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F2
A biopsy of the tibialis anterior muscle (Figure 2) demonstrated marked variability in myofiber size diameters, muscle fiber necrosis, regenerating fibers, internalized nuclei, and fiber splitting in addition to several muscle fibers harboring rimmed vacuoles without inflammation.