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Making the Diagnosis of Myositis: Muscle Biopsy and Interpretation

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Managing Myositis

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Abstract

Histopathologic examination of skeletal muscle is an important component of the evaluation of a patient with suspected myopathy, especially inflammatory myopathy. Proper biopsy site selection is important and can be guided by clinical examination and ancillary testing. The history should be provided to the pathologist who then processes the specimen for frozen sections at minimum. There is a variety of histochemical and immunohistochemical staining that can be performed. Characteristic findings are seen in most of the inflammatory myopathies. Dermatomyositis is characterized by perivascular, perimysial predominant pathology with a capillary microangiopathy and humoral immune response, whereas polymyositis and inclusion body myositis exhibit invasion of non-necrotic fibers by cytotoxic T cells. In IBM, there is also a degenerative component with rimmed vacuoles and various inclusions. The histopathology in autoimmune necrotizing myopathy is nonspecific myofiber degeneration and regeneration with no or subtle lymphocytic inflammation in most cases. The histopathology of anti-synthetase syndrome, even in patients without a rash, is similar to dermatomyositis.

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Authors and Affiliations

  1. Departments of Neurology and Pathology (Neuropathology), University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    David Lacomis

  2. UPMC, Pittsburgh, PA, USA

    David Lacomis

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  1. David Lacomis
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Correspondence to David Lacomis .

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Editors and Affiliations

  1. Division of Rheumatology and Clinical Immunology, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA

    Rohit Aggarwal

  2. Division of Rheumatology and Clinical Immunology, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA

    Chester V. Oddis

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Lacomis, D. (2020). Making the Diagnosis of Myositis: Muscle Biopsy and Interpretation. In: Aggarwal, R., Oddis, C. (eds) Managing Myositis. Springer, Cham. https://doi.org/10.1007/978-3-030-15820-0_13

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  • DOI: https://doi.org/10.1007/978-3-030-15820-0_13

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-15819-4

  • Online ISBN: 978-3-030-15820-0

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