UNIVERSITY OF TEXAS MEDICAL BRANCH
DEPARTMENT OF PATHOLOGY
GALVESTON, TX 77555-0743
MUSCLE BIOPSY INFORMATION SHEET
Specimen: Skeletal muscle biopsy (fresh, unfixed) for
diagnosis of neuromuscular disease.
Provide two pieces of unfixed muscle - one single
fascicle in the clamp (< 1 mm diameter) and a second larger unclamped piece
(min. size 0.3 x 0.3 x 0.5 cm). This is the minimum amount of tissue for routine
Wrap the tissue with a barely-moist gauze to prevent drying and
cool the sealed specimen container with water/ice during transport.
Page the neuropathologist on call when the biopsy is ready and
deliver the tissue to the Surgical Pathology Gross Room within 15 min.
after excision. Mark "STAT - FOR NEUROPATHOLOGY"
- Requirements: (More Details to follow)
- Closed containment of tissue according to universal precautions.
- Label container with patients name and hospital number.
- Surgical Pathology Tissue Consultation Request form, properly completed, must accompany
- The Surgical Pathology Gross Room and/or the Neuropathologist on call must be notified
prior to delivery of the biopsy.
NOTE: THE LABORATORY WILL NOT ACCEPT THE BIOPSY UNTIL THE
ABOVE REQUIREMENTS ARE SATISFIED.
HOURS: Laboratory: 8 am - 5 p.m. M-F. At any other time you must page the
neuropathologist on call to arrange for proper collection and processing.
Pathologists' Office: (409) 772-2418 Rm. 5.503 Clinical Science Building
Surgical Pathology: (409) 772-2855 Rm. 2.186 John Sealy Annex
Dr. Campbell: 409-643-3389 (inside hospital - 40878)
Dr. Gelman: 409-643-3579 (inside hospital - 46591
Pathology Resident on call: call hospital operator
The DO's and DON'Ts
- Page the neuropathologist on call as soon
as possible after the procedure is scheduled, since advance preparations are required.
- Obtain a muscle biopsy clamp from the Surgical Pathology Gross Room. The clamp is for a small
fascicle for electron microscopy that is separate from the larger piece for histology and histochemistry.
Both non-sterile metal clamps and single-use pre-sterilized plastic clamps are
What diagnostic services are available?
1. Muscle histology (routine)
2. Muscle histochemistry (routine, selected by pathologist)
3. Immunohistochemistry and immunofluorescence (special studies)
4. Electron microscopy (special study)
5. Computer-assisted muscle fiber morphometry (special study)
6. Transfer of muscle tissue to outside laboratories for certain special studies
What do we do routinely?
- Light microscopic diagnosis based on selected histologic and histochemical stains -
H&E, oil red-O for neutral lipids, modified Gomori trichrome, PAS, NADH-TR
(NADH-tetrazolium reductase) and ATP-ase at pH 9.6, 4.6 and 4.35.
- We routinely fix the thin fascicle in the muscle clamp in
gluteraldehyde/paraformaldehyde fixative and hold it in case electron microscopy (EM) is
necessary. EM is a separate study (at considerable additional cost).
- We routinely freeze and hold at -80░C any additional tissue not used for the above
studies in case special biochemical or molecular biologic studies by outside laboratories
are needed (e.g. analysis of dystrophin, mitochondrial enzymes or mitochondrial DNA). We
can arrange to ship frozen muscle tissue to outside laboratories, but the submitting
physician is responsible for supplying sufficient tissue and completing the required
clinical data and billing forms.
Special studies in addition to the routine procedures described above are done
at the discretion of the neuropathologist and carry additional charges. If special studies
are specifically requested, please provide adequate clinical data to justify the
performance of these studies.
Information Required on the Tissue Consultation
- Patients name, UH #, ICD9 code and financial account number.
- Date and time of excision of biopsy.
- Attending physicians name, doctor #, page and telephone numbers and address to
- Names and addresses of any other physicians to receive reports. Please include the names
of the neurology and/or neurosurgery consultants.
- Clinical diagnosis (both neuromuscular disease and any other relevant diagnoses).
- Clinical history, physical findings and laboratory data relevant to neuromuscular
disease, including electromyographic (EMG) diagnosis and creatine kinase (CK) levels.
Collection and Processing Details:
At any other time you
must page the neuropathologist on call to arrange for collection of the biopsy. If you are
performing a muscle biopsy outside of the O.R. suite and/or the procedure is not on the
O.R. schedule, it is imperative that you call the Neuropathology office or page the
neuropathologist on call prior to the procedure, since processing this tissue requires
certain advance preparations.
Turn-around Time: Standard time for processing, staining and interpreting
the slides is 7 days, but time may vary depending on the week day received and any
additional studies that may be required for diagnosis Please call the neuropathologist for
information on the status of the report. A preliminary verbal report covering only the
presence or absence of inflammation for cases of suspected inflammatory myopathy can
generally be made by the next day if specifically requested.
FOR FURTHER INFORMATION PLEASE CALL: Gerald A. Campbell, Ph.D.,
M.D., Division of Neuropathology, UTMB at the above telephone number.
- Obtaining a muscle biopsy clamp: Many services do not keep
muscle clamps in stock. If you do not have a clamp, please call the Surgical
Pathology Gross Room to arrange
for loan of an appropriate clamp. You can then send a messenger to pick up the clamp to
the Surgical Pathology Gross Room prior to the procedure. The reusable metal clamps are not supplied
sterile and must be autoclaved before use. If you send your own clamp, your messenger can
pick it up on the day following delivery of the biopsy.
- Requirement for rapid transport to the laboratory: The unclamped portion
of the biopsy must be frozen in the laboratory under special conditions and the clamped
piece must be placed in EM fixative as soon as possible after removal from the patient,
generally within 30 minutes, but the shorter the delay the better. These requirements are
necessary to preserve the enzymatic activity of the muscle tissue, which is required for
successful histochemical staining, and for optimal preservation of light microscopic and
ultrastructural (EM) morphology.
- Delivery to the laboratory: Most muscle biopsies are performed in the
O.R., and in most respects muscle biopsies should be treated in the same manner as frozen
sections. Muscle biopsies should be delivered to the Surgical Pathology Gross Room, during
the hours 8 a.m. - 5 p.m., M-F. Please mark the biopsy "STAT" and notify the
gross room technician that the biopsy is for Neuropathology.
TOP OF PAGE
Revision Date: 10/14/04 Reviewed 06/22/12
Replaces Rev. of: 3/21/02