Clinical History:
- This 50-year-old patient underwent muscle biopsy to evaluate for muscle weakness.
What is the material seen outside of the muscle fibers in this patient’s muscle biopsy?
A. Polyglucosan body
B. Lafora body
C. Fungus
D. Talc granules
Figure 1: This higher magnification images shows numerous round to oval somewhat irregular clear refractile granules outside of the muscle fibers.
Figure 2: The granules have a slight magenta color with modified Gomori Trichrome stain.
Figure 3: Under polarized light, the granules show what has been described as a “Maltese Cross” type appearance.
Correct Answer:
- Talc granules (talcum powder) is the correct answer. The granules of talc show a “Maltese cross” type appearance on polarized light. Some neuromuscular labs dust their muscle biopsies specimens in talcum powder before snap freezing them.
Reference(s) / additional reading:
- Wolman M. Polarized light microscopy as a tool of diagnostic pathology. J Histochem Cytochem. 1975 Jan;23(1):21-50. doi: 10.1177/23.1.1090645. PMID: 1090645.
- https://surgexppathol.biomedcentral.com/articles/10.1186/s42047-020-00085-w
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