Gomori Modified Trichrome
Succinyl Dehydrogenase
NADH
Cytochrome Oxidase
PAS with Diastase
Oil-Red-O
Acid Phosphatase
Alkaline Phosphatase
Non-Specific Esterase
ATPase (pH 9.4 and 4.5)
Congo Red

Spectrin
Dystrophin (N-terminal, C-terminal, Rod-domain)
Alpha, beta, delta, and gamma- Sarcoglycans
Beta-Dystroglycan
Utrophin
Merosin
Merosin-M
Emerin
Caveolin-3
Dysferlin
Collagen IV, Collagen VI
Laminin beta-1
Lamin A/C

CD3
CD20
CD8
CD4
CD68
Ubiquitin
MHC-Class 1
C5b-9
Congo Red with polarization and fluorescence microscopy

Modified SDH/COX double stain
Myophosphorylase
Myoadenylate Deaminase
PAS on plastic-embedded muscle sample
Electron microscopy for abnormal mitochondria, excess glycogen and lipid

If a specific muscle is not dictated by the clinical presentation, the following muscles are preferred (in order of preference):

Quadriceps
Biceps
Deltoid

Adequate size

2 cm x 1 cm x 1 cm

Avoid end stage muscle.
No infiltration with local anesthetic.
No clamps, or tying to tongue blade.
Do not freeze specimen.

Preparation for shipment

Wrap specimen loosely in saline-moistened gauze or Telfa. Do not immerse in saline.
Place wrapped specimen into dry container e.g. specimen cup, and seal.
Surround container with wet ice. Do not ship on dry ice.
Pack in a Styrofoam container and Ship via courier, cab, FedEx or air.

If the specimen cannot be delivered to OHSU by 4:00 pm, the following procedure can be followed:

The specimen should be retained at the sending lab until the following OHSU workday. Specimens should be kept on saline-moistened (not soaked) gauze, in a dry closed container, in the refrigerator. If the following day is a Saturday or a holiday, then the specimen should be held (even over the weekend if necessary), until the next available OHSU workday. The next morning, OHSU should be contacted prior to shipping, and then the specimen shipped in the morning on moistened gauze, in a dry container, on wet ice, to Lab Central at OHSU. This is not the recommended treatment for optimal preservation of the specimen. Consideration should be given to rescheduling the biopsy to allow coordination between the sending facility and OHSU.

Preferred length: 6 cm Avoid stretching or crushing nerve. Keeping the fresh nerve straight, place it on a narrow strip of filter paper, cut slightly longer than nerve. Immerse in 10% neutral buffered formalin (NBF). The nerve will adhere to the paper and this will maintain the orientation of the fibers. Exception: if the clinician is suspecting paraproteinemia-associated neuropathy, send two samples: one fresh or in transport medium for immunofluorescence and another fixed in 10% NBF for light and electron microscopy.  When we receive the nerve specimen, we will transfer a portion of the biopsy to glutaraldehyde.

Suspected cases of small fiber neuropathy undergo a standard 3mm punch biopsy of the skin in distal and proximal extremity locations. These tissues are processed with special tissue techniques and labeled with a PGP 9.5 antibody to quantify the intraepidermal nerve fibers with the light microscope. The results are expressed as a numerical figure as the number of nerve fibers per mm of epidermis and compared with published normal values.  These biopsies require a special fixative which we will provide.  Fixation time must be carefully controlled and special processing is needed, so we request that these biopsies be performed Monday-Thursday only.

Please contact immunohistochemistry for transport kit and instructions at (503) 494-5755, at least one day before the biopsy.