Neuromuscular Pathology Consultations

Instructions for Surgeons

Normal processing of muscle and nerve specimens and after hours policy

Our laboratory specializes in processing muscle and nerve biopsy specimens. Regarding muscle specimens, routine studies on all frozen sections include staining with hematoxylin and eosin (H&E), Gomori trichrome, NADH-TR, ATPase (pHs 4.3, 4.6, 9.4), PAS, oil-red-O, succinic dehydrogenase, cytochrome oxidase and esterase. In selected cases, succinic dehydrogenase, cytochrome oxidase, acid phosphatase, PAS-diastase, myophosphorylase, phosphofructokinase, and myoadenylate deaminase reactivities can be assessed. Paraffin sections are stained with H&E and Congo Red in all cases. Immunohistochemistry is available for dystrophin, alpha-sarcoglycan, dysferlin, merosin, membrane attack complex (C5b-9), CD31 (endothelial cell marker) leukocyte common antigen, T- and B-cell markers, actin, myosin, desmin, TDP-43, and beta-amyloid. Electron microscopy is available if needed.

H&E Paraffin: Trichinella spiralis             PAS (frozen) - McArdle's disease                   
Peripheral nerves are sectioned and processed as follows: Paraffin sections are stained with H&E, trichrome, Congo red, and CD3 (pan-T-cell marker). Teased fiber preparation is performed in selected cases. One micron thick resin-embedded sections are stained with toluidine blue. Ultrastructural studies are performed in selected cases. Immunohistochemistry is available for leukocyte typing, identification of type of amyloid, complement deposition, etc.
Vesicular Demyelination: Guillain-Barre Syndrome

Our turnaround time for muscle pathology reports is about 4-7 working days via FAX. Verbal or preliminary reports are available in 24-48 hours in selected cases. Nerve histopathology reports take about 5 days (paraffin and plastic section results). The teased fiber preparation results are issued in an addendum since processing takes longer.  However, a preliminary report (verbal or FAX) will be issued within 48 hours in cases of vasculitis. Electron microscopy turnaround is 10-14 days. Of course, interpretation of glass slides alone is faster.

Specimens cannot be processed until we have received adequate identifying information and clinical history. Complete the Neuropathology Consultation Request Form and the Clinical History Form and send it with the specimen.

The lab should be notified in advance of specimen submission by calling (412) 647-6503 prior to biopsy (24 hours requested).

Billing Information

Specimens can only be received from 6:30 AM to 2:00 PM Monday thru Friday.

Fresh specimens should be sent promptly-- arrive within 2 hours -- by special messenger and hand carried to the Histopathology Laboratory at UPMC. The Histopathology lab is located at:

UPMC Clinical Lab Building
Histology - Muscles
2nd Floor Room 2031
3477 Euler Way
Pittsburgh, PA 15213
Tel: 412-647-6503

If requesting tissue be sent for genetic or biochemical testing the following process should be followed:

The requesting clinician’s office needs to obtain insurance authorization first and then forwards the completed requisition and insurance information with the authorization number to Neuropathology. Neuropathology will forward the requisition and insurance information to Histology.  Histology will then send the tissue to the reference laboratory who will bill the patient’s insurance. There will be no institutional billing.  A copy of the report should come to neuropathology, and an addendum will be added to the surgical report.