title: Nerve biopsy findings in Niemann-Pick type II (NPC)
abstract: The severe infantile form of Niemann-Pick disease type II was diagnosed in a 4-year-old girl and confirmed by demonstrating in cultured skin fibroblasts a deficiency of low-density lipoprotein-stimulated cholesterol ester synthesis of < 5% of normal. Electrodiagnostic studies revealed changes of a predominantly demyelinating motor and sensory polyneuropathy. Light microscope and ultrastructural examination of a peroneal nerve biopsy showed unique changes. Compacted myelin sheaths were disproportionately thin with marked globular irregularities in single teased nerve fibres and evidence of chronic demyelination. The majority of axons were preserved but axonal spheroids and cytoskeletal abnormalities akin to neuroaxonal dystrophy were noted. Membrane-bound multi-lobulated lysosomal inclusions of floccular and electron-dense material were present in Schwann cells (SC), endoneurial fibroblasts, macrophages, pericytes and endothelial cells. SC of myelinated fibres were stuffed with whorls of concentric osmiophilic membraneous profiles and electron-lucent material. The findings are diagnostic and differ from those of classical Niemann-Pick disease.
authors.affiliation: Department of Clinical Neurological Sciences and Biochemistry, University of Western Ontario, London, Canada.
authors.forename: A F
authors.initials: AF
authors.lastname: Hahn
authors.forename: J J
authors.initials: JJ
authors.lastname: Gilbert
authors.forename: C
authors.initials: C
authors.lastname: Kwarciak
authors.forename: J
authors.initials: J
authors.lastname: Gillett
authors.forename: C F
authors.initials: CF
authors.lastname: Bolton
authors.forename: C A
authors.initials: CA
authors.lastname: Rupar
authors.forename: J W
authors.initials: JW
authors.lastname: Callahan
mesh_terms: D001369:Axons / Q000648:ultrastructure; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008247:Lysosomes / Q000201:enzymology; D008854:Microscopy, Electron; D009132:Muscles / Q000473:pathology; D009412:Nerve Fibers / Q000648:ultrastructure; D009542:Niemann-Pick Diseases / Q000201:enzymology / Q000473:pathology*; D010543:Peroneal Nerve / Q000473:pathology*