title: Ultrastructural examination of the axillary skin biopsy in the diagnosis of metabolic diseases.
abstract: There is little information in the literature regarding the usefulness of ultrastructural examination of axillary skin biopsies in the evaluation of metabolic diseases. This is a retrospective clinicopathologic review of 143 patients who underwent axillary skin biopsies as part of evaluations for metabolic disease. Twenty-three (16%) had abnormalities, classified as follows: mitochondrial (n = 12), lysosomal (n = 6), increased glycogen (n = 3), nonspecific cytoplasmic inclusions (n = 2), ceroid lipofuscinosis (n = 1), and intradermal giant cells containing vacuoles and tubular inclusions (n = 1). Muscle biopsies were performed in 13 of the 23 patients; 11 showed abnormalities, including those related to mitochondria (n = 4) and other nonspecific changes (n = 7). Two patients underwent postmortem examination. Follow-up was available in 21 patients. A clinical or biochemical diagnosis was reached in 11 patients: metachromatic leukodystrophy (n = 2), electron transport chain abnormalities (n = 2), glutaric aciduria type II (n = 1), Unverricht disease (n = 1), Lennox-Gastaut syndrome (n = 1), ketotic hypoglycemia of childhood (n = 1), probable Leigh disease (n = 1), 5-methyl tetrahydrofolate homocystine methyltransferase deficiency (n = 1), and pyruvate dehydrogenase deficiency (n = 1). Of the 120 patients with negative skin biopsy results, 29 had abnormal findings on muscle (n = 27), nerve (n = 7), or brain (n = 3) biopsies. One patient had an abnormal heart biopsy result, and 3 patients underwent postmortem examinations. Follow-up was obtained in 27 of 29 patients. Diagnoses were achieved in 15 patients: electron transport chain abnormalities (n = 5), cortical dysplasia (n = 3), myoclonic epilepsy (n = 1), leukodystrophy (n = 2), Pallister-Killian mosaic syndrome (n = 1), Rett syndrome (n = 1), Landau-Kleffner syndrome (n = 1), and mitochondrial cardiomyopathy (n = 1). In conclusion, axillary skin biopsy is helpful in the evaluation of some causes of metabolic disease, but often the findings are nonspecific. A negative biopsy result does not rule out the possibility of metabolic disease, but a positive result may provide direction for further evaluation.
authors: Departments of Anatomic Pathology and Pediatric Neurology, The Cleveland Clinic Foundation, Cleveland, OH, USA.
authors: C M
authors: CM
authors: Abramovich
authors: R A
authors: RA
authors: Prayson
authors: J T
authors: JT
authors: McMahon
authors: B H
authors: BH
authors: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D001365:Axilla; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006003:Glycogen / Q000032:analysis; D006801:Humans; D002479:Inclusion Bodies / Q000648:ultrastructure; D007223:Infant; D008055:Lipids / Q000032:analysis; D008247:Lysosomes / Q000648:ultrastructure; D008297:Male; D008661:Metabolism, Inborn Errors / Q000175:diagnosis*; D008854:Microscopy, Electron; D008875:Middle Aged; D008928:Mitochondria / Q000648:ultrastructure; D012867:Skin / Q000737:chemistry / Q000648:ultrastructure*; D014617:Vacuoles / Q000648:ultrastructure
chemical_list: D008055:Lipids; D006003:Glycogen