Neurolymphomatosis is the direct endoneurial infiltration of lymphoma cells. Bone marrow biopsy is a widely practiced procedure that is generally considered to be relatively safe. However, bone marrow biopsy can also result in pain and long-term consequences such as nerve injury. Here we report a case of a 68-year-old male who presented with lumbosacral plexopathy due to neurolymphomatosis that was superimposed on a probable traumatic lumbosacral plexopathy mostly involving the sciatic nerve immediately after a bone marrow biopsy.

Muscle and nerve biopsy may be vital diagnostic tools in various neuromuscular disorders. Since these procedures are invasive, it matters to decide when to perform a biopsy, which muscle or nerve to be selected, and how to interpret the pathologies. This review addresses the indications, methods of biopsies, and also significant pathological findings frequently encountered in muscle and nerve pathology.

Diabetic polyneuropathy (DPN) causes neuropathic pain with reduced quality of life as well as diabetic foot ulceration which sometimes resulted in amputation. Early detection and improved knowledge of pathogenic pathways are important to prevent and to manage DPN. The screening methods and several tests to diagnose DPN-quantitative sensory testing, skin biopsy, corneal confocal microscopy, etc.-will be described.

Skin biopsy and staining the specimens with immuno-reactive markers has been proven to be a useful method to demonstrate the pathologic status of small nerve fibers. Quantification of intraepidermal nerve fiber density using anti-protein gene product 9.5 antibody is a standard method to diagnose small fiber neuropathy. Skin biopsy also makes it possible to differentiate the nerve fibers according to their function by using different markers. Quantification of dermal structures with different types of nerve fibers could reveal the pathophysiologic mechanism of the disease state.

Citations

• Neurological aspects of anhidrosis: differential diagnoses and diagnostic tools
  Kee Hong Park, Ki-Jong Park
  Annals of Clinical Neurophysiology.2019; 21(1): 1.     CrossRef
• Microneedle-mediated delivery of cosmeceutically relevant nucleoside and peptides in human skin: challenges and strategies for dermal delivery
  Ae-Ri Cho Lee
  Journal of Pharmaceutical Investigation.2019; 49(6): 587.     CrossRef

Skin biopsy with investigation of small nerve fiber in human epidermis and dermis has been proven to be a useful method for demonstration of small fiber neuropathy. Quantification of intraepidermal nerve fiber density using anti-Protein Gene Product 9.5 (PGP 9.5) antibody is standardized method to diagnose the small fiber neuropathy. Skin biopsy method also makes it possible to differentiate the type of nerve fibers by using different antibodies. Quantification of dermal structures with different type of nerve fibers could be used to invest pathophysiologic mechanism of diseased state.

Analysis of intraepidermal nerve fibers using skin biopsy is a recently developed technique, providing diagnosticinformation on small fiber neuropathies. The specimens are obtained by 3 mm punch biopsy, which is safe andminimally invasive. Immunohistochemical staining by Protein gene product (PGP) 9.5 demonstrate not onlyintraepidermal nerve fibers but dermal structures, such as sweat gland and erector papillae. Up to now, many studiesagree that intraepidermal nerve fiber density is dramatically reduced in various sensory neuropathies. The utility ofdensity measure was confirmed with high sensitivity in the diagnosis of sensory neuropathy, comparable to sural nervebiopsy or quantitative sensory testing. Besides quantitative methods, morphological changes like axonal swelling andfragmentation can be used as predegenerative markers. This article reviews the technique of skin biopsy and clinical andexperimental usefulness of skin biopsy in diagnosing and monitoring peripheral neuropathies.