Limb-girdle muscular dystrophy: clinical and pathologic reevaluation.

To better define limb-girdle muscular dystrophy (LGMD), we examined 58 patients clinically and pathologically who fulfilled the criteria for LGMD and had normal dystrophin expression in their muscle biopsies. Only 27.6% of patients had evidence of inheritance. The onset of disease varied from 2 to 58 years of age, averaging 17.2 years. The disease progression also differed from patient to patient. In addition to evidence of muscle fiber necrosis and regeneration, in all muscle biopsies there were fibers with architectural changes of disorganized intermyofibrillar networks including moth-eaten (100%), lobulated (40%), whorled (17%) and targetoid (8%) fibers. The lobulated fibers which have never been reported in Duchenne muscular dystrophy (DMD) were seen in the advanced stages of LGMD, although the significance of such fibers remains unknown. On immunohistochemical examination, dystrophin-associated proteins (DAPs) and laminin were normally expressed along the surface membrane of muscle fibers, including the lobulated fibers.