Centronuclear myopathies

Histopathological features are dominated by the large number of centrally-placed muscle nuclei, sometimes affecting more than 90% of muscle fibers. The nuclei form long chains in the middle of the fiber and are surrounded by cytoplasm, which contains mitochondria and membranous vesicles, but no myofibrils. This morphological appearance has prompted comparison with myotubes, and in fact centronuclear myopathies are sometimes referred to as myotubular myopathies. This is a misnomer, however, since although the affected fibers retain some of the structural features of myotubes, and maturational arrest may play a role in their formation, the vast majority of such fibers are fully differentiated histochemically into either type 1 or type 2. 

Late-onset centronuclear myopathies show a predominance of limb-girdle and truncal muscle weakness with only rare facial or eye involvement. Although this group is classified with the congenital myopathies, weakness only becomes appar-... 

Centronuclear myopathy with type 1 fiber hypotrophy is sometimes regarded as a separate entity because many cases show central nuclei only in the hypotrophic type 1 fibers, while the type 2 fibers are morphologically normal. Affected type 1 fibers are even more myotubelike than in other variants of the disorder, with the exception of the severe X-linked form, due to the persistence of a mitochondria-rich core within a peripheral ring of myofibrils. These features are clearly demonstrable using histochemical methods for the localization of SDH activity and myofibrillar ATPase, respectively. 

The severe X-linked form of centronuclear myopathy is often associated with reduced fetal movement and hydramnios, and may be fatal in the neonatal period due to respiratory failure. Children may survive for several years but often only with assisted ventilation. In only a few reported cases has the condition allowed any form of active life. Female relatives may show a carrier state characterized by the presence of some small myotubelike type 1 fibers in an otherwise normal muscle fiber population. 

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