5 ways to differentiate Lewy body and Pick body in a brain biopsy or during autopsy

Degenerative brain diseases are seldom biopsied. They are diagnosed predominantly during autopsies. Lewy body and Pick body are particularly difficult to distinguish.

Lewy bodies:  They are seen in Parkinson’s disease as well as dementia with lewy bodies. Cortical lewy bodies are characteristic of dementia with lewy bodies whereas lewy bodies in the basal ganglia are seen in Parkinson’s disease.

Pick bodies:  They are seen fronto-temporal dementia.  As the name suggests,  they can be seen in frontal and temporal areas.

Here are 5 ways to differentiate lewy body and pick body based on light microscopy,  immunohistochemistry and electron microscopy.

1. STAINING

Pick bodies are slightly more basophilic compared to Lewy body.

2. PRESENCE OR ABSENCE OF A CENTRAL DOT

Lewy body has an eosinophilic central dot, as in the above picture which pick body lacks.

3. PRESENCE OR ABSENCE OF A PERIPHERAL HALO

Lewy body has a peripheral halo wheras Pick body doesn’t

4. IMMUNOHISTOCHEMICAL STAINS

Lewy body stains positive with anti-alpha synuclein antibodies. Pick body stains positive with anti-tau antibodies.

5. ELECTRON MICROSCOPY

On electron microscopy Lewy body is composed of fuzzy deposits on filaments that radiated from a central core. Pick body is composed of random filaments of smooth contour.

That’s all the ways to differentiate PICK BODY AND LEWY BODY

For YouTube video click

If you are interested in illustrations click below