In morphological observations of normal muscle tissues, the presence of lysosomes or autophagic vacuoles is rarely noted. Hence, for a long time, the role of autophagy in muscle cells remained unclear. The importance of autophagy in muscle cells, however, started to attract attention with the identification of a subgroup of muscle diseases accompanied by many autophagic vacuoles in muscle cells. Myopathies caused by autophagy abnormality in skeletal muscles are called autophagic vacuolar myopathies. They collectively represent muscle diseases defined by conditions in which autophagic vacuoles present in muscle cells. 1 Currently, this subgroup can be categorized into three subtypes according to its pathomechanical and morphological characteristics (Table 1).The first subtype is Pompe disease, also known as glycogen storage disease type II. This is an autosomal recessive inherited disorder caused by a deficiency in acid alpha-glucosidase, a lysosomal enzyme. 2 Muscle pathology found that excessive glycogen accumulated in lysosomes and observed the formation of large autophagic vacuoles that occupy the entire cell. 3 The second subtype is a group of diseases caused by abnormalities in the structure and function of lysosomes. Since this subtype is characterized by the presence of specific autophagic vacuoles known as autophagic vacuoles with sarcolemmal features (AVSF), it is referred to as AVSF myopathies, 4 which is the focus of this article.Danon disease, a representative disease, is caused by a primary deficiency of lysosomal-associated membrane protein 2 (LAMP-2). 5,6 This subtype includes a few diseases besides Danon disease.The third subtype is a group of diseases with distinctive autophagic vacuoles called rimmed vacuoles. This subtype, rimmed vacuolar myopathy, is listed along with many diseases. 7,8 However, since all the causative genes identified in this subtype are present outside lysosomes, formation of rimmed vacuoles may be caused by an autophagy abnormality due to secondary lysosomal dysfunctions.