S12C20P10-Elastosis Perforans Serpiginosa

S12C20P10-1: The epidermis shows a localized area of pseudoepitheliomatous hyperplasia. In a claw-like pattern, the hyperplastic epithelium encloses a collection of necrotic debris (pale green arrows); the debris consists in large part of the break-down product of inflammatory cells. The claw extends into the upper portion of the reticular dermis; it extends beyond the stroma supporting the epidermis (i.e., the papillary dermis). The depth to which the cytologically benign epithelium has extended is a morphologic feature qualifying the pattern as pseudoepitheliomatous hyperplasia; epithelium has extended beyond its stroma. At the extremity of the claw-like extension, the debris contains bright red fibers (yellow arrows); these are altered elastic fibers of the reticular dermis. Some of the fibers, particularly on the right side of the claw, extend from the reticular dermis into the defect. Histiocytes have collected in loose, granulomatous patterns at the interface between the debris and the underlying, intact reticular dermis ( elastosis perforans serpiginosa).

S12C20P10-2: The hyperplastic epithelium in claw-like fashion partially encloses necrotic debris. The zone of necrotic debris extends in the upper portion of the dermis to the left. Markers for a basal layer and basement membrane are not apparent in the area in which epithelium presses upon the debris. The inflammatory focus may promote the invasive growth of the epithelium (immunostimulation).

S12C20P10-3: Several collections of debris are in transit through the epidermis to the surface of the skin. Some of the material has collected in the keratin layer. The movement of cellular debris upward through the epidermis is dependent on cellular kinetics (“transepidermal elimination”).

S12C20P10-4: The bright red elastic fibers in the area of perforation have a fibrinoid quality. Histiocytes have collected at the interface between the dermis and the defect.

S12C20P10-5: In this areas of perforation, there are numerous, brightly acidophilic, elastic fibers in the inflammatory debris. There also scattered collections of acantholytic cells.

S12C20P10-6: Thin collagen bundles of the dermis to the left are widely spaced; the dermis is edematous. Vessels are tortuous and ectatic. The column of epithelium that extends into the dermis on the right contains basophilic, inflammatory debris. Bright red, elastic fibers are free in the lumen, along with inflammatory debris; elastic fibers have “perforated” the epithelium. Actually, the epithelium has invaded the dermis to entrap the elastic fibers. The entrapped elastic fibers, and cellular debris are in transit to the surface in the process of  “transepithelial elimination.”

S12C20P10-7: The area of perforation is to the right at the margin of the field. To the left of this area, arrows identify zones of loosely cellular, delicate fibrous tissue; the patterns are compatible with reactive fibroplasia. These zones of fibroplasia represent the trail of the perforating process. The damaged dermis undergoes repair, but is recognizable, as the trail, by an absence of elastic tissue. The process of perforation is migrating to the righ (elastosis perforans serpiginosum).

 

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