S15C5P2-LE

S15C5P2-1: The epidermis shows hyperkeratosis, acanthosis, and a prominent granular layer. There is liquefaction degeneration at the dermal-epidermal interface; rete ridges have pointed extremities. Dermal infiltrates are loose  and perivascular in the upper portion of the dermis. Melanin incontinence is a prominent feature. The reaction has lichen planus-like qualities, but the clinical setting was “lupus erythematosis” in an HIV+ patient.
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S15C5P2-2: At a higher magnification, the patterns are lichenoid; the rete patterns provide senescent LP-like qualities. The cell-poor qualities at the dermal-epidermal interface might be characterized as a LE-like feature. Drug eruption should be considered in the differential diagnosis. The diagnosis of inflammatory disorders in patients with HIV infection is difficult.

S15C5P2-3: A cell-poor lichenoid reaction is represented. There is hyperkeratosis, acanthosis, effacement of rete ridges, and liquefaction degeneration at the dermal-epidermal interface. The papillary dermis is widened and edematous. Vessels are ectatic; there are perivascular deposits of hyalin. In the reticular dermis, to the left of the center of the field, there are interstitial infiltrates of lymphocytes, histiocytes, and plasma cells. The upper 1/3 of the reticular dermis shows sclerosis; some of the collagen bundles are arranged in parallel arrays. Below the area of sclerosis, the spaces among collagen bundles are widened; this alteration is interpreted as evidence of a mucinosis. The patterns are compatible with lupus erythematosus but, as a type, many of the features are shared with those of LS&A, and superficial morphea.

S15C5P2-4: The patterns are compatible with discoid lupus erythematosis, but LS&A, as well as superficial morphea, should be mentioned in the differential diagnosis. The thickened, hyalinized basement membrane is a feature strongly in favor of LE, but similar epidermal changes occasionally may be encountered in lesions of morphea. The interstitial lymphohistiocytic collagenosis may be seen in LE, LS&A, and superficial morphea. The plasma cell component is more common in lesions of LS&A and superficial morphea. Perivascular hyalin, a feature which is better represented in Fig. S15C5P2-3, is usually a feature of lesions of discoid LE, but LS&A  and morphea may also show somewhat similar changes.

S15C5P2-5: The patterns are LS&A-like, but the thickened basement membrane and the perivascular hyalinosis are features in keeping with changes seen in discoid LE.

S15C5P2-6: A cell-poor lichenoid reaction, a thickened, hyalinized basement membrane (reduplicated patterns), and perivascular hyalin deposits are features of LE. The epidermal changes are also characteristic (but not diagnostic). The basal unit is atrophic. The epidermis has the features of a hypertrophied superficial unit with compact hyperkeratosis.

 

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