S1C18P8CellTypesMisc

S1C18P8-1: In this lesion of secondary lues, the epidermal patterns are both lichenoid and psoriasiform. The elongated rete ridge (a feature of psoriasiform processes) to the left is a component of a hyperplastic basal unit. To the right, the rete ridges are effaced and there is liquefaction degeneration at the dermal-epidermal interface (lichenoid properties). This combination of features can be accommodated in the category of pityriasic disorders. Lesions of secondary lues commonly have pityriasic qualities. Older lesion may be lichenoid; some will even qualify as senescent lichenoid reactions. In the dermis, the reaction is florid and rich in plasma cells. The laminated, meshwork of brightly acidophilic material is fibrinoid; it is perivascular in distribution. The vascular changes qualify the pattern affecting the vessel as a vasculitis. The superficial unit of the epidermis is hyperplastic; its keratinocytes are individually enlarged and pale.

S1C18P8-2: The fibrinoid involving the wall and adventitia of a vessel is a marker for a vasculitis in this lesion of secondary lues. The dermal infiltrate is rich in plasma cells.

S1C18P8-3: In this area of a lesion of secondary lues (same lesion as S1C18P8-2), a rete ridge is thin and elongated. There are liquefactive changes at the interface between the rete ridge and the dermis. At this interface, the defect is uniform in thickness; it contains lymphocytes, histiocytes, and plasma cells. Blue arrows identify migratory histiocytes. Fibrin deposits and reduplicated basement membrane provide evidence of erosion of the basal layer of the epidermis; they are markers for the lytic effects of a lichenoid process. Dermal infiltrates are rich in plasma cells. At the dermal-epidermal interface, the patterns are lichenoid.

S1C18P8-4: In the epidermis in this lesion of secondary lues, blue arrows identify delicate spirochetes (Warthin-Starry).

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