S2C16P10NecrolyticErythema



S2C16P10-1: The distinction between basal unit and superficial unit of the epidermis is accentuated by the effects of a metabolic defect. The keratinocytes of the basal unit have scanty, basophilic cytoplasm and closely spaced, small, dark nuclei. The patterns of rete ridges are irregular. Cells of the superficial unit of the epidermis have pale cytoplasm and widely spaced nuclei. Some of the keratinocytes of the superficial unit show perinuclear vacuoles. A granular layer is not clearly defined. The product at the skin surface is parakeratotic. There are irregular defects in the parakeratotic layer. The upper portion of the dermis is edematous and hypercellular. Some of the cells appear to be histiocytes (NECROLYTIC MIGRATORY ERYTHEMA).

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S2C16P10-2: The cytoplasmic pallor of the cells of the superficial unit of the epidermis and the defect in the keratinized product at the skin surface are features of necrolytic migratory erythema.

S2C16P10-3: The alterations are not simply those of a defect in the terminal differentiation of keratinocytes of the superficial unit of the epidermis. Clearly, the basal unit is also affected. The cells of the basal unit are somewhat shrunken and have dense chromatin patterns. There is some degree of inter-cellular edema. The basement membrane is poorly defined. There are peculiar vacuoles among keratinized lamellae at the surface. Cells of the superficial unit show perinuclear vacuoles.

S2C16P10-4: Changes, similar to those of S2C16P10-1-3 (but of a different degree), are represented in this field from another case of necrolytic migratory erythema (an example that is symptomatic of a functioning neuroendocrine tumor of the pancreas [see S2C16P10-6]). The specimen is better preserved; there is hyperplasia of both the basal and the superficial units of the epidermis. The patterns have a psoriasiform quality. A granular layer is not represented. The dermis is edematous.

S2C16P10-5: The interface between the basal and superficial units of the epidermis is represented. The defect in keratinization is evident in the absence of a granular layer and in the character of the keratin layer. The keratinocytes of the basal unit have “lavender” cytoplasm (an chromatic attribute that is a mystery to most residents, regardless of the histologic setting, cell type, or sex of the residents) and an enlarged nucleus with prominent nucleoli. There are two dyskeratotic cells in the basal unit. There are vacuoles in the cytoplasm of keratinizing cells near the zone of parakeratosis.

S2C16P10-6: The neuroendocrine tumor of the pancreas is represented in ribbons and festoons.

S2C16P10-7: In this area, the neuroendocrine tumor of the pancreas is composed of uniform cells; they are clustered to form irregular nests. Some of the cells are darker and have dendritic qualities; these cells may be sustentacular cells.

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