P8-TEN


S4C16P8-1: In this field from a lesion of toxic epidermal necrolysis, the basal layer of the epidermis has undergone complete lysis; the epidermis has separated from the dermis. The papillary dermis is widened and fibrotic. It contains sparse lymphoid infiltrates and loosely spaced histiocytes and melanophages. Connective tissue cells are activated. A basal layer and basal unit are not represented in the roof of the defect.


	S4C16P8-2: In this field of a lesion of toxic epidermal necrolysis, the patterns are erythema multiforme-like. Cytopathic changes affect the basal layer of the epidermis. Keratinocytes of a hyperplastic superficial unit have pale cytoplasm. Some of the cells show ballooning degeneration. There are scattered dyskeratotic cells with a suggestion of a whorl of keratinocytes near the left upper corner of the field. Some of the keratinocytes contain melanin deposits.

S4C16P8-3: This lesion is representative of an acute, exfoliating disorder in a patient with leukemia. The patient died on the second day of exfoliation. The lesion is a subepidermal bulla with scattered necrotic keratinocytes in the roof of the defect. The patterns provide an erythema multiforme-like quality. To the right of the defect, the epidermis shows liquefaction degeneration at the dermal-epidermal interface. The clinical impression was toxic epidermal necrolysis.

S4C16P8-4: The epidermis shows necrosis and lysis of basal keratinocytes. The prominence of nuclear debris in association with the coagulated cytoplasm of necrotic keratinocytes produces a pattern in keeping with a graft-vs-host reaction (i.e., apoptotic debris). The clinical data is incomplete. An history of a bone marrow transplant is not documented.

S4C16P8-5: Cytopathic changes include ballooning degeneration and individual cell necrosis. The prominent fragments of nuclear debris are often emphasized in descriptions of the morphology of pathologic apoptosis . The clinical features suggested TEN, but the histologic features do not exclude a graft-vs-host reaction.

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