S5C10P4DLE


S5C10P4-1: The patterns are classic for a lesion of discoid LE. Green arrows identify perivascular zones of hyalinization. Follicular lichenoid patterns are prominent. As in this case, the follicular changes of discoid LE commonly are more cell-rich than the changes at the dermal-epidermal interface. The basement membrane is thickened, and hyalinized. The widened spaces among collagen bundles of the reticular dermis probably are a manifestation of a mucinosis. Infiltrates of inflammatory cells are prominent, even about a sweat duct near the bottom of the field on the left. The ostium of the follicle is plugged.


S5C10P4-2: In this region, in which follicles are closely spaced, the inflammatory infiltrates appear diffuse in the upper portion of the reticular dermis. They tend to be sparse in the papillary dermis and at the dermal-epidermal interface. Characteristically, the infiltrates hug the follicles (a cell-rich component). The follicles are so closely spaced that the perifollicular components appear to be confluent (DLE ).


S5C10P4-3: At a higher magnification, there are vacuolar changes at the dermal-epidermal interface. The interface is straight; a basal layer is not well defined. Green arrows identify a vessel with a thick, hyalinized wall, a common feature of lesions of discoid lupus erythematosus (DLE).

S5C10P4-4: The features include: a straight interface; vacuolar changes (involving not only the dermal-epidermal interface but, also, the interface between follicular epithelium and perifollicular connective tissue sheaths at the bottom of the field); a thick, hyalinized basement membrane; incontinence of pigment; a cell-poor lichenoid pattern; and dermal fibrosis.

S5C10P4-5: Basement membrane changes of this type are most characteristic of LE. Somewhat similar changes may be seen in lesions of radiodermatitis. Green arrows identify the ubiquitous migratory histiocytes that are so common in disorders affecting the interface region.

S5C10P4-6: In this example, the reaction at the dermal-epidermal interface is cell-rich. Red arrows point to areas with a thickened, hyalinized basement membrane. Green arrows point to fragments of nuclear debris. Leukocytoclasia, in the absence of a component of neutrophils, is common near the dermal-epidermal interface in lesions of LE. There is a cell-rich, well defined cleft above the basement membrane. The combined patterns include both lupus erythematosus-like patterns and lichen planus-like features; combinations of this type may be encountered in the LP-LE overlap syndrome.

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