S5C7P1-1: In this figure, the patterns at the epithelial-stromal interface are lichenoid and cell-poor. There is liquefaction degeneration at the stromal-epithelial interface; the basal unit focally is somewhat compromised. The superficial unit is hyperplastic. This is a non-specific pattern but, in the appropriate clinical setting, it assumes some degree of specificity. The tissue is esophagus and the disorder is a graft vs host reaction. This reaction serves as a model for changes encountered in a variety of cell-poor lichenoid reactions. It is cell-mediated disease expressed in patterns of cytopathy and, here, affecting cells of the basal unit of squamous epithelium. Only slight modifications are required to adapt this model in squamous epithelium to changes in a variety of epithelia in various organ system; all the epithelial adaptations would be in the same basic category as a cell-poor “lichenoid” reactions (and embrace the concept of apoptosis). They all would provide evidence of a cell-mediated immune reaction.

S5C7P1-2: This is a most subtle, cell-poor lichenoid reaction. There is focal, mild hyperkeratosis. The superficial unit is only slightly altered. There are focal vacuoles in the basal layer of the epidermis. Some of the basal keratinocytes show damage as manifested in increased cytoplasmic acidophilia. Loose, mild perivascular and interstitial infiltrates of lymphocytes and histiocytes are present in the upper portion of the reticular dermis. Migratory histiocytes are loosely spaced at the dermal-epidermal interface. It is a paradox of the pathology of cutaneous lupus erythematosus that there is an inverse relationship between the density of the inflammatory infiltrates and the severity of the disease. The pattern is compatible with systemic lupus erythematosus (SLE).

S5C7P1-3: This is another example of a lesion of systemic LE. The epidermis shows hyperkeratosis, a prominent granular layer, focal atrophy of the superficial unit, complete absence of a basal unit above the damaged basal layer, and cytolysis of basal keratinocytes. There are perivascular infiltrates in the upper portion of the reticular dermis. The infiltrates are mild, but diffuse, along the basement membrane zone. The reticular dermis shows some atrophy of collagen bundles and widened spaces among the altered bundles (LE).

S5C7P1-4: In this field of a lesion of systemic LE, the basal layer shows liquefaction degeneration and cytolysis of basal keratinocytes. Inflammatory cells have collected at the basement membrane zone; the infiltrates are rich in migratory histiocytes (green arrows). There are small fragments of nuclear debris, some of which are apoptotic in nature.

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