S5C13P7-LE-misc



S5C13P7-1: To the left, there is a small lytic defect in the epidermis above the basement membrane. Green arrows identify clustered, and individual, colloid bodies (immunoglobulin-impregnated necrotic keratinocytes) on the dermal side of the basement membrane. The features are lichen planus-like (LP-LE overlap syndrome).


S5C13P7-2: Lytic defects in the epidermis near the basement membrane are a prominent feature. They contain lymphocytes, histiocytes, and necrotic keratinocytes. Migratory histiocytes are a prominent feature of the dermal infiltrates (green arrows). The patterns have a lichen planus-like quality (LP-LE overlap syndrome).

S5C13P7-3: The epidermal pattern is psoriasiform There are ill-defined, small lytic defects in the basal unit of the epidermis. Edematous dermal papillae contain loose infiltrates of lymphocytes and histiocytes. The upper portion of the dermis shows edema and loose perivascular infiltrates of chronic inflammatory cells (neonatal LE).

S5C13P7-4: At higher magnification, there are vacuolar and cytolytic changes in the basal layer of the epidermis. There are occasional apoptotic cells. Green arrows identify migratory histiocytes (neonatal LE).

S5C13P7-5: At a higher magnification, basal keratinocytes show cytolytic and coagulative changes; there are occasional necrotic keratinocytes. Green arrows identify migratory histiocytes (neonatal LE).

S5C13P7-6: This is a scalp lesion of DLE. Follicles are atrophic and the sites of atrophy are marked by columns of fibrous tissue. The fibrous columns are perpendicular to the surface of the skin. The dermal-epidermal interface is straight; rete ridges focally are completely effaced. The papillary dermis is widened and fibrotic. There is a lytic defect at the dermal-epidermal interface on the right. This is an artefactual separation, but the defect reveals a site in which liquefactive changes have altered the integrity of bonds between epidermis and dermis; the area is susceptible to the trauma of processing the tissue. Effacement of rete ridges is an expected feature of alopecic LE. The lesion also qualifies as a senescent lichenoid reaction and as scarring alopecia. The effaced rete ridges might be cited as a feature favoring a diagnosis of scarring alopecis as a feature of LE.

S5C13P7-7: This is an example of erythema multiforme (or an erythema multiforme-like pattern) in the setting of LE. Beneath the green arrows, the partly necrotic epidermis has separated from the dermis. At both margins of the sub-epidermal defect, the epidermis is better preserved. The patterns at the dermal-epidermal interface are lichenoid .

S5C13P7-8: At a higher magnification, there is extensive necrosis of the basal unit of the epidermis. To the right, the epidermis has separated from the dermis. There is focal parakeratosis.

S5C13P7-9: At this margin of the lesion, the pattern is a classic erythema multiforme-like type. There is lysis of the basal layer; the surviving epidermis has taken on the qualities of a pale superficial unit. Clusters of necrotic keratinocytes are in transit to the surface (whorled transepidermal elimination). Pigment deposits are prominent in the lytic defects at the dermal-epidermal interface. A basal unit is partially preserved to the left of the center of the field. Unlike the basal unit of a lesion of PLVA, in which the cells of the basal unit tend to show lavender cytoplasm, the basal unit, where preserved in a lesion of EM, shows a greater degree of cytoplasmic acidophilia.

S5C13P7-10: At higher magnification, the lytic defects contain lymphocytes, histiocytes, and melanophages. To the left of the center of the field, the patterns have the qualities of whorled transepidermal elimination.

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