P12-LE tumidus


S5C18P12-1: This is an example of the mucinosis of LE but, in this field, the mucinous changes are prominent in the subcutaneous tissues. They are associated with a reduction in the number of mature lipocytes. This may represent an early phase of lupus profundus , but inflammatory infiltrates are not a prominent feature. The lesion appears to be a relatively pure mucinosis in the subcutaneous component.

S5C18P12-2: Focally, changes in the epidermis are characteristic of those seen in lesions of LE; they provide a perspective for the interpretation of the dermal changes. Red arrows identify areas showing duplication and irregular coarsening of the basement membrane. Infiltrates at the dermal-epidermal interface are rich in histiocytes (LE mucinosis [tumidus]).

S5C18P12-3: In the reticular dermis, mucinous components are relatively rich in activated histiocytes. The histiocytes probably have a role in the progression of the mucinous process. They may interact with fibroblasts in a manner that promotes a mucinous inter-cellular matrix at the expense of the collagenous component. Elastic fibers are preserved.

S5C18P12-4: Activated histiocytes are also prominent in the perivascular infiltrates of the reticular dermis.

S5C18P12-5: The keratin layer is relatively normal, but there are changes at the dermal-epidermal interface. The epidermis is mildly hyperplastic (acanthotic). Blue arrows identify zones with vacuolar changes at the dermal-epidermal interface. There are mild perivenular infiltrates of lymphoid cells (post-organ transplant, graft vs host disease).

S5C18P12-6: At higher magnification, there are vacuolar changes involving the basal layer of the epidermis. In addition, there are cytopathic changes with irregularly spaced, necrotic keratinocytes, mostly in the basal layer. The necrotic (apoptotic) cells are rounded and have acidophilic cytoplasm. They have pulled away from neighboring, viable keratinocytes. They have rounded, pyknotic nuclei, some of which are fragmented. This is a cell-poor lichenoid reaction (graft vs host reaction).

S5C18P12-7: The reaction is most prominent in a slightly hyperplastic basal unit of the epidermis. The basal unit also shows an increased number of migratory and dendritic histiocytes with occasional combinations that qualify as “satellite cell necrosis.” The relatively normal keratin layer might correlate with the acuteness of the reaction. The lesion is a cell-poor lichenoid reaction. Perhaps, the patterns are better compared to those of an erythema multiforme-like process than a classic LE-like reaction. Actually, it is a lichenoid reaction of graft vs host type (in the setting of graft vs host disease).

S5C18P12-8: Migratory and dendritic histiocytes are a prominent component of the reaction in the basal unit of the epidermis.

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