S5C20P13LEProfundus


S5C20P13-1: Lesions of lupus profundus usually are associated with a dermal mucinosis. Perivenular infiltrates of lymphocytes and histiocytes are usually a prominent feature in the lower portion of the dermis. Plasma cells also are a characteristic feature of the perivascular infiltrates. In this example, the connective tissue mucin is not deeply stained, but this merely reflects on the quality of the H&E stain. Spaces among the collagen bundles are widened.



S5C20P13-2: This area over a lesion of lupus profundus shows minimal, nonspecific epidermal changes. In lesions of lupus profundus, the epidermal changes of LE may, or may not, be represented in association with the changes in the lower portion of the dermis and the subcutaneous fat. There is widening of spaces among collagen bundles of the reticular dermis. There are mild perivenular infiltrates of lymphoid cells.

S5C20P13-3: In the deeper portion of the dermis in this lesion of lupus profundus, infiltrates are more prominent (they are somewhat nodular in relationship to small muscular vessels). Sclerodermoid patterns of sclerosis are a common feature of the patterns at the interface between the dermis and subcutis; lupus profundus is another disorder that may be characterized by a straight interface between fat and reticular dermis (“squared-off”). The sclerosis may affect the adventitia (stroma) of sweat glands; as the changes progress, the sclerosis may result in atrophy of sweat glands. In this example, some of the glands are dilated and the epithelium is flattened.

S5C20P13-4: In this area in the lower portion of the reticular dermis, the perivascular infiltrates are dense and nodular. A peripheral nerve is enlarged and hypercellular. Green arrows point to a vessel showing characteristic patterns of hyalinization.

S5C20P13-5: This is the classic pattern of atrophy and hyalinization in a lesion of lupus profundus. This probably is a late stage; earlier, the patterns might have included mucinous changes with fibrin deposits. Large lesions of this type tend to undergo necrosis; they, then, may be associated with areas of dystrophic calcification. In this field, the rounded spaces are interpreted as ghost lipocytes; a flattened nucleus is not represented at the periphery of any of the rounded spaces. Coagulation necrosis with preservation of the ghost outlines of cells is a common regional variation in the setting of lupus profundus.

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