S6C11P5-pemphigus

S6C11P5-1: This is the classic pattern along the floor of a bulla in a lesion of pemphigus vulgaris. In this example, neutrophils and eosinophils are loosely sprinkled in the defect.

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S6C11P5-2: This lesion shows patterns of pemphigus vulgaris along the surface. There is involvement of follicles and, in the follicular component, the patterns focally are above the suprabasal level. In most areas along the follicles, several layers of cells form the floor of the acantholytic process. By the criteria herein, the follicular component might be characterized as an intermediate pattern.

S6C11P5-3: The patterns are superficial and acantholytic. They are of a type classified as pemphigus foliaceus. Cells of the superficial unit of the epidermis form the floor of the defect. Acantholytic cells at the surface of the floor of the defect are better represented along the luminal surfaces of the follicles than along the surface of the skin. The follicles afford some degree of protection from abrasive forces along the surface.

S6C11P5-4: This is a nice photograph for the demonstration of the dyskeratosis which accompanies, or perhaps precedes, acantholysis. This, and the next, photomicrographs are favorites of mine. The original was a lantern slide; the photographic equipment was a B&L micoscope and optical bench with bellows attachment. The lenses were not of the “plan” type but were apochromats. The photomicrograph is of 1960 vintage ( pemphigus foliaceus).

S6C11P5-5: At the surface of this superficial defect, an acantholytic keratinocyte is rounded; it shows a perinuclear halo and a condensation of the cytoplasm peripherally. The cell is acantholytic, and dyskeratotic ( pemphigus foliaceus) (when I look at these old lantern slides, Ray Johnson, who was the photographler for the Department of Pathology at Tulane, comes to mind).

S6C11P5-6: An intraepidermal vesicle in the setting of pemphigus is represented. Acantholytic cells are present in the defect. This might be categorized as an intermediate variant, but the character of the epithelium along the floor is more in keeping with regeneration of squamous epithelium. The patterns are in keeping with a “healing” lesion. Only the acantholytic cells in the defect provide insight into the nature of the lesion.

 

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