S6C7P1-Pemphigus Vulgaris

S6C7P1-1: The roof of this flaccid bulla is a thin layer of epidermis; the keratin layer is relatively normal. Dermal papillae are partially preserved along the floor. A single layer of basal keratinocytes remains attached to the papillary dermis along the floor. There are small, separate areas of suprabasilar acantholysis to the left of the main lesion (pemphigus vulgaris).

S6C7P1-2: At a higher magnification, the basal row of keratinocytes is well-defined. Near the left margin of the field, keratinocytes are erect and separated from their neighbors; they are attached to the basement membrane. The pattern has a “tombstone-like” quality. To the right, dermal papillae are preserved; they project into the defect. The lesion is relatively free of inflammatory cells.

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S6C7P1-3: Basal keratinocytes have lost an attachment to their neighbors, but remain attached to the basement membrane; this is a characteristic pattern of acantholysis in a suprabasilar distribution. It is the characteristic pattern of acantholysis in lesions of pemphigus vulgaris (common or basal pemphigus). Basal keratinocytes have plump, round nuclei and acidophilic cytoplasm. The basal cells are variably pigmented (melanized). Inflammatory infiltrates are minimal in the dermis and the epidermis. The absence of fibrin in the defect makes it difficult to identify the defect as a manifestation of an inflammatory process. As the basic morphologicdefect, the inter-cellular attachments between neighboring basal keratinocytes are affected; intercellular bridges are not represented.

 

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