S6C16P10-Pemphigoid

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S6C16P10-1: The subepidermal defect extends from the center to the left margin of the field. The basal layer, of that portion of the epidermis which forms the first cell layer of the roof of the bulla, is ragged; there are scattered defects. There is a second smaller subepidermal defect near the right hand margin of the field. The epidermis between the two defects is hyperplastic in psoriasiform patterns. Along the floor of the vesicle on the left, dermal papillae are only partially preserved. The upper portion of the reticular dermis contains perivascular infiltrates of lymphoid cells ( pemphigoid).

S6C16P10-2: The basal layer of the epidermis that forms the roof of the bulla is ragged. The subnuclear portion of the cytoplasm of each basal cell is acidophilic (coagulated). Basal keratinocytes have shrunken, pyknotic nuclei. The defect contains fibrin and a loose infiltrate of lymphocytes and histiocytes. The papillary dermis is thin. Dermal papillae are partially preserved (bullous pemphigoid). The changes in the basal layer along the roof of the bulla have a cytopathic quality. Surely, these changes are pathogenetically important in the evolution of the bulla.

S6C16P10-3: Basal keratinocytes are damaged. They are shrunken with acidophilic cytoplasm and pyknotic nuclei. The subepidermal defects are spotty in distribution. Focally to the far right, the basement membrane appears to be attached to the dermis rather than the roof of the defect. At the far left, basement membrane is not identified along the floor of the bulla. A loose infiltrate of histiocytes is present in the papillary dermis; the reaction is cell-poor (bullous pemphigoid).

S6C16P10-4: In the reticular dermis, there are mild, loose infiltrates of lymphocytes, histiocytes, and eosinophils (blue arrows). Perivascular infiltrates are mild. The dermis is edematous (the spaces among collagen bundles are widened and clear). The tubular structure is interpreted as an altered sweat duct (bullous pemphigoid).

S6C16P10-5: This subepidermal bulla of bullous pemphigoid is cell-poor. The roof of the vesicle shows mild hyperplasia in the pattern of a superficial unit. It shows cellular disarray  and focal dyskeratotic cells. A basal layer is not represented in the epidermis forming the roof of the bulla. The papillary dermis is cell-poor. Perivascular infiltrates are mild. To the right in the epidermis, there are scattered dyskeratotic cells.

S6C16P10-6: This example of a cell-poor, subepidermal bulla of bullous pemphigoid shows mild perivascular infiltrates in the upper portion of the reticular dermis. A few eosinophils are present in the infiltrates. Inflammatory cells are strung along the floor of the vesicle. The defect contains fibrin and loose infiltrates of inflammatory cells, including eosinophils. Dermal papillae are partially preserved. The papillary dermis is slightly edematous. Keratinocytes forming the thin roof of the vesicle show degenerative changes.

 

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