S6C22P16CPemphigoid

S6C22P16-2 (cicatricial pemphigoid): The row of red arrows near the top of the field point to the surface of a dermal papilla and to the basement membrane zone. With this stain, collagen bundles are red; cells, such as endothelial cells and fibroblasts, yellow; and mucinous matrix blue. There is a minute zone of mucinosis, with interruption of the fibrous portion of the basement membrane, at the tip of the papilla. There is fibrolysis and mucinosis; the integrity of the basement membrane has been violated (colloidal iron).

S6C22P16-3 (cicatricial pemphigoid): At the tip of the papilla with this connective tissue stain (Verhoeff-van Gieson stain), connective tissue fibers (red) are delicate and faintly stained; they are partially digested. The fibrous matrix of the basement membrane zone has been compromised.

S6C22P16-1(cicatricial pemphigoid): A Snook’s reticulum stain impregnates reticular fibers. Affinity for the silver, with this stain in this manner, defines the positive fibers as reticular fibers. The interrupted and partially stained fibers along the surface of this dermal papillae provide evidence of fibrolysis in the region of the basement membrane. This compromise of the integrity of the basement membrane may provide an avenue for the ingrowth of fibroblasts from the stroma of the papillary dermis into the condensed fibrin along the floor of the bulla. Such a migration would lead to the deposition of newly formed fibrous tissue in the domain of the fibrin; it would then lead to accretive fibrosis along the surface of the papillary dermis (organization).

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S6C22P16-4 (cicatricial pemphigoid): Connective tissue fibers are red. The undulating surface defined by the red component is representative of collagenous tissue adjacent to the basement membrane zone. The stroma of the papillae is fibrotic. Near the center of the field, angulated, yellow cells with a blue-green interstitium are representative of an island of squamous epithelium that has remained attached at the basement membrane zone. In areas, the actual membrane is separated from the stroma of the dermal papilla by a clear, irregularly mucinous zone. The yellow zone, to the right and above, is a cluster of inflammatory cells (colloidal iron).

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