S7C4aP1a-Herpes Gestationis

S7C4aP1a-1: The same basic features of herpes gestationis are represented, but the patterns are mostly those of “psoriasiform” epidermal hyperplasia (basal unit hyperplasia in psoriasiform patterns) and uniform papillary dermal edema. Near the center of the field, the papillary dermis has disintegrated to form a small subepidermal vesicle. A portion of a small sub-epidermal vesicle is bordered to its left by the longest rete ridge in the field. There are perivenular infiltrates of lymphoid cells in the upper portion of the reticular dermis. Focally, lymphoid cells have collected at the dermal-epidermal interface.

S7C4aP1a-2:  At higher magnification, the basal unit hyperplasia is associated with intra-, and inter-cellular edema. The papillary dermis is edematous (pale and delicately fibrous). In the region of the red arrows, the edema has progressed; a small subepidermal defect containing lymphocytes, histiocytes, and eosinophils has formed at the dermal-epidermal interface. The interface changes are a precursor of a more significant subepidermal vesicle but, in any case, the changes are representative of interface disease.

S7C4aP1a-3:  In this area, the roof of the vesicle is thin. At the margin of the vesicle on the right, the basal unit is hyperplastic and edematous. It is difficult to define the boundary between a subepidermal defect and the papillary dermis, but the red arrows are are arranged in an attempt to define such an interface. The meshwork of delicate fibrils outlined by blue arrows is composed of fibrin, it is within the defect. Eosinophils are present in the infiltrates.

S7C4aP1a-4: This is a ruptured subepidermal bulla with the roof of the ruptured portion folded back over the neighboring epidermis. Centrally, there are several suprapapillary abscesses. Clefts containing collections of neutrophils separate the compressed papilla from the overlying epidermis. To the far right, the separation is confluent; it contains neutrophils; in this area, the zones of acute inflammation have lost their relationship to the tips of dermal papillae. The lesion was interpreted as IgA linear dermatosis, but the patterns are more in keeping with those of dermatitis herpetiformis. If immunofluorescent findings formed the basis for the interpretation, they should be reviewed. As in pathology in general, there is room for error in the interpretation of immunofluorescent findings.

S7C4aP1a-5: In this field, the patterns are those of suprapapillary abscesses; dermatitis herpetitformis should be mentioned in the differential diagnosis (linear IgA dermatosis?).

 

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