S7C6P3-Vesicular-misc.

S7C6P3-1: This old photomicrograph shows many of the features of incontinentia pigmenti. Cytopathic changes include dyskeratosis and lytic defects at the dermal-epidermal interface. The superficial unit is hyperplastic. Red arrows outline a rounded defect containing fibrin and cellular debris (whorled transepidermal elimination). The inflammatory infiltrates of the dermis and the epidermis are rich in eosinophils. The superficial unit of the epidermis is hyperplastic.

S7C6P3-2: In this lesion of incontinentia pigmenti, the patterns are clearly those of an erythema multiforme-like type. Eosinophils are present in the infiltrates, but this feature would not exclude erythema multiforme. There are prominent cytopathic changes with necrotic keratinocytes (apoptosis) and cytolytic phemonena. Clusters of necrotic keratinocytes have been transported to the surface in patterns of whorled transepidermal elimination.

S7C6P3-3: The damage to keratinocytes primarily affects those of the basal unit; the changes are of a cytopathic type. There are scattered necrotic keratinocytes in the basal unit. Some of the relationships are similar to those of “satellite cell necrosis.” Clusters of necrotic keratinocytes are present in the superficial unit; the process of whorled transepidermal elimination has been initiated.

S7C6P3-4: In this example of incontinentia pigmenti, inflammation and cytopathic changes are not a prominent feature at this magnification. There are scattered dyskeratotic cells. The basal and superficial units are hyperplastic in verrucous patterns. The basal unit shows inter-cellular edema (“verrucous stage” of incontinentia pigmenti).

S7C6P3-5: In this area of a verrucous variant of incontinentia pigmenti, cytopathic changes are evident. Blue arrows identify some of the eosinophils in the epidermal infiltrates.

 

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