S7C8P5-Vesicular Pemphigus, etc.

S7C8P5-1: In vesicular pemphigus, the defects are rounded; they are outlined on the dermal side by a single row of flattened basal cells. The keratin layer is not remarkable. The basal unit between the defects is hyperplastic, but intact.

S7C8P5-2: The rounded character of the defect suggests that there is increased pressure; the flattening of the basal keratinocytes along the floor would offer support for such an interpretation. The papillary dermis is widened and inflamed.

S7C8P5-3: This supra-basilar defect is rounded in outline; it contains eosinophils and histiocytes. If this were the most representative pattern of the lesion, an observer might not be willing to accept the defect as a marker identifying the process as acantholysis. Eosinophilic spongiosis might then be a consideration in the differential diagnosis. The papillary dermis is edematous.

S7C8P5-4: Along the basement membrane zone of the rounded defect to the left of the field, basal keratinocytes are irregular in outline; inter-cellular bridges are not a feature. The cells outlining the defect are separated from their neighbors; the patterns have both an acantholytic and dyskeratotic quality. There are vacuolar changes at the dermal-epidermal interface with an occasional neutrophil. There are also fragments of nuclear debris at the dermal-epidermal interface. A separate, small area of suparbasilar acantholysis is seen at the extreme right of the field. The papillary dermis is edematous. Occasional eosinophils are present in the dermal infiltrates.

S7C8P5-5: Within the vesicles, the reacting cell is an eosinophil. There are scattered, acantholytic (rounded), dyskeratotic cells in the defect. Fibrin fibrils form a meshwork in the background.

S7C8P5-6: Flattened keratinocytes, many of which are necrotic, form the floor of the vesicle. The inflammatory infiltrates in the dermis are composed of lymphocytes, histiocytes, and eosinophils. In this area, the widened papillary dermis has features of inflamed granulation tissue.

 

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