S8C30P16HyalineAngiopathies

S8C30P16-2: A trichrome stain accentuates the basement membrane and the perivascular hyalinosis in this lesion of DLE (collagen = blue). Atrophy of the superficial portion of the reticular dermis is also a prominent feature (clear areas).

S8C30P16-3: With a colloidal iron stain, the hyalinosis has tinctorial qualities that are different from those of the collagen bundles at the bottom of the field. The membranous material is a complex deposit in which other materials, such as immunoglobulins, are embedded. The granular green deposits near the basement membrane zone are melanin deposits (melanin incontinence as a result of the lichenoid reaction). The mucinous (blue) interstitium of a thin basal unit of the epidermis is evident. There is also faint mucinosis in the areas of dermal atrophy.


S8C30P16-1: The epidermis shows hyperkeratosis and parakeratosis. It has separated from the dermis (an artefactual cleft). The basement membrane shows hyalinization (attached to the roof of the defect [blue arrows]). Blue arrows also identify a thickened follicular basement membrane. Band-like, perifollicular infiltrates hug the follicle below the isthmus (a cell-rich lichenoid pattern). The lesion is cell-poor at the dermal-epidermal interface and along the infundibular portion of the follicle. The upper portion of the dermis shows atrophy and telangiectasia. The patterns are those of classic discoid lupus erythematosus (DLE). Green arrows identify a vessel showing hyalinization of its wall. Perivascular hyalin is common in lesions of DLE.

S8C30P16-4: The pattern along the floor of this cell-poor, sub-epidermal vesicle is characteristic of changes seen in lesions of porphyria cutanea tarda (PCT). The characteristic site selected for biopsy in this clinical setting is the hand. The epidermis forming the roof of the vesicle is recognizable as being representative of an acral site; it shows degenerative changes. Dilated vessels are prominent in the papillary dermis and the dermal papillae. Although fibrosis of the dermal papillae might be cited as the explanation for their “rigidity,” vascular hyalinosis may be the basic process; the thickened, hyalinized vessels may serve as a scaffold, supporting the papillae in an erect fashion.

S8C30P16-5: Deposits of polyclonal immunoglobulins in the walls of vessels produce a pattern of vascular hyalinosis (PCT). They also collect along the basement membrane zone; on occasion, they may be sufficient to be characterized as hyalinosis, even on H&E stained sections (PAS- hematoxylin stain).

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