S13C6cP4c-Histiocytic Spongiosis



S13C6cP4c01: The basic pattern is that of a spongiotic disorder, but the vesicle is distinguished by a high component of distinctive histiocytes. The papillary dermis is slightly widened. Perivascular lymphoid infiltrates extend along vessels into the papillary dermis and into the overlying epidermis. This distinctive lesion generally is characterized as a reaction.

S13C6cP4c-2: The histiocytes of the vesicle have pale, acidophilic cytoplasm; they show some variation in nuclear size and outline. Green arrows point to necrotic keratinocytes; the lesion has ill-defined lichenoid qualities. In the lower portion of the vesicle, intercellular fluid is more abundant. The cells in this area of the vesicle are more widely spaced; there is a sprinkling of lymphoid cells among the histiocytes in this area.

S13C6cP4c-3: Some of the pale histiocytes have a notched nucleus. Near the bottom of the field, small yellow arrows identify a necrotic keratinocyte with a lymphocyte in close apposition (pattern of “satellite cell necrosis”).

S13C6cP4c-4: This is a separate focus of inflammation in the same biopsy specimen as S13C6cP4c-1-3. In this field, the pattern of the infiltrate of histiocytes in the epidermis might be characterized as pagetoid histiocytosis . Histiocytes are more prominent in the epidermis than in the dermis. The degenerating cells, that are clustered in a defect in the keratin layer, are histiocytes.

S13C6cP4c-5: Pagetoid histiocytosis of the epidermis. Histiocytes are present in the dermal papillae.

S13C6cP4c-6: This field shows a pattern of pagetoid histiocytosis. Green arrows identify plump, intra-epidermal histiocytes, presumably variants of “Langerhans cells.” The plump histiocytes have an enlarged nucleus with irregular nuclear outlines.

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