S9C11P4Morphea

S9C11P4-1: As indicated in the discussion of dermatomyositis, many disorders, that have sclerosing qualities in the skin, are first, and most prominently, manifested at interfaces. In this field, the lower portion of the reticular dermis is represented (sweat gland at bottom of field on right). In the lower 1/2 of the field, collagen bundles are coarsened; they tend to be arranged in parallel arrays with their longitudinal axis parallel to the surface of the skin. The location of the fibrosing process and the respective patterns are characteristics of a lesion of morphea. The blue arrows outline a small area with interstitial infiltrates of lymphoid cells; this small focus qualifies as the lymphohistiocytic collagenosis of morphea (scleroderma). In this approach, the cells of the infiltrate have a relationship with the sclerosing process. They influence the connective tissue cells; the connective cells are activated. In the process, connective tissue cells, in response to activation, produce collagen. The product is manifested in abnormal patterns.

S9C11P4-2: The interface between dermal type fibrous tissue and adipose tissue is represented. The adipose tissue shows mild lipoatrophy with an increased prominence of a pale, acidophilic matrix among lipocytes and with variation in the size of lipocytes. There is an increased prominence of small vessels in the adipose tissue (a regular feature of lipoatrophy). The fibrous tissue near the top of the field shows the characteristic alterations seen in lesions of morphea (coarsening of collagen bundles). The arrows identify a zone of distinctive, pale, delicate fibrous tissue. A few, scattered, small lipocytes are entrapped in this newly formed fibrous matrix. It is by this process of interface fibroplasia that the vertical dimensions of the reticular dermis are increased during the evolution of a lesion of morphea; the process qualifies as the substitutive collagenosis of morphea. Interstitial infiltrates of lymphoid cells, often with an admixture of plasma cells, are also characteristic of the process at this interface in a lesion of morphea).

S9C11P4-3: In this field, changes similar to those in S9C11P4-2 are represented. The newly formed matrix of the substitutive collagenois of morphea is represented; it is associated with markers for a lymphohistiocytic collagenosis. The coarse bundles of collagen above the blue arrows are a more advanced (older) stage of the substitutive collagenosis.

S9C11P4-4: This example of morphea shows coarsening of collagen bundles in the lower 1/3 of the field. The entire reticular dermis is affected by a lymphohistiocytic collagenosis in a spotty fashion. The epidermis is hyperplastic in psoriasiform patterns. The papillary dermis is widened and fibrotic (pattern of superficial morphea), but the patterns are not those of classic LS&A. They are the patterns of classic superficial morphea (interstitial, lymphohistiocytic collagenosis of scleroderma).

S9C11P4-5: The infiltrates in this lesion of morphea spill from the perivascular spaces into the interstitial spaces of the reticular dermis. They are composed of lymphocytes, histiocytes, and occasional plasma cells. Spaces among collagen bundles appear widened, but some of the apparent widening is a consequence of the unbundling of collagen fibrils (fibrillation of collagen bundles of the reticular dermis). A vessel in cross-section near the bottom of the field is ectatic; its wall is thickened and hyalinized ( angiopathy of scleroderma).

S9C11P4-6: This is another field showing the lymphohistiocytic collagenosis of morphea (scleroderma). Some of the collagen bundles in the areas of inflammation are fibrillated. Some of the defects in the collagen bundles might be characterized as clefting (a variation in the patterns of unbundling.

S9C11P4-7: The deep, interface-sclerosis of morphea is represented in the area outlined by blue arrows. Often in old lesions, the substituted fibrous tissue at this deep interface is more brightly acidophilic than the less involved dermis; it may also be PAS+ to a greater degree than the superficial, less involved dermis.

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