S9C8aP1aMyxedema


S9C8aP1a-1: The epidermis is hyperplastic; rete ridges are elongated. The papillary dermis is widened and fibrotic. The reticular dermis is pale. At this magnification, iindividual collagen bundles of the reticular dermis are thin and inconspicuous. The alteration in the reticular dermis is most prominent in the upper 2/3’s (pretibial myxedema).

S9C8aP1a-2: At higher magnification, the papillary dermis is widened and fibrotic. Collagen bundles of the reticular dermis are delicate; they are loosely spaced in a pale (mucinous) matrix. There is only a mild hyperplasia of mesenchymal cells (myxedema).

S9C8aP1a-3: Collagen bundles are delicate; some of the changes might be characterized as an “unbundling” of collagen fibrils. There is a pale, faintly basophilic matrix among the collagen bundles. As an incidental finding, there are dermal melanocytes (pigmented dendritic melanocytes) in the center of the field.

S9C8aP1a-4: In this case, a stain for acid mucopolysaccharides shows an increased prominence of a mucinous matrix in the reticular dermis. The widened papillary dermis is also mucinous and widened, but mucinous changes in the papillary dermis are of less significance. The epidermis is hyperplastic. The papillary dermis shows papillomatosis and lamellar fibrosis.

S9C8aP1a-5: A PAS-alcian blue stains shows an increased amount of mucinous matrix in the reticular dermis (lower portion of the field; greenish-blue material). Collagen bundles are pink; they are arranged in prominent lamellar patterns in the dermal papillae (i.e., lamellar fibrosis, as often emphasized in the histologic diagnosis of lichen simplex chronicus).

S9C8aP1a-6:With a trichrome stain, the delicate, widely spaced collagen bundles of the reticular dermis are accentuated (myxedema). The blue fibers are collagen bundles. With this stain, the interstitial matrix is not accentuated, except as a negative image.

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