S9C18P10LSALike


S9C18P10-1: This lesion of morphea has, in addition to classic changes in the deeper portion of the reticular dermis, a superficial sclerosing component. This superficial component extends from the dermal-epidermal interface through the papillary dermis into the upper portion of the reticular dermis. Blue arrows define the interface between classic changes of morphea and a distincive superficial zone in which the changes overlap with those of LS&A.

S9C18P10-2: The patterns are those of morphea with involvement of the papillary dermis. There are cell-poor lichenoid patterns at the dermal-epidermal interface. On the basis of patterns, as represented in this field, it would be difficult to make a distinction between LS&A and superficial morphea. At best, the distinctions would be somewhat arbitrary and, perhaps, insignificant. LS&A of the non-genital type might be a variation of superficial morphea.

In this example, there are clear features of classic morphea as well as a superficial component. As in classic LS&A, there is a lymphohistiocytic collagenosis (mild in this example) just deep to the superficial zone of fibrosis (the more homogeneous, less cellular [hyalinized] zone that abuts upon the epidermis). Vessels in the hyalinized zone are ectatic. The fibrosing reaction beneath the homogeneous zone is characteristic of examples of morphea which have extended into the upper portion of the reticular dermis. On the other hand, it is also characteristic of the reaction which extends into the reticular dermis from the zone of hyalinization in a lesion of LS&A. The two sclerosing disorders are closely akin. If differences are to be made, they consist of subtle, subjective phenomena such as degree of edema, hyalinization, or fibrosis. Both forms of superficial dermal sclerosis are associated with lichenoid patterns at the dermal-epidermal interface. Superficial morphea and LS&A are examples of superficial, sclerosing disorders.

S9C18P10-3: The changes at the dermal-epidermal interface are lupus erythematosus-like (i.e., cell-poor and lichenoid), but are also acceptable as the interface reaction of a lesion of LS&A. In this field, the basement membrane is not significantly coarsened, or even identifiable as a well-defined structure. There is irregular pigmentation of the basal layer; the upper portion of the dermis contains melanophages. The hyalinized fibrous matrix, which resembles LS&A at low-magnification (S9C18P10-2), is both homogeneous and partitioned in bundles. In addition, basophilic elastic fibers are among the bundles, particularly to the right. The features of these fibers identify them as a marker for a residual, but altered, fibrous component of the original reticular dermis. This preservation of a distinctive fibrous components, in an ambiguous lesion such as this example, might be cited as being evidence in favor of a variant of superficial morphea rather than LS&A. Such an assignment, at this level of magnification, and in this limited domain, would be most arbitrary. The presence of elastotic fibers in the superficial zone of fibrosis is not a feature distinguishing LS&A from superficial morphea.

S9C18P10-4: In this same lesion with an LS&A-like superficial component in a lesion of morphea, the transition-zone is represented in this field. The first boundary (red arrow-heads at top of field) marks a transition zone from homogenous hyalin to a zone in which remnants of the fibrous component of the reticular dermis are distorted, but represented (this marks an extension of a process from an altered papillary dermis into the upper reaches of the reticular dermis). The boundary defined by both the red and green arrow-heads separates the hyalinized zone from the area of the lymphohistiocytic collagenosis. The bottom row of arrow-heads define the boundary between the zone of the collagenosis and a less involved reticular dermis.

S9C18P10-5: In this deeper portion of the reticular dermis, collagen bundles are variably pale; some have a fibrillated quality. A vessel to the right has a thickened, hyalinized wall (angiopathy of morphea). The perivascular infiltrates contain plasma cells; this is a common feature of lesions of morphea (scleroderma). Arrows identify plasma cells. Plasma cells are a common feature of the perivascular infiltrates of both LS&A and superficial morphea in the perivascular infiltrates at the level of the lymphohistiocytic collagenosis in the reticular dermis near the transition zone.

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