S9C27P18NLD


S9C27P18-1: In this lesion of NLD, the yellow areas are produced by the infiltrates of inflammatory cells (Verhoeff-van Giesen) (some are obscured by overstaining with the Verhoeff stain). The perivascular infiltrates are mostly lymphohistiocytic but, in foci, are also granulomatous. The interstitial infiltrates are mostly horizontal in orientation; they are mainly granulomatous. An alteration in the orientation of collagen bundles is a basic feature of fully developed lesions in this inflammatory process. In this process, collagen bundles in parallel arrays appear to be streaked across the field. In the streaked patterns, collagen bundles are arranged parallel to each other and to the surface of the skin.


S9C27P18-2: Layering of inflammatory (granulomatous) infiltrates is most prominent in the upper 1/3 of the reticular dermis. In the deeper portion, the dermis is pathologically fibrotic with sclerosis (coarsening and compact aggregation of collagen bundles) and pallor (pale staining) of collagen bundles. The vertical dimension of the dermis is increased. Abnormal fibrous tissue extends well below the level of a sweat gland which is entrapped in the lower portion of the dermis (blue arrows). The sweat glands in this site might be taken as a marker for what would have been the lower margin of the dermis in normal skin. In the areas showing pale, collagenous tissue, there is also elastolysis (the areas are devoid of elastica) (NLD).

S9C27P18-3: On the right, the collagen bundles are loosely spaced and associated with coarse elastic fibers. The coarse elastic fibers are characteristic of those of the reticular dermis. The elastic fibers appear to be increased in number per unit area, but this may be an artefact related to the partial collapse of the collagenous framework. Yellow cells among the collagen bundles to the right are histiocytes and giant cells (granulomatous collagenosis). To the left and above, the collagen bundles are pale and reddish-yellow. They are swollen and, focally, they are so closely spaced that they appear to have fused with their neighbors. In this same area, elastic fibers are poorly represented; fibrolysis has destroyed the elastic framework (fibrolytic and granulomatous collagenosis; NLD).

S9C27P18-4: The connective tissue changes in this lesion are those of NLD, but the lesion shows a paucity of inflammatory cells. Collagen bundles are streaked in a direction parallel to the skin. Below the center of the field, a vessel is cut twice in cross-section; the sparse, perivascular infiltrates in this area are composed of epithelioid histiocytes; this component offers some support for a diagnosis of NLD.

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