S9C29P20NLD


S9C29P20-1: This is another example of NLD showing marked substitutive fibrosis; the dermis is approximately twice its normal vertical dimension. The expansion, in part, has been accomplished by the deposition of a new fibrous matrix. The new matrix has expanded inferiorly and, in the process, has incorporated a portion of the domain of the subcutaneous fat. The new interface, defining a boundary between the fibrous tissue (as a product of substitutive fibrosis) and the fat, is straight. At this magnification, the deep contours of the dermis can be appropriately characterized as “squared-off.” The lesion also shows layers of inflammatory infiltrates and a collagenosis in which collagen bundles are arranged in parallel arrays.

S9C29P20-2: Infiltrates of nflammatory cells are represented in layers (green arrows); they are both lymphohistiocytic and granulomatous. At all levels, collagen bundles are streaked. The rounded structure, below the center of the field and to the right (near the interface between the dermis and the fat, and at the lower margin of the field), is a muscular vessel showing an intramural, granulomatous infiltrate. On the left at the interface between fibrous tissue and fat, there is a zone of fibrous tissue in which collagen bundles are thin, parallel, and loosely spaced in a clear matrix. This is a zone in which substitutive fibrosis is in progress.

S9C29P20-3: This area can be easily matched with that of S9C29P20-2. The perivascular and interstitial infiltrates are granulomatous. At the top of the field, the collagenosis is characterized by streaked, coarse, brightly acidophilic collagen bundles; the connective tissue in this area is acellular (necrobiosis). In the area outlined by green arrows, there are irregular, dense, basophilic deposits; they are seen at higher magnification in S9C29P20-5.

S9C29P20-4: In this field, the arrangement of altered collagen bundles might be characterized as a “basket-weave” pattern. Granulomas are both perivascular and interstitial.

S9C29P20-5: The basophilic deposits seen in S9C29P20-3 are represented at a higher magnification; the deposits are both fiber-like and granular. The changes are those of a calcific elastosis. The lavender color is tinctorially characteristic of calcium deposits. The lavender fibers are identifiable as calcified elastic fibers (green arrow). The changes in the elastic tissue are of a type that might be seen in a lesion of pseudoxanthoma elasticum, but might also be encountered in other settings. Calcific panniculitis, as seen in renal dialysis patients, is one of the settings in which this change occurs.

S9C29P20-6: The spicular and granular, lavender deposits are calcified elastic fiber. Some of the calcified fibers have been reduced to granular debris. Some of the fibers are fractured. Defects which contain irregular calcific deposits form at the sites of fractures.

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