Dermatology Practical & Conceptual

Epidermal multinucleated giant cells are not always a histopathologic clue to a herpes virus infection: multinucleated epithelial giant cells in the epidermis of lesional skin biopsies from patients with acantholytic dermatoses can histologically mimic a herpes virus infection

…onsistent with a herpes virus infection. (A) An intraepidermal vesicle with suprabasilar epidermal acantholysis and cleft formation is noted. (B and C) Closer views show neutrophils and eosinophils in both the intraepidermal vesicle and the dermis; i…

Differential Diagnosis in Dermatopathology

Discussions

…of an insect “bite” that consists clinically of a vesicle atop an urticarial papule or plaque will reveal a large central intraepidermal vesicle with smaller intraepidermal vesicles that taper progressively in size toward the periphery o…

Histologic Diagnosis of Inflammatory Skin Diseases

Urticaria

Urticaria Synonyms Nettle rash Hives Wheals Presentation stereotypical Age and sex Any age, especially young persons, in both sexes Distribution of lesions Localized, as in cold urticaria, regional as in solar urticaria, or widespread as in urtica…

Histologic Diagnosis of Inflammatory Skin Diseases

Dermoepithelial Interface

The basement membrane was defined first by conventional microscopy as a thin band situated immediately beneath basal keratocytes, a strip that was stained magenta by the periodic acid-Schiff method (Fig. 1.70). In time, with the aid of electron micr…

Differential Diagnosis in Dermatopathology

Urticarial reaction to an arthropod assault vs. Urtica

A blistering inflammatory disease in which acantholysis occurs in the upper part of the spinous zone or granular zone of the epidermis, the result of the process being flaccid blisters that give way to erosions and crusts accompanied by erythema. Wh…

Histologic Diagnosis of Inflammatory Skin Diseases

Images

Images 10.99.1A: Vasculitis, small vessel, neutrophilic; panniculitis, lobular; perivascular and interstitial dermatitis, and vesicular dermatitis, subepidermal + 10.99.1B: Thrombi in the lumen of venules and countless bacteria in the int…

Histologic Diagnosis of Inflammatory Skin Diseases

Selection of the Method for Surgery

Not only the lesion for biopsy but also the method of biopsy must be chosen deliberately. It is obvious that certain methods of biopsy should not be employed when an inflammatory disease is suspected clinically, for example, curettage and electrocau…

Histologic Diagnosis of Inflammatory Skin Diseases

Errors and Reasons

Error: Abortive is an accurate modifier of particular pathologic processes, e.g., abortive dermatofibroma, abortive morphea, and abortive T-cell lymphoma. Reason: The idea itself is abortive! For example, what is called “abortive T-cell lympho…

Histologic Diagnosis of Inflammatory Skin Diseases

Images

…pidermal + 10.10.5B: Many eosinophils in the dermis and in vesicles in the epidermis = Bullous pemphigoid, vesicular Both authentic intraepidermal (spongiotic) vesicles and subepidermal vesicles are present. In addition, some intraepidermal vesic…