received skin covered grey white - kimsmedicalcollege.org · out epidermis • basal cell layer...

• RECEIVED SKIN COVERED GREY WHITE PUNCH BIOPSY BIT MEASURING 3 X 3 mm.

A/E - 1

• Hyperkeratosis

• Follicular plugging

• Focal thinned out epidermis

• Basal cell layer vacuolation

• Melanin incontinence

• Interface dermatitis

Perivascular and periadnexal lymphocytic infiltration

Periadnexal lymphocytic infiltration

DIFFERENTIAL DIAGNOSIS

• Discoid lupus erythematosus

• Systemic lupus erythematosus

• Subacute cutaneous lupus erythematosus

DLE

MICROSCOPY

DLE SCLE

SLE

HYPERKERATOSIS Prominent Less prominent Less prominent

COLLOID BODIES Less common Common Common

DERMAL EDEMA Less common Common Common

FIBRINOID DEPOSITS Less prominent Less prominent Prominent

MICROSCOPY DLE SCLE SLE

INFLAMMATORY

INFILTRATE

Prominent Less severe Less severe

VASCULARITY Less marked Less marked Increased

SUBCUTANEOUS

FAT

Not involved Not involved Involved

M U C I N

DEPOSITION

Lesser Increased Increased

BASEMENT MEMBRANE

Mild thickening Mild thickening Marked thickening

• Moderate mononuclear infiltrate

• Dermal edema

• Subepidermal vacuolization

• Melanin incontinence

SCLE

SLE

•ACUTE FORMS

DISCOID LUPUS ERYTHEMATOSUS

HISTOPATHOLOGICAL FINDINGS

• STRATUM CORNEUM Hyperkeratosis with follicular plugging

• EPITHELIUM Thinning and flattening of stratum malpighii , hydropic degeneration of basal cells , squamatisation of basilar keratinocytes

• BASEMENT MEMBRANE Thickening and tortuosity

• STROMA Lymphocytic infiltrate along dermal epidermal junction ,

around hair follicles and other appendages , interstitial mucin

deposition , vasodilation

Atrophy of pilosebaceous units

COLLOID BODIES ( CIVATTE BODIES ) may be present in

the lower epidermis .

LICHEN PLANUS

DIFFERENTIAL DIAGNOSIS

• Lymphocytic lymphoma : atypical lymphocytes , do not surround pilosebaceous units .

• Lymphocytoma cutis : extensive inflammation , polymorphous lymphocyic population .

• Polymorphous light eruption : dermal edema , no BV.

• Lymphocytic infiltration of the skin of Jessner

• Poikiloderma

• Erythema multiforme

• Drug eruptions

POLYMORPHOUS LIGHT ERUPTION

POIKILODERMA

NO BASAL VACUOLATION , HYPERKERATOSIS , NO INTERFACE CHANGES

SPECIAL STUDIES

REFERENCES

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