oval nucleus
Giant cell: multiple nuclei in one cell
Plasma cell: clock‐faced nucleus on one side of cell, perinuclear clear space
Characteristic body sites
The location on the body (body site) can often be determined by training the eye/brain to perceive certain features
Figure 4: Acral (A), mucosal (B), eyelid (C), axilla (D)
Figure 4(A) Acral skin
Note Meissner’s corpuscles (black arrow), Pacinian corpuscles (red arrow), and thick stratum corneum with a stratum lucidum (green arrow).
Figure 4(B) Cutaneous lip (top row) has keratin and a granular layer (green arrow) as well as adnexal structures
Skeletal muscle is often present (black arrows)
Normal mucosal lip (bottom row) lacks keratin and a granular layer; the keratinocytes are pale pink with abundant cytoplasm
The mucosa shown is abnormal as there is subtle parakeratosis (black arrow bottom right image)
Figure 4(C) Eyelid skin has a thin epidermis with dermal vellus hairs (red arrow) and skeletal muscle (black arrow)
Figure 4(D) Axilla
The epidermis is undulating, often with basilar melanin pigment. There are apocrine glands in the deep dermis
Table 2(see page 22) shows a differential of “normal”‐appearing skin. Some entities, like vitiligo, require special stains (i.e., a melanocytic marker).
Figure 5(A) Argyria
There are fine black granules in the basement membrane of hair follicles and eccrine glands
Black granules are also deposited on elastotic fibers, so‐called “pseudo‐ochronosis”
Source: Case courtesy of James E. Fitzpatrick, MD.
Figure 5(B) Ichthyosis vulgaris
This example from an older patient has solar elastosis in the dermis
There is hyperkeratosis above an attenuated granular layer
Source: Case courtesy of Jeff D. Harvell, MD.
Figure 5(C) Tinea versicolor
Yeast and hyphal forms in the stratum corneum
Figure 5(D) Urticaria
Urticaria can appear “normal” at low power, particularly when inflammation is sparse
There are perivascular and interstitial lymphocytes and eosinophils
Table 2 Some entities to consider for a gestalt impression of “normal” skin.
| “Normal” skin | Look for |
|---|---|
| Argyria | Flecks of black material around eccrine glands; elastic fibers may be discolored (Figure 5A) |
| Ichthyosis vulgaris | Hyperkeratosis above hypogranulosis or absent granular layer (Figure 5B) |
| Macular amyloidosis | Amorphous, smooth pink globules in the papillary dermis Pigment incontinence |
| Scleredema | “Square”/rectangular biopsy shape Increased space +/‐ mucin between collagen bundles |
| Tinea versicolor | Spores and pseudohyphae in the stratum corneum (Figure 5C) |
| Urticaria | Mixed inflammation (interstitial and perivascular) (Figure 5D) |
Конец ознакомительного фрагмента.
Текст предоставлен ООО «ЛитРес».
Прочитайте эту книгу целиком, купив полную легальную версию на ЛитРес.
Безопасно оплатить книгу можно банковской картой Visa, MasterCard, Maestro,
