S6C8P2-Pemphigus Vulgaris

S6c8P2-1: The epidermis shows mild hyperkeratosis in “basket-weave” patterns. There is suprabasilar acantholysis with scattered clusters of loosely aggregated keratinocytes in the defect. The lesion is relatively free of inflammation. The superficial unit of the epidermis is hyperplastic (pemphigus vulgaris).

S6C8P2-2: The roof of the bulla has been partially denuded on the left. To the right, the epidermis is hyperplastic in psoriasiform patterns. In the transition zone from right to left, the defects are first evident in an intermediate location between the basal and superficial units of the epidermis. The superficial unit is hyperplastic. There are mild perivascular infiltrates of lymphocytes in the dermis (pemphigus vulgaris).

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S6C8P2-3: Basal keratinocytes, forming the floor of the suprabasilar defect, are elongated; it is as if they were stretched along their long axis before they lost inter-cellular attachments. The basal cells are thin and elongated. Cells in the defect are not attached to their neighbors; they show condensed acidophilic cytoplasm (dyskeratosis) and dense nuclear chromatin. The pale acidophilic droplets in the defect are interpreted as fragments of cytoplasm. The superficial unit, exclusive of cells bordering the defect, shows preservation of basic inter-cellular attachments; inter-cellular bridges are preserved above the defect. Some of the cells, immediately bordering the defect, show perinuclear vacuoles; a peripheral zone of cytoplasm is condensed and acidophilic (dyskeratosis). Acantholytic, dyskeratotic cells in the defect tend to be rounded in outline (pemphigus vulgaris).

S6C8P2-4: The acantholytic cells in the defect show distinctive cytologic features, including: rounded outlines; condensed cytoplasm; rounded, enlarged nuclei; open chromatin patterns; and a prominent central nucleolus. To the left of the center of the field, a dermal papilla, covered by a single row of basal keratinocytes, projects into the defect; it is cut in cross section. Along the surface of the epidemis, the patterns have an acantholytic quality; the patterns are both supra-basilar and superficial (pemphigus).

S6C8P2-5: The papillary dermis is edematous. Edematous dermal papillae, that are covered by a single layer of basal keratinocytes, project into the defect in the epidermis. Migratory histiocytes are loosely spaced in the edematous papillary dermis.

S6C8P2-6: On the right, the suprabasilar, acantholytic process extends along a follicle.

S6C8P2-7:  The follicular acantholysis involves the infundibular portion of the follicle and extends into the bulges (in this example, the bulges probably are protrusions with the potential to develop into sebaceous glands, if the resting bulb were to be activated). Inflammation is not a feature.

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