Histopathological reporting of biopsies taken for the diagnosis of Inflammatory Skin Disease
The term 'Inflammatory skin
disease' is used to described all non-neoplastic
-A detailed clinical history should be obtained from the clinician which should include age, patient, sex, personal and family history of skin disease, drug history, allergies, type and distribution of rash.
-Biopsy should be taken from the edge of the lesion. The specimen should include normal tissue and should be deep enough to include subcutaneous adipose tissue.
(Gross examination of the skin specimen)
- Decide on the major patterns of involvement .
The inflammatory skin disease is classified according to the type of tissue reaction and nature and distribution of the inflammatory infiltrate.
Types of Tissue Reaction:
When biopsy looks relatively normal:
-Levels are performed as pathological features may be present in deeper level.
-Special stains may be required in case of certain "invisible dermatosis".
Bullous lesions require immunofluorescence for confirmation of diagnosis.
Immunofluorescence plays an important role in the investigation of inflammatory skin disease specially in vesiculo-bullous disorders.
Pathology Report should comment on
the following features:
- Hyperkeratosis ;
- Parakeratosis ;
- Hypergranulosis ;
- Spongiosis and spongiotic vesicles ;
- Acantholysis ;
- Papillomatosis ;
- Acanthosis (irregular, saw-tooth or psoriasiform) ;
- Atrophy ;
- Intraepidermal bulla ;
- Inflammatory cellular infiltrate ;
- Presence of viral inclusion ;
- Civatte body ;
- Erosions and ulceration.
II Dermoepidermal junction
Subepidermal bulla formation:
- With eosinophils , neutrophils or little or no inflammatory infiltrate ;
- Vacuolar degeneration;
- An inflammatory infiltrate (band-like, patchy, plasma cells) ;
- Basement membrane thickening.
Change in collagen pattern:
- Presence of edema fluid ;
- Edema fluid and eosinophils ;
- Edema fluid and mast cells ;
- Thickening of bundles ;
- Dense superficial bands of collagen;
- Thickening and obliteration of fibres ;
- Deep extension and entrapment of sweat glands and subcutaneous adipose tissue;
- Hyalinization with swirling pattern ;
- Deposition of mucin ;
- Presence of flame figures ;
- Destruction of collagen.
- Neutrophilic ;
- Mast cells ;
- Lymphocytic ;
- Lymphoplasmacytic ;
- Follicular ;
- Granulomatous ;
- Band-like ;
- V-shaped ;
- Perivascular inflammation (superficial or superficial and deep) ;
- Neutrophils around hair follicles ;
- Mononuclear inflammatory infiltrate around nerves.
Arterial ; arteriolar ; capillary ; venous
Abnormalities of hair follicle:
Microbes: Special stains are often used to demonstrate organisms.
IV Subcutis :
Septal Panniculitis or Lobular Panniculitis
- Presence of calcification
- Extension of reticular dermis .
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