Vascular tumors
Eckart Haneke in Histopathology of the NailOnychopathology, 2017
There is usually marked hyperkeratosis and thinning of the epidermis over the lesion itself with elongated rete pegs at the margin of the lesion. A well-circumscribed, dense lymphocytic infiltrate is present around dilated vessels that extends from the papillary dermis down to the subcutaneous tissue. The epidermis is not invaded. Immunohistochemistry shows an equal amount of mature T and B lymphocytes,79 an argument for pseudolymphoma.76 CD8+ suppressor cells are more numerous than CD4+ helper cells.80 One study also found abundant CD20 positive B lymphocytes.81 Cutaneous lymphocyte antigen was demonstrated in the high venule endothelial cells, which might be the reason for the self-perpetuation of the lymphoid proliferation.82
Skin Flap Physiology
John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie in Basic Sciences Endocrine Surgery Rhinology, 2018
The superficial layer of dermis has a waveform pattern in proximity to the rete pegs, which is known as the papillary layer. The deeper counterpart is known as the reticular dermis. The papillary dermis has an enriched capillary network that is 10–20 microns in diameter. Deeper to it, there are several arteriovenous shunts (diameter of 10–30 microns), most notable in the reticular dermis. The capillary plexus provides nutritional support to the epidermis, whereas the arteriovenous shunt contributes to the thermoregulation and systemic blood pressure of the body. They are both connected with the deep subdermal plexus. Under normal skin conditions blood flow though the skin amounts to approximately 9 mL/min per 100g of tissue, 10 times above the rate fulfilling the skin’s metabolic needs. In extremely hot climates blood flow can increase up to 20 times with maximal vasodilation. In contrast, when the body is exposed to cold, blood flow can reduce to levels that are marginal for skin nutrition.17
Which women develop vulvar cancer?
Miranda A. Farage, Howard I. Maibach in The Vulva, 2017
Although there is an appeal to use similar terminology when describing neoplastic and pre-invasive lesions of the lower genital tract (cervix, vagina, and vulva), it is increasingly evident that VIN is not the same as CIN. The depth of cell maturation and differentiation from the cervical basement membrane and extending through the extent of the epithelium lends itself to divisions of CIN 1, CIN 2, and CIN 3, or the more recent Bethesda classification of low-grade and high-grade squamous intraepithelial lesions. However, the vulva is skin, or epidermis, often with variations in the thicknesses and undulations of the layers, especially the strata spinosum and corneum (prickle cell and cornified layers). The shape and length of the rete pegs or ridges, especially with different pathologies, show considerable variation. Therefore, attempts to define the basal third or half of this skin, as for VIN 1, becomes inconsistent. Secondly, in the cervix, CIN 1 occurs more frequently than higher-grade intraepithelial neoplasia, and over time may progress from CIN 1 to CIN 3. However, VIN 1 is uncommon compared with VIN 3, and there is little evidence of a continuous spectrum of neoplastic progression from VIN 1 to VIN 3; in fact, what we have previously called VIN 1 may have no neoplastic potential and may represent alterations in the prickle cells from infection with low-oncogenic HPV types or in response to scratching.
Lichen sclerosus associated with Nd:YAG laser therapy
Published in Journal of Cosmetic and Laser Therapy, 2019
Seher Bostanci, Bengu Nisa Akay, Pelin Ertop, Seçil Vural, Aylin Okcu Heper
A 43-years-old woman with color change in genital area was admitted to our clinic. Medical history revealed type II diabetes mellitus (DM) and Hashimoto thyroiditis. The patient had six sessions of whole body laser assisted hair removal with long pulsed 1064 nm Nd:YAG laser in last 2 years. Lesions had developed 2 weeks after the last session. Dermatological examination revealed perifollicular atrophic depigmented macules on perineum and mons pubis. Figure 1a The shape, size, and location of the lesions correlated with the width of laser probe and treatment area. Patient was Fitzpatrick phototype IV. White clods on multiple white structureless areas and perifollicular hypopigmentation were observed on dermatoscopic examination. Figure 1b Histopathological examination of incisional biopsy specimens from mons pubis revealed acanthosis, hyperkeratosis, and loss of rete pegs in epidermis. In upper dermis there was hyalinized zone with increased connective tissue. Mononuclear cell infiltration dispread from upper dermis to middle dermis was observed. Figure 1c With these findings patient was diagnosed with LS. Borrelia burgdorferi antibodies were negative. Antinuclear antibody and nuclear antibody immunoblot tests were also negative. Treatment choice for this patient was tacrolimus monohydrate 0.1 ointment twice daily for 3 months and mometasone furoate cream usp 0.1 once daily for 1 month; 90% clinical response was achieved with this treatment.
Punctal pseudoepitheliomatous hyperplasia mimicking a mass lesion
Published in Orbit, 2021
Nandini Bothra, Mohammad Javed Ali
A 46-year-old lady presented to us with a growth on the right upper eyelid (Figure 1, Panel A), which was gradual, progressive and painless over the last 6 months and associated with a foreign body sensation. On examination, there was an elevated pinkish lesion with surface vessels in the punctal area, measuring about 2 × 3 mm, engulfing the punctal opening (medial to *, Panel B). The differential diagnosis at this stage was either a punctal granuloma or papilloma. The punctal opening could be clinically still negotiable (Panel C). Anterior segment optical coherence tomography (AS-OCT) showed the punctal opening and the vertical canaliculus on the surface of the lesion (arrow, Panel D). Dacryoendoscopy did not show any extension of the lesion into the proximal canaliculus (Panel E). The lesion was confined to the punctal area of the upper punctum of the right eye. While placing a Bowman’s lacrimal probe in the upper lacrimal passage (Panel C), excision biopsy of the mass lesion was taken. Placement of a lacrimal stent was avoided based on our differential diagnosis. Histopathology revealed hyperplastic stratified squamous epithelium with saw-tooth like rete pegs. Underlying stroma showed proliferating blood vessels and few chronic inflammatory cells, thus, giving the diagnosis of PEH with mild reactive atypia (Panel F).
Lichen sclerosus of the oral mucosa: clinical and histopathological findings. Review of the literature and a case report
Published in Acta Odontologica Scandinavica, 2018
Anna-Maija Matela, Jaana Hagström, Hellevi Ruokonen
Discoid lupus erythematosus consists of usually atrophic, round lesions with white keratotic striae. Ulcerations are common and erythematous areas are usually seen. Histopathologically, the same features exist in oral LS such as hyperkeratosis, atrophy of rete pegs, liquefaction degeneration of basal cells, lamina propria oedema and deep diffuse inflammatory infiltration. Direct immunofluorescence is positive and IgA, IgG, IgM and complement components are found at the basement membrane [39].
Related Knowledge Centers
- Epidermis
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