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Sanchez I, Ibraheim MK, Lee BA, Kraus CN, Elsensohn A. Eosinophils in Traditionally Noneosinophil-Rich Dermatoses. Am J Dermatopathol 2023; 45:820-821. [PMID: 37883982 DOI: 10.1097/dad.0000000000002550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
ABSTRACT The presence or absence of tissue eosinophilia has previously aided in the diagnosis of inflammatory skin conditions. However, recent studies have elucidated the presence of eosinophils in traditionally eosinophil-poor inflammatory skin diseases, such as dermatomyositis (DM), psoriasis, and lichen sclerosus (LS). This systematic review of the literature explores previous studies of tissue eosinophilia in skin biopsies of dermatoses that are believed to be classically poor in eosinophil. We identified 26 studies, the majority of which were retrospective reviews. The percent of specimens with increased eosinophils in psoriasis ranged from 18%-73%, pityriasis rubra pilaris (PRP) 22%-63%, LS 29%-53%, DM 15%-44%, morphea 8%-45%, hypertrophic lichen planus (LP) 0%-21%, and oral LP 0%-4%. These reports of tissue eosinophilia in reputed eosinophil-poor dermatologic conditions present a diagnostic pitfall and suggest that tissue eosinophilia itself should not be used to rule out a diagnosis of one of these conditions.
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Affiliation(s)
- Isabella Sanchez
- Department of Dermatology, University of California Irvine, Irvine, CA
| | - Marina K Ibraheim
- Department of Dermatology, Loma Linda University Health, Loma Linda, CA; and
| | - Bonnie A Lee
- Department of Dermatology, University of California Irvine, Irvine, CA
| | - Christina N Kraus
- Department of Dermatology, University of California Irvine, Irvine, CA
| | - Ashley Elsensohn
- Department of Dermatology, Loma Linda University Health, Loma Linda, CA; and
- Department of Pathology, Loma Linda University Health, Loma Linda, CA
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Caro-Chang LA, Fung MA. The role of eosinophils in the differential diagnosis of inflammatory skin diseases. Hum Pathol 2023; 140:101-128. [PMID: 37003367 DOI: 10.1016/j.humpath.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
Eosinophils are known to be present in inflammatory skin diseases, but their diagnostic utility is not well established. Upon review of the published status of lesional eosinophils, several categories were identified. 1) Lesional eosinophils highly characteristic such that, in their absence, the pathologist may question the diagnosis. These include arthropod bite reactions and scabies, urticarial dermatitis, and other eosinophilic dermatoses. 2) Lesional eosinophils rare or absent, such that, in their presence, the pathologist may question the diagnosis. These include pityriasis lichenoides, graft versus host disease, and connective tissue disorders. 3) Lesional eosinophils variable and, while in some cases expected, are not required for diagnosis. These include drug reactions, atopic dermatitis and allergic contact dermatitis. 4) Lesional eosinophils variable and not expected but may be seen to a limited extent. These include lichen planus and psoriasis.
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Saknite I, Gill M, Alessi-Fox C, Zwerner JP, Lehman JS, Shinohara MM, Novoa RA, Chen H, Byrne M, Gonzalez S, Ardigo M, Tkaczyk ER. In Vivo Reflectance Confocal Microscopy of Cutaneous Acute Graft-Versus-Host Disease: Concordance with Histopathology and Interobserver Reproducibility of a Glossary with Representative Images. J Eur Acad Dermatol Venereol 2022; 36:1034-1044. [PMID: 35175678 DOI: 10.1111/jdv.18004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The reliability to noninvasively identify features of inflammatory dermatoses by reflectance confocal microscopy (RCM) remains unknown. Lack of formal training among RCM readers can result in inconsistent assessments, limiting clinical utility. Specific consensus terminology with representative images is necessary to ensure consistent feature-level interpretation among RCM readers. OBJECTIVES (1) Develop a glossary with representative images of RCM features of cutaneous acute graft-versus-host disease (aGVHD) for consistent interpretation among observers, (2) assess the interobserver reproducibility among RCM readers using the glossary, and (3) determine the concordance between RCM and histopathology for aGVHD features. METHODS Through an iterative process of refinement and discussion among five international RCM experts, we developed a glossary with representative images of RCM features of aGVHD. From April to November 2018, patients suspected of aGVHD were imaged with RCM and subsequently biopsied. 17 lesions from 12 patients had clinically and pathologically confirmed cutaneous aGVHD. For each of these lesions, four dermatopathologists and four RCM readers independently evaluated the presence of aGVHD features in scanned histopathology slides and 1.5x1.5 mm RCM submosaics at 4 depths (blockstacks), respectively. RCM cases were adjudicated by a fifth RCM expert. Interobserver reproducibility was calculated by U statistic. Concordance between modalities was determined by fraction agreement. RESULTS We present a glossary with representative images of 18 aGVHD features by RCM. The average interobserver reproducibility among RCM readers (75%, confidence interval, CI: 71%-79%) did not differ significantly from dermatopathologists (80%, 76%-85%). The concordance between RCM and histopathology was 59%. CONCLUSIONS By using the glossary, the interobserver reproducibility among RCM readers was similar to the interobserver reproducibility among dermatopathologists. There was good concordance between RCM and histopathology to visualize aGVHD features. The implementation of RCM can now be advanced in a variety of inflammatory conditions with a validated glossary and representative image set.
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Affiliation(s)
- I Saknite
- Department of Dermatology, Vanderbilt University Medical Center, 719 Thompson Lane, One Hundred Oaks Suite 26300, Nashville, TN, 37204, USA.,Biophotonics Laboratory, Institute of Atomic Physics and Spectroscopy, University of Latvia, Jelgava Str 3 - #605, Riga, LV1004, Latvia
| | - M Gill
- SkinMedical Research and Diagnostics, PLLC, 64 Southlawn Ave, Dobbs Ferry, NY, 10522, USA.,Department of Pathology, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA.,Medicine and Medical Specialties Department, Alcalá University, 28871, Alcalá de Henares, Madrid, Spain
| | - C Alessi-Fox
- Clinical Development, Caliber Imaging and Diagnostics Inc, 50 Methodist Hill Drive, Suite 1000, Rochester, NY, 14623, USA
| | - J P Zwerner
- Department of Dermatology, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - J S Lehman
- Division of Dermatology, Department of Medicine, Department of Laboratory Medicine and Pathology, University of Washington, Box 356524, Seattle, WA, 98195, USA
| | - M M Shinohara
- Department of Dermatology, Department of Pathology, Stanford University, 300 Pasteur Dr Rm H1507, MC 5627, Stanford, CA, 94305, USA
| | - R A Novoa
- Department of Biostatistics, Vanderbilt University Medical Center, 1301 Medical Center Dr Suite 3903, Nashville, TN, 37232, USA
| | - H Chen
- Department of Biostatistics, Vanderbilt University Medical Center, 1301 Medical Center Dr Suite 3903, Nashville, TN, 37232, USA.,Vanderbilt-Ingram Cancer Center, 1301 Medical Center Dr #1710, Nashville, TN, 37232, USA
| | - M Byrne
- Vanderbilt-Ingram Cancer Center, 1301 Medical Center Dr #1710, Nashville, TN, 37232, USA
| | - S Gonzalez
- Medicine and Medical Specialties Department, Alcalá University, 28871, Alcalá de Henares, Madrid, Spain
| | - M Ardigo
- San Gallicano Dermatological Institute - IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - E R Tkaczyk
- Department of Dermatology, Vanderbilt University Medical Center, 719 Thompson Lane, One Hundred Oaks Suite 26300, Nashville, TN, 37204, USA.,Vanderbilt-Ingram Cancer Center, 1301 Medical Center Dr #1710, Nashville, TN, 37232, USA.,Dermatology Service and Research Service, Tennessee Valley Healthcare System, Department of Veterans Affairs, 1310 24th Avenue South, Nashville, TN, 37212, USA
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Russell AJ, Musiek AC, Staser KW, Rosman IS. Histopathologic and immunophenotypic features of cutaneous solid organ transplant-associated graft-vs-host disease: Comparison with acute hematopoietic cell transplant-associated graft-vs-host disease and cutaneous drug eruption. J Cutan Pathol 2021; 48:1480-1488. [PMID: 34173980 DOI: 10.1111/cup.14093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although it is relatively common after hematopoietic cell transplant (HCT), graft-vs-host disease (GVHD) is a rare complication following solid organ transplantation (SOT). METHODS This study evaluated skin biopsy specimens from five cases of SOT GVHD, 15 cases of HCT GVHD, and 15 cases of cutaneous drug eruption. Immunohistochemical staining for CD3, CD4, CD8, T-bet, and GATA-3 was performed to examine the density and immune phenotype of skin-infiltrating lymphocytes. RESULTS Similar to HCT GVHD, the predominant histopathologic findings in skin biopsy specimens of SOT GVHD were widespread vacuolar interface dermatitis with scattered necrotic keratinocytes. However, the density of dermal inflammation was considerably higher in SOT GVHD. Features that were more predictive of a cutaneous drug eruption over GVHD included spongiosis, confluent parakeratosis, and many eosinophils. Involvement of the hair follicle epithelium was seen in all three disorders. Both forms of cutaneous GVHD showed a predominance of Th1 (CD3+/T-bet+) lymphocytes within the inflammatory infiltrates. This shift was more pronounced in SOT GVHD, particularly among intraepidermal T-cells. CONCLUSIONS SOT GVHD shares many histopathologic features with HCT GVHD. However, SOT GVHD has a greater tendency to develop brisk lichenoid inflammation.
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Affiliation(s)
- Aaron J Russell
- Department of Medicine, Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri, USA.,Departments of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Amy C Musiek
- Department of Medicine, Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Ilana S Rosman
- Department of Medicine, Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri, USA.,Departments of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
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Shalin SC, Racher LM, Campbell KK. Lichenoid dermatoses involving the vulva: A clinical-pathologic correlation ✰. Semin Diagn Pathol 2020; 38:3-18. [PMID: 32951943 DOI: 10.1053/j.semdp.2020.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 01/06/2023]
Abstract
The lichenoid tissue reaction pattern generally signifies cytotoxic damage to the epithelium. When such reaction pattern occurs on vulvar skin or mucosa, the effects can result in considerable morbidity. None of the entities discussed in this review are entirely unique to the vulva, however, some entities may classically occur at this site, while others tend to be widespread diseases that may incidentally affect vulvar skin and mucosa. Given the complex anatomy of the vulva and the bridging of a site showing both keratinizing squamous epithelium and non-keratinizing squamous mucosa, histopathologic features may display variation in presentation. Although identification of a "lichenoid reaction pattern" alone may provide insight into the disease process, understanding of clinical presentation and specific sites of involvement, along with recognition of the nuanced features of the disease entities can help establish a specific diagnosis. Accurate histopathologic diagnoses by pathologists can improve the ability for treating clinicians to implement timely and effective treatment.
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Affiliation(s)
- Sara C Shalin
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Luann M Racher
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Katelynn K Campbell
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR
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6
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Quantitative Assessment of Eosinophils in Dermatomyositis Skin Biopsies With Correlation of Eosinophils to Pruritus and Other Clinical Features. Am J Dermatopathol 2020; 43:287-290. [PMID: 32852288 DOI: 10.1097/dad.0000000000001765] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The objective of this retrospective study was to analyze dermatomyositis skin biopsies for the presence of eosinophils and correlate this finding with other histopathologic and clinical characteristics. Cases of dermatomyositis evaluated in a single dermatologist's adult autoimmunity practice over a 2.5-year period were identified via ICD-10 diagnosis code. Dermatopathology archives were then searched for any corresponding biopsies consistent with dermatomyositis, and those identified were assessed for eosinophils, adnexal involvement, epidermal atrophy, dermal mucin, and basement membrane thickening. Histopathologic findings were correlated with key clinical features, including itch. A total of 39 biopsies from 17 patients were included. Eosinophils were noted in 44% of biopsies (n = 17) from 12 patients. Dermal mucin deposition and adnexal interface dermatitis were noted in 72% (n = 28) and 44% (n = 17) of biopsy specimens, respectively. Of 12 patients with eosinophils present in at least 1 biopsy specimen, 11 (92%) patients had a clinical history of pruritus of their skin lesions (P = 0.052). Limitations of this study include retrospective design and small number of patients.
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7
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Pityriasis Lichenoides: A Large Histopathological Case Series With a Focus on Adnexotropism. Am J Dermatopathol 2020; 42:1-10. [PMID: 31880634 DOI: 10.1097/dad.0000000000001448] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Pityriasis lichenoides (PL) is an infrequent skin disorder. The clinical manifestations are usually specific enough for a reliable diagnosis, although the histopathological assessment of a biopsy is sometimes needed to differentiate between PL and a range of other diseases. The objectives of this study were to review cases of PL managed in our hospital, confirm the classical histopathological features of PL, and identify signs that may be of value in the diagnosis of PL. MATERIALS AND METHODS All cases of PL assessed in our pathology department between January 2007 and December 2017 were retrieved, and all slides were reviewed. Cases were selected only if a diagnosis of PL was initially suggested by a dermatologist and then confirmed by the histopathological assessment. RESULTS Seventy-one cases met the study criteria. The following features were almost always present: vacuolar changes or necrotic keratinocytes (100%), both superficial and deep lymphocytic infiltrates (99%), and the infiltration of lymphocytes into the adnexal epithelium (97%). The inflammatory cells were always small- to medium-sized lymphocytes. There were no eosinophilic infiltrates. Superficial perivascular and/or intraepidermal red blood cells were observed in 83% of cases. DISCUSSION We highlighted the presence of a deep dermal lymphocytic infiltrate, with a "T-shaped" periadnexal arrangement along the full length of the follicular and sudoral epithelia. This might be a feature that enables the differentiation of PL from other diseases. Our findings also prompted a number of physiopathological hypotheses for PL. CONCLUSIONS Our present results confirmed the classical histological aspects of PL and provided some useful new diagnostic features.
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Morán-Villaseñor E, Serrano-Pacheco C, Orozco-Covarrubias L, Murata C, Rodríguez-Jurado R, Olaya-Vargas A, Saez-de-Ocariz M. Are apoptosis-determining techniques useful to establish an early diagnosis of acute graft-vs-host disease in pediatric patients under treatment with multiple drugs? J Cutan Pathol 2020; 47:517-523. [PMID: 32031289 DOI: 10.1111/cup.13662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 01/15/2020] [Accepted: 01/19/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are no pathognomonic histopathological features to distinguish acute graft-vs-host disease (aGVHD) from skin drug reactions (SDRs) in pediatric patients with multiple drug regimens that have received blood transfusions and/or transplants. We aimed to determine if the addition of apoptosis markers is helpful to distinguish aGVHD from SDRs in these patients. METHODS Skin biopsy specimens from patients with a clinical diagnosis of aGVHD or SDRs were evaluated for the presence of apoptotic bodies, satellitosis, interface damage, vasculitis, and inflammatory infiltrate on H&E stain. Information was completed with apoptotic markers (transferase-mediated dUTP nick end-labeling [TUNEL], bcl-2, and caspase-3). RESULTS The skin biopsy specimens of 32 patients with aGVHD and 11 with SDRs were included for study. Only the number of apoptotic keratinocytes per 10 high-power fields (hpf) showed a significant difference between both groups (P = 0.02); the presence of ≥4 apoptotic keratinocytes per 10 hpf was identified as the optimal cut-off point to discriminate aGVHD from SDRs. No SDRs cases had follicular apoptotic cells. TUNEL, bcl-2, and caspase-3 determination showed no difference between both groups. CONCLUSIONS The presence of ≥4 apoptotic keratinocytes per 10 hpf (in aGVHD) and the absence of follicular apoptotic cells (in SDRs) might be a useful marker to distinguish between them.
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Affiliation(s)
| | | | | | - Chiharu Murata
- Department of Research Methodology, National Institute of Pediatrics, Mexico City, Mexico
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9
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Deschaine MA, Lehman JS. The interface reaction pattern in the skin: an integrated review of clinical and pathological features. Hum Pathol 2019; 91:86-113. [DOI: 10.1016/j.humpath.2019.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/18/2019] [Accepted: 06/20/2019] [Indexed: 12/14/2022]
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10
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Chojnacki A, Wojcik K, Petri B, Aulakh G, Jacobsen EA, LeSuer WE, Colarusso P, Patel KD. Intravital imaging allows real-time characterization of tissue resident eosinophils. Commun Biol 2019; 2:181. [PMID: 31098414 PMCID: PMC6513871 DOI: 10.1038/s42003-019-0425-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 04/10/2019] [Indexed: 12/22/2022] Open
Abstract
Eosinophils are core components of the immune system, yet tools are lacking to directly observe eosinophils in action in vivo. To better understand the role of tissue resident eosinophils, we used eosinophil-specific CRE (eoCRE) mice to create GFP and tdTomato reporters. We then employed intravital microscopy to examine the dynamic behaviour of eosinophils in the healthy GI tract, mesentery, liver, lymph node, skin and lung. Given the role of eosinophils in allergic airway diseases, we also examined eosinophils in the lung following ovalbumin sensitization and challenge. We were able to monitor and quantify eosinophilic behaviours including patrolling, crawling, clustering, tissue distribution and interactions with other leukocytes. Thus, these reporter mice allow eosinophils to be examined in real-time in living animals, paving the way to further understanding the roles eosinophils play in both health and disease.
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Affiliation(s)
- Andrew Chojnacki
- Department of Physiology and Pharmacology, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Katarzyna Wojcik
- Department of Physiology and Pharmacology, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Björn Petri
- Department of Microbiology, Immunology and Infectious Diseases, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Gurpreet Aulakh
- Department of Physiology and Pharmacology, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK Canada
| | - Elizabeth A. Jacobsen
- Division of Allergy and Clinical Immunology, Mayo Clinic Arizona, Scottsdale, AZ USA
| | - William E. LeSuer
- Division of Allergy and Clinical Immunology, Mayo Clinic Arizona, Scottsdale, AZ USA
| | - Pina Colarusso
- Department of Physiology and Pharmacology, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Kamala D. Patel
- Department of Physiology and Pharmacology, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
- Department of Biochemistry and Molecular Biology, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
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Wolstencroft PW, Rieger KE, Leatham HW, Fiorentino DF. Clinical factors associated with cutaneous histopathologic findings in dermatomyositis. J Cutan Pathol 2019; 46:401-410. [DOI: 10.1111/cup.13442] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 01/23/2019] [Accepted: 01/24/2019] [Indexed: 12/31/2022]
Affiliation(s)
| | - Kerri E. Rieger
- Department of DermatologyStanford University School of Medicine Stanford California
| | - Hayley W. Leatham
- Department of DermatologyStanford University School of Medicine Stanford California
| | - David F. Fiorentino
- Department of DermatologyStanford University School of Medicine Stanford California
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12
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Horizontal and vertical sections of scalp biopsy specimens from dermatomyositis patients with scalp involvement. J Am Acad Dermatol 2018; 78:1178-1184. [DOI: 10.1016/j.jaad.2018.01.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 01/05/2018] [Accepted: 01/17/2018] [Indexed: 11/19/2022]
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13
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Rosa G, Fernandez AP, Schneider S, Billings SD. Eosinophils are rare in biopsy specimens of psoriasis vulgaris. J Cutan Pathol 2017; 44:1027-1032. [DOI: 10.1111/cup.13042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/06/2017] [Accepted: 09/08/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Gabriela Rosa
- Department of Pathology; Cleveland Clinic; Cleveland Ohio
| | - Anthony P. Fernandez
- Department of Pathology; Cleveland Clinic; Cleveland Ohio
- Department of Dermatology; Cleveland Clinic; Cleveland Ohio
| | | | - Steven D. Billings
- Department of Pathology; Cleveland Clinic; Cleveland Ohio
- Department of Dermatology; Cleveland Clinic; Cleveland Ohio
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Abstract
Zoledronic acid (ZA) is a bisphosphonate given intravenously, most commonly for the treatment of postmenopausal osteoporosis. Increase in usage of ZA because it was FDA-approved has resulted in increasing reports of side effects. For the most part, these are systemic. Cutaneous side effects associated with ZA are infrequent and limited to 2 reports of dermatomyositis to date. In both, patients presented with clinical and laboratory stigmata of dermatomyositis soon after initiation of therapy. In this report, we describe a 62-year-old woman who presented with diffuse, erythematous scaly plaques over the right thigh after 12 hours of infusion of ZA. Histopathologic examination of a skin biopsy from the right thigh revealed patchy scale crust containing neutrophils and inspissated serum, interface change with scattered individually necrotic keratinocytes, and a mild, superficial perivascular lymphocytic infiltrate with scattered eosinophils and pigment incontinence—findings consistent with an interface dermatitis. Given that the patient had no other systemic manifestations or laboratory abnormalities, to the best of our knowledge, ours is the first report of interface dermatitis secondary to ZA with the caveat that longer follow-up is required to definitively exclude the development of drug-induced connective tissue disease.
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15
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Histopathologic Distinguishing Features Between Lupus and Lichenoid Keratosis on the Face. Am J Dermatopathol 2016; 37:875-81; quiz 882-4. [PMID: 26588332 PMCID: PMC4894796 DOI: 10.1097/dad.0000000000000298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: The occurrence of lichenoid keratosis (LK) on the face is not well characterized, and the histopathologic distinction between LK and lupus erythematosus (LE) occurring on the face is often indeterminate. The authors aimed to describe differences between LE and LK occurring on the face by hematoxylin and eosin alone. Methods: Cases of LK and LE were obtained using computer-driven queries. Clinical correlation was obtained for each lupus case. Other diagnoses were excluded for the LK cases. Hematoxylin and eosin–stained sections were reviewed. Results: Forty-five cases of LK and 30 cases of LE occurring on the face were identified. Shared features included follicular involvement, epidermal atrophy, pigment incontinence, paucity of eosinophils, and basket-weave orthokeratosis. Major differences between LK and LE, respectively, included perivascular inflammation (11%, 90%), high Civatte bodies (44%, 7%), solar elastosis (84%, 33%), a predominate pattern of cell-poor vacuolar interface dermatitis (7%, 73%), compact follicular plugging (11%, 50%), hemorrhage (22%, 70%), mucin (0%, 77%), hypergranulosis (44%, 17%), and edema (7%, 60%). A predominate pattern of band-like lichenoid interface was seen more commonly in LK as compared with LE (93% vs. 27%). Conclusions: The authors established the occurrence of LK on the face and identified features to help distinguish LK from LE. Follicular involvement, basket-weave orthokeratosis, pigment incontinence, paucity of eosinophils, and epidermal atrophy were not reliable distinguishing features. Perivascular inflammation, cell-poor vacuolar interface, compact follicular plugging, mucin, hemorrhage, and edema favored LE. High Civatte bodies, band-like lichenoid interface, and solar elastosis favored LK.
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16
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Rosa G, Fernandez AP, Vij A, Sood A, Plesec T, Bergfeld WF, Billings SD. Langerhans cell collections, but not eosinophils, are clues to a diagnosis of allergic contact dermatitis in appropriate skin biopsies. J Cutan Pathol 2016; 43:498-504. [DOI: 10.1111/cup.12707] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 01/12/2016] [Accepted: 03/05/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Gabriela Rosa
- Department of Pathology; The Cleveland Clinic; Cleveland OH USA
| | - Anthony P. Fernandez
- Department of Pathology; The Cleveland Clinic; Cleveland OH USA
- Department of Dermatology; The Cleveland Clinic; Cleveland OH USA
| | - Alok Vij
- Department of Dermatology; The Cleveland Clinic; Cleveland OH USA
| | - Apra Sood
- Department of Dermatology; The Cleveland Clinic; Cleveland OH USA
| | - Thomas Plesec
- Department of Pathology; The Cleveland Clinic; Cleveland OH USA
| | - Wilma F. Bergfeld
- Department of Pathology; The Cleveland Clinic; Cleveland OH USA
- Department of Dermatology; The Cleveland Clinic; Cleveland OH USA
| | - Steven D. Billings
- Department of Pathology; The Cleveland Clinic; Cleveland OH USA
- Department of Dermatology; The Cleveland Clinic; Cleveland OH USA
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17
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Vonderheid EC, Kadin ME, Telang GH. Commentary about papular mycosis fungoides, lymphomatoid papulosis and lymphomatoid pityriasis lichenoides: more similarities than differences. J Cutan Pathol 2015; 43:303-12. [PMID: 26566599 DOI: 10.1111/cup.12653] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/04/2015] [Accepted: 10/07/2015] [Indexed: 12/24/2022]
Affiliation(s)
- Eric C Vonderheid
- Sidney Kimmel Cancer Center, Johns Hopkins Medical Institutes, Baltimore, MD, USA
| | - Marshall E Kadin
- Department of Dermatology, Boston University and Roger Williams Medical Center, Providence, RI, USA
| | - Gladys H Telang
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Rosa G, Bennett D, Piliang MP. Eosinophil-rich syphilis: a report of four cases. J Cutan Pathol 2015; 42:554-8. [PMID: 25997023 DOI: 10.1111/cup.12540] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 12/06/2014] [Accepted: 01/11/2015] [Indexed: 11/28/2022]
Abstract
The differential diagnosis for eosinophil-rich skin lesions often includes a drug reaction, allergic contact dermatitis and rarely, response to a helminth infection. However, many unrelated entities, such as infections, neoplasms and inflammatory dermatoses, can have a prominent eosinophilic infiltrate. Syphilis is classically associated with plasma cells, but other patterns of inflammation have been reported, including ulcerative, granulomatous and eosinophil-rich. Classic teaching might indicate that the presence of eosinophils argues against a diagnosis of syphilis. We present four cases of secondary syphilis with increased eosinophils, ranging from 8 to >200 eosinophils per 10 high-power fields (×400 magnification). Patient 1 had lesions on the penis and scrotum, with greater than 200 eosinophils per 10 high-power fields. Patient 2 had lesions on the back, with 150 eosinophils per 10 high-power fields. Patient 3 had lesions on the bilateral arms, with 8 eosinophils per 10 high-power fields. Patient 4 had lesions involving the anus, with 17 eosinophils per 10 high-power fields. These cases highlight that the presence of an eosinophil-rich infiltrate on skin biopsy should not exclude syphilis from the differential diagnosis.
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Affiliation(s)
- Gabriela Rosa
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Dan Bennett
- Department of Dermatology, University of Wisconsin, Madison, WI, USA
| | - Melissa P Piliang
- Sections of the Departments of Dermatology and Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
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Lehman JS, Gibson LE, el-Azhary RA, Chavan RN, Hashmi SK, Lohse CM, Flotte TJ. Acute cutaneous graft-vs.-host disease compared to drug hypersensitivity reaction with vacuolar interface changes: a blinded study of microscopic and immunohistochemical features. J Cutan Pathol 2014; 42:39-45. [DOI: 10.1111/cup.12427] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 06/13/2014] [Accepted: 07/19/2014] [Indexed: 01/09/2023]
Affiliation(s)
- Julia S. Lehman
- Department of Dermatology; Mayo Clinic; Rochester MN USA
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester MN USA
| | - Lawrence E. Gibson
- Department of Dermatology; Mayo Clinic; Rochester MN USA
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester MN USA
| | | | | | | | | | - Thomas J. Flotte
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester MN USA
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Lester EB, Swick BL. Eosinophils in biopsy specimens of lichen sclerosus: a not uncommon finding. J Cutan Pathol 2014; 42:16-21. [PMID: 25404144 DOI: 10.1111/cup.12445] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 04/26/2014] [Accepted: 04/26/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evolving lesions of lichen sclerosus (LS) pose a diagnostic challenge owing to an absence of classic findings of epidermal atrophy, dermal sclerosis, a band-like lymphocytic infiltrate and the presence of eosinophils. METHODS Retrospective specimens of LS were reviewed. Demographic information, biopsy vs. excision and the following histopathological characteristics were noted: presence and number of eosinophils, epidermal hyperplasia, spongiosis, early/transitional LS, well-developed LS and coexisting squamous cell carcinoma (SCC). Linear regression analysis was performed. RESULTS The data consisted of 66 biopsies (36 male [M], 30 female [F]), from 53 individuals (33M, 20F), including 57 genital and 9 extragenital biopsies. Seven biopsies showed SCC, 28 showed epidermal hyperplasia and 14 exhibited spongiosis. Thirty-five specimens were early/transitional LS and commonly exhibited epidermal hyperplasia (57%), epidermotropism of lymphocytes (97%) and basement membrane thickening (97%). Thirty-five biopsies (53%) contained eosinophils (23 early/transitional lesions). Male gender (p = 0.074) was associated with increased eosinophils. The presence of SCC (p = 0.014) was a significant predictors of eosinophil number. CONCLUSIONS Epidermal hyperplasia, epidermotropism of lymphocytes and basement membrane thickening are helpful features in identifying early LS. Eosinophils are not an uncommon finding in LS and are most common in male genital lesions and in LS associated with SCC.
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Alomari A, McNiff JM. The significance of eosinophils in hypertrophic lichen planus. J Cutan Pathol 2014; 41:347-52. [DOI: 10.1111/cup.12275] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 10/16/2013] [Accepted: 10/31/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Ahmed Alomari
- Department of Pathology; Yale University School of Medicine; New Haven CT USA
| | - Jennifer M. McNiff
- Department of Pathology; Yale University School of Medicine; New Haven CT USA
- Department of Dermatology; Yale University School of Medicine; New Haven CT USA
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Interface (Lichenoid) Dermatoses. Dermatopathology (Basel) 2014. [DOI: 10.1007/978-1-4471-5448-8_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Toxic Epidermal Necrolysis and Graft-versus-Host Reaction: Revisiting a Puzzling Similarity. ISRN DERMATOLOGY 2013; 2013:651590. [PMID: 23862070 PMCID: PMC3686138 DOI: 10.1155/2013/651590] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 05/12/2013] [Indexed: 12/14/2022]
Abstract
Drug-induced toxic epidermal necrolysis (TEN) and acute cutaneous graft-versus-host reaction (GVHR) under immunopreventive therapy share some histopathological resemblance. So far, there are no serum biomarkers and no immunohistochemical criteria distinguishing with confidence and specificity the skin lesions of TEN and GVHR. Both diseases present as an inflammatory cell-poor necrotic reaction of the epidermis. This report compares three sets of 15 immunostaining patterns found in TEN, GVHR, and partial thickness thermal burns (PTTB), respectively. Three series of 17 skin biopsies were scrutinized. Irrespective of the distinct causal pathobiology of TEN and GVHR, similar secondary effector cells were recruited in lesional skin. Burns were less enriched in cells of the monocyte-macrophage disease. These cells likely exert deleterious effects in TEN and GVHR and cannot be simply regarded as passive bystanders. These life-threatening conditions are probably nursed, at least in part, by macrophages.
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Abstract
The complex and fascinating spectrum of inflammatory skin disease, and the comprehension of it, is ever expanding and evolving. During the first decade of the 21st century, numerous advances in the understanding of inflammatory disease mechanisms have occurred, particularly in psoriasis and atopic dermatitis. Continuation of this trend will assure a future in which molecular tests for biomarkers of immediate clinical relevance are used in routine patient care, not only for diagnosis but also for prognosis and management. This article focuses on selected recent or noteworthy developments that are clinically relevant for the histologic diagnosis of inflammatory skin diseases.
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Affiliation(s)
- Maxwell A Fung
- UC Davis Dermatopathology Service, Department of Dermatology, University of California Davis School of Medicine, 3301 C Street, Suite 1400, Sacramento, CA 95816, USA.
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