Ch13Papillary Dermis

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F1Ch13 (112942): The epidermis is hyperplastic; there is hyperplasia of the superficial with hypergranulosis. Rete patterns are mostly effaced. There are vacuolar changes at the dermal-epidermal interface. To the right of the center of the field, there are areas showing reduplication of the basement membrane. Just to the left of the center of the field, distinctive collagen bundles are arranged as vertically oriented lamella; they extend to the dermal-epidermal interface. A “normal” papillary dermis is not a feature. The upper portion of the dermis shows some degree of fibrosis. Near the bottom of the field, collagen bundles are more loosely aggregated. Some of the vessels in the deeper portion of the field have perivascular, pale, hyaline deposits.

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F2Ch13 (112942): In the areas identified by red arrows, vertically oriented fibers extend to the basement membrane zone; epidermal hyperplasia is prominent in this area. A basal unit of the epidermis is better developed in this area than in the epidermis to the right or left. Blue arrows identify a collection of “duplicated” basement material.To the left of the center of the field, the epidermis shows liquefaction degeneration; vacuoles are present on both sides of the basement membrane. A pattern of interwoven coarse collagen bundles extend to the dermal- epidermal interface; there is no evidence of a normal papillary dermis. The vertically oriented fibers may represent altered basement membrane material; there are scattered loops in this collection of fibers.

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F3Ch13 (112942): Mononuclear cells are sequested among the vertically oriented fibers. There are melanin deposits in the dermis. Some of the pigment is intracytoplasmic; the pigmented cells have the features of melanophages. Some of the larger cells in the dermal component could be melanocytes.

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F4Ch13 (112942): This is a portion of the field seen in F1 (i.e., area identified with blue arrows).To the right, the acidophilic fibers near the dermal-epidermal interface have basement membrane qualities. Yellow arrows identify basement membrane material in more usual patterns; there are vacuolar changes, particularly on the dermal side. To the left of the center of the field, some of the basal cells show basal cytoplasmic acidophilia. There are scattered small, basal dendritic cells (melanocytes?). To the left, some of the keratinocytes show perinuclear vacuoles.

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F5Ch13 (112942): The superficial unit of the epidermis is hyperplastic. A basal unit is poorly developed and spottily represented. A basement membrane is better developed on the left than on the right. Two basement membrane loops, each containing a dendritic cell, are represented at the dermal-epidermal interface (yellow arrows). Beneath the loop on the left, a yellow arrow identifies a dendritic cell in a lacuna. The three cells could represent melanocytes that have “dropped” into the dermis.

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F6Ch13 (112942): The changes at the dermal-epidermal interface have the qualities of a cell-poor lichenoid reaction. Scattered cells in the neighboring dermis have “lacunar” qualities (yellow arrows); it would be of interest to examine the cells for melanocytic markers. Two cells in a clear space are identified with yellow arrows on the left. One of these cells shows melanin in its cytoplasm, but the possibility that this is a melanophage cannot be ruled out. Just beneath the dermal-epidermal interface at the margin of the field on the left, a membranous loop encloses a cell that is cytologically similar to the cells in the dermis that are identified by yellow arrows.

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F6Ch13 (112942): There is variation in basement membrane patterns. To the right, there is a epidermal bulge in the pattern of an attentuated rete ridge. At the extremity of this bulge (on the dermal side), basement membrane material is duplicated; each lamina is coarsened and hypereosinophilic. Many of the basal keratinocytes show basal cytoplasmic acidophilia. There are scattered vacuoles along the dermal-epidermal interface. A vertically oriented column of red arrows indentify reduplicated lamina of basement membrane type. The single red arrow to the left identifies a basement membrane loop. This loop confines a single cell with faintly pigmented cytoplasm; the nucleus has a triangular outline. These features suggest that the cell is a melanocyte that has been caught in the act of “dropping off.” Blue point to dyskeratotic basal cells. There is no evidence of a normal papillary dermis.

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