Pathology
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Atlas of dermatopathology
Josef Feit, Hana Jedličková, Günter Burg, Luděk Matyska, Spasoje Radovanovic et al.
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+ Introduction
+ Literature
+ Support
+ Skin biopsy
+ Non-tumorous skin diseases
+ Skin tumors
+ Cysts of the skin and subcutis
+ Soft tissue lesions
+ Some lesions of the oral cavity
+ Dermatovenerology
+ Collection of histological slides by prof. Günter Burg
+ Collection of histological slides by prof. Werner Kempf
+ Collection of histological slides of dr. Ram Chandra Adhikari
Antibodies aganist neutrophilic cytoplasm (ANCA)
Introduction

Standardized spreads of neutrophils, fixed by alcohol or formaldehyde, are most common sources of antigens. This method is sometimes less sensitive.

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Homogenous ANA type, rat liver imprints: Homogenous ANA, rat liver, indirect IF (26)

Homogenous type fo fluorescecne on the substrate of cell culture HEp-2.

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Homogenous (+ peripheral) type ANA, cell culture HEp-2: Homogenous ANA, cell culture, indirect IF (27)

Peripheral type ANA: ANA, peripheral type, indirect IF (28)

Test with the substrate from Crithidium luciliae. This protozas have their flagella attached to the kinetoplast containing native dsDNA. Positive test therefore indicates presence of anti-dsDNA antibodies. This test is highly specific but less sensitive.

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Coarse speckled immunofluorescence indicates antibodies against U1-snRNP antigene (typical of Sharp's syndrome) or against Sm proteins (indicates systemic lupus erythematodes). Similar is large speckled type (antibodies against ribonuclear proteins of nuclear matrix), positive in some cases of Sharp's syndrome and other rheumatic diseases. Fine speckled positivity is found eg. in presence of anti Ro (SS-A) and La (SS-B).

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Nucleolar type of fluorescence of the serum, systemic scleroderma. Further subtypes of nucleolar fluorescence are associated with systemic scleroderma.

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Systemic scleroderma, nucleolar type, indirect immunofluorescence: Systemic scleroderma, nucleolar type, indirect IF (31)

Antibodies against centromeres are characteristic for about 60% cases of CREST syndrome.

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CREST syndrom, antibodies against centromeres: CREST syndrome, anti-centromere antibodies, indirect IF (32)

Few nuclear dots type antibodies appear as about 6 discrete dots in one nucleus. These antibodies are present in primary biliary cirrhosis and chronic active hepatitis. The antigen (p80-coilin) belongs to the group of small nuclear ribonucleoproteins and is associated with fibrillarin. Its function is unknown. Similar is multiple nuclear dots fluorescence (about 10 dots/nucleus), associated with Sjögren's syndrome, less common systemic lupus erythematosus and primary biliary cirrhosis.

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ANA antibodies, few nuclear dots type: Few nuclear dots ANA antibodies, indirect IF (33)

Antimitochondrial antibodies are characteristic of primary biliary cirrhosis; sometimes is present in people with systemic scleroderma or mixed cases. This antibodies are detected using HEp-2 or rat tissues (liver, kidney, stomach).

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Antimitochondrial antibodies (AMA): Antimitochondrial antibodies (AMA), indirect IF (34)

Detection of surface antigens of keratinocytes is less sensitive than direct immunofluorescence, nevertheless positive in about 90% of developed cases of pemphigus vulgaris. Antibodies are of IgG4 and IgG1 types. Net-like deposits are characteristic of antidesmosomal antibodies (desmoglein I. in pemphigus vulgaris and desmoglein III. in pemphigus foliaceus).

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Bullous pemphigoid is characterized by antibodies against the basement membrane zone. Main antigens were characterized by immunoblotting as BP 230 and BP 180 (herpes gestationis BP 180). Correlation with the disease activity is less tight. In cicatrical pemphigoid (antibodies against laminin) indirect immunofluorescence usually fails.

Antibodies (IgA) against the endomysium are characteristic of dermatitis herpetiformis Duhring and celiac sprue.

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Antibodies against endomysium: Antiendomysial antibodies, indirect IF (39)

Antibodies against cytoplasmic antigens of neutrophils (ANCA) are important in diagnosing vasculitides and monitoring on activity of some vasculitides. In C-ANCA type granular and homogenous positivity of cytoplasm with minimal fluorescence of nuclear lobes is present. Antigene is proteinase 3. Positivity is found in Wegener's granulomatosis, Churg Strauss sydrome and microscopic polyarteritis.

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C-ANCA antibodies against cytoplasmic antigens of neutrophils: C-ANCA antibodies against cytoplasmatic antigenes of neutrophils, indirect IF (40)

P-ANCA type is characterized by fluorescence of the borders of nuclear lobes. Positivity is found in polyarteritis nodosa, ulcerous colitis, sclerotising cholangitis, Crohn's disease, some forms of uveitis, microscopic polyarteritis, systemic lupus erythematodes and rheumatoid arthritis. The antigen is myeloperoxidase.

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