Pathology
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Atlas of dermatopathology
Josef Feit, Hana Jedličková, Günter Burg, Luděk Matyska, Spasoje Radovanovic et al.
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Contents
Authors
ExpSys: non-tumors
ExpSys: tumors
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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
Lupus erythematosus (SLE, CDE a SCLE); (immunofluorescence)
Introduction

Specimen taken from sun exposed areas are positive in 90% of cases. Lupus band with IgG (and c3, IgM, IgA and fibrin too) in the area of dermoepidermal junction is crucial for the diagnosis. The band can be homogenous, granular or even fibrillar. Similar positivity is found around adnexal basement membrane as well (sweat glands, follicles). In florid SLE is the lupus band present in clinically normal skin.

Rarely the deposits of anti-Ro (SSA) and anti-La (SSB) antibodies can be demonstrated as fine granules among the cells of the basal layer. Such positivity is found in the subacuet LE, systemic LE and Sjögren's syndrome.

Pictures

Lupus erythematodes, lupus band: LE, lupus band, FITC (16)

Lupus erythematodes, lupus band around sweat glands: LE, lupus band, sweat glands, FITC (17)

Lupus erythematodes, lupus band in uninvolved skin: Lupus band, unaffected skin, FITC (18)

Lupus erythematodes, lupus band: Discoid lupus erythematodes chronic, anti-IgG, FITC 20x (4021) Discoid lupus erythematodes chronic, anti-IgG, FITC 20x (4022) Discoid lupus erythematodes chronic, anti-IgG, FITC 20x (4023)

In addition to the lupus band the aggregates, oval formations in subepidermal and periadnexal areas are being found. Rarely (in cases with basement membrane destruction in CDE and lichen ruber) such aggregates are intraepidermally located. Usually show IgM positivity, but sometimes react with IgG and c3 as well.

In cases of CDE there is usually fluorescence of the connective tissue in the upper corium. This sign alone is not a diagnostic sign, however.

Pictures

Lupus erythematodes, IF aggregates: LE, aggregates, FITC (19)

Lupus band is formed by immune complex aggreages and can be sometimes found in other diseases as well, especially in diseases affecting the face, which are accompanied by angiectasias (rosacea, scleroderma or even tinea faciei).

In addition, in systemic lupus erythematodes cytoplasmatic fluorescence of some keratinocytes is sometimes present.

Pictures

Lupus erythematodes, positive cytoplasm of keratinocytes: LE, keratinocytes, FITC (20)

Lupus erythematodes, subacute, fluorescence positivity anti-Ro: Lupus erythematodes subacute, anti-IgG, FITC, Evans 40x (630) Lupus erythematodes subacute, anti-IgG, FITC, Evans 100x (629) Lupus erythematodes subacute, anti-IgG, FITC, Evans 40x (632) Lupus erythematodes subacute, anti-IgG, FITC, Evans 100x (631)