| case number |
sample |
clinical
?/diagnosis |
final path.
diagnosis |
notes |
| LMC-85-? |
skin |
our first case; ER patient with bullae; DX 2 hours after BX. |
BP |
linear BMZ pos. |
| LMC-01-614 |
skin |
TEN |
meds related? |
|
| S01-10098 |
skin |
SPD |
IEN-type IgA pemphigus & possible medication effect |
original 1999 Dx. elsewhere on H&E alone |
| S01-7524 |
skin |
r/o coll. vasc. dis. |
immune leukocytoclastic vasculitis |
only very acute lesions have vascular fibrinogen |
| S01-7511 |
skin |
EBA |
c/w EBA |
|
| S01-5314 |
conjunctiva |
occular pemphigoid |
? linear IgA |
|
| S01-5237 |
skin |
lupus |
MCTD |
|
| S01-4984 |
skin |
drug vs. SLE |
complex overlap SLE, pemphigus, pemphigoid |
IgG gran. BMZ, linear BMZ & intercellular |
| S03-8966 |
skin |
blisters work up |
|
keratinocytic granular ANA and granular cytoplasmic (not AMA) detected;
pt. has high RF |
| S06-13997 |
skin |
pruritic work up, r/o DH |
extensive H&E of thawed DIF biopsy, negative for polys @ papilla tips = DH is ruled out. |
DIF agents neg. |
| S06-14029 |
skin |
blisters work up, pregnant (highly suggestive of HG) |
herpes gestationis DX by the thawed H&E plus clinical |
DIF agents neg |
| S06-15825 |
skin |
photo-type rash work up, r/o SLE |
superficial inflammation, probably photo-toxic, w/ epidermal in vivo ANA suggesting MCTD, lupus, or other connective tissue disease |
DIF agents neg except IgG strongly epidermal nuclear ANA
positivity |
| S07-135 |
skin |
DH vs BP, PV, EBA |
superficial papillary dermal edema w/ epidermal in vivo ANA suggesting MCTD, lupus, or other connective tissue disease |
DIF agents w/ only faintly granular BMZ C3 & IgG strongly positive speckled epidermal nuclear ANA
positivity |
| S07-302 |
skin |
photo-dermatitis, r/o psoriasiform |
some parabasal keratocyte balooning and sparse basal vacuolar. Probable lupus...watch for psoriasis |
DIF agents w/ only strong granular BMZ IgG, IgA, & C3 positivity (pos. "lupus band") plus the same agents deposited intra-epidermally around intra-corneal clusters of polys (psoriasis-like) |
| L07-1119 |
skin |
86 y/o in ICU: severe 3rd space edema due to CHF & renal failure and pre-blistering "look", r/o beginning EM/TEN |
some possible sparse basal keratocyte basal vacuolar degen.; DIF negativity & presence of marked edema & probably basal vac. due to toxic and low-grade hypoxic; doubt EM/TEN |
DIF agents all negative |
| L07-1189 |
skin |
60 y/o: pyoderma ganrenosum vs., vs. EM, vs. bullous SLE, vs. fixed drug |
some sparse basal keratocyte degen.; BMZ DIF negativity & presence of basal cytoplasmic positivity favors EM/TEN |
DIF basal keratocyte cytoplasmic pos. G, A, M, & C3 & BMZ negative; thawed H&E focal basal cell damage plus melanophages |
| S07-1538 |
skin |
46 y/o S/P transplant for CML, r/o GVH |
much melanophage presence & some basal keratocyte vacuolar degen.; in vivo ANA suggesting MCTD & casting doubt on GVH |
DIF agents all negative except trace to 1+ focal keratocyte cytoplasm pos. & 1-2+ speckled IgG epidermal nuclear ANA
positivity |
| S07-2225 |
skin |
47 y/o with blisters backs of hands |
H&E looks like PCT; but did IgG DIF looking for in vivo keratocyte ANA as possible evidence of PCT associated collagen vascular disease |
IgG-only DIF done and showed smooth mural positivity of papillary dermal vessel walls and keratocyte nuclear ANA negativity |
| S07-2265 |
skin |
72 y/o , left upper back BX, BP vs. DH |
DIF BP & DH negative; so, rapid thaw and process for H&Es = negative; both diagnoses unlikely |
DIF = dermal vessels IgG mildly remindful of PCT...probably just an actinic phenomenon. Go to H&E. |
| S07-3037 |
skin |
46 y/o, right cheek lesion = folliculitis vs. psoriasis vs seb. derm., r/o lupus |
DIF BMZ "lupus band test" neg.; so, rapid thaw and process for H&Es = negative for spongiosis, interface, or psoriasiform change;
deposits c/w acquired localized ochronosis & some chronic follicular inflammation = folliculitis related to bleaching? |
DIF battery & BMZ "lupus band test" neg.; go to H&E. |
| S07-3110 |
skin |
34 y/o, left cheek DLE-like lesion...is it DLE?, r/o BCC |
rapid thaw and process for H&Es = negative for BCC; |
IgG-only DIF = BMZ "lupus band test" pos.; go to H&E to r/o the BCC. |
| L07-2485 |
skin |
59 y/o w/ UTI, trunk H&N acute painful, erythroderma, exanthematous; steroid TX...mid-afternoon BX, concern EM, SJ, TEN. |
rapid thaw and process for H&Es = AGEP |
FS DX as DIF slides being cut = DX of probable subcorneal pustulosis problem & DIF then not impetigenized pemph. foliaceus & no
evidence EM/SJ TEN. |
| L07-3526 |
skin |
59 y/o, vessiculating lower legs with venous insufficiency & possible cellulitis & r/o immunobullous. |
H&E BX plus rapid thaw and process for H&Es = no suggestion of cellulitis & pos. for prominent stasis change & epidermal spongio-edema; DX = not cellulitis & is vesicular, bullous stasis dermatitis |
stasis vessels fibrinogen-only DIF positive = c/w inflammed vascular component of stasis dermatitis. |
| S07-8288 |
normal skin |
61y/o, r/o SLE, SCLE, CCLE |
pretty good evidence against the r/o diseases |
DIF negative, including negativity for epidermal nuclear ANA (epidermal nuclear staining [ENS]) |
| S07-8599 |
skin lesion |
69y/o, r/o DH vs. BP. |
DIF c/w DH; H&E slightly concerning for lupus (overlap?) = address on clinical & serological grounds |
DIF only pos. for finely granular IgA heaviest over dermal papillae. H&E neg for tip polys but has some superficial & deep chronic inflammation. |
| S07-9508 |
skin lesion |
59y/o F, r/o "limited BP" vs. hydroa estivale (has only had a few blisters in her life). |
IFA anti-skin abs pos. @ 1:80 for PV-like intercellular (can see with BP) & H&E notes numerous dermal eos. & w/ DIF = probable BP |
DIF neg. for BMZ & trace vascular pos. IgM & C3. |
| S07-10963 |
skin lesion |
57y/o F, r/o BP vs. PCT. |
except for actinic dermis, vessels & skin normal by H&E...no eosinophils & w/ DIF = PCT |
DIF pos. for linear BMZ IgG & C3 & homogeneously in dermal vessels |
| S07-11104 |
skin lesion |
18y/o F, r/o "HSP". |
H&E= pustule over suppuration.
| DIF pos. for granular vascular IgA, C3 & fibrinogen in dermal capillaries indicative of HSP. |
| S07-14407 |
skins of back |
59 F, dermatomyositis v. lupus v. Wegener's v. vasculitis |
| |
| S07-14996 |
skin lesion |
56 y/o F, r/o LE |
H&E neg = favor some type cutaneous LE
| DIF BMZ granular pos. faint in epidermis & much more in adnexa |
| L08-87 |
skin lesion (pathologist consulted, surgeon BX) |
76 y/o F, exfoliating dermatosis = EM/TEN? |
H&E parakeratosis & some basal vacuolation & neg DIF = favor medication reaction
| DIF totally negative |
| S08-1012 |
skin lesion |
50 y/o F, vasculitis |
H&E some vessel fibrin thrombi = immune-mediated vasculitis c/w Wegener's
| DIF multi-agent vascular deposits & we got serum ANCA positive |
| S08-1211 |
skin lesion shoulder |
57 F, BP vs pemphigus vs allergic |
H&E cleft & ? acantholysis, w/ DIF = pemphigus
| DIF chickenwire epidermal pos IgG & C3 |
| S08-4490 |
skin lesion |
59 M, BP vs. PV vs EBA |
pemphigus
| pericellular IgG, IgA, C3 & F |
| S08-4794 |
skin lesion hand |
76 F r/o BP |
c/w BP & also suspicious for PCT
| linear BMZ & focal mild PCT-like vascular (IgG, IgA, & F) |
| S08-4838 |
skin lesion foot |
43 F BP vs. bullous eczema vs bullous LP |
immune-mediated dermatosis of uncertain classification
| 1+ linear BMZ IgG & "stasis-like" papillary dermal vessels pos. for IgM, C3, & F |
| S08-16663 |
skin lesion upper back |
62 M r/o lupus |
lichen planus
| 1+ granular BMZ IgG & C3 plus myriad papillary dermal globular bodies (when very numerously present it is LP; small numbers may not r/o LP but myriad is diagnostic) IgA & IgM |
| S09-122 |
gingiva |
64 F BP vs LP |
lichen planus
| wedged hypergranulosis by H&E plus numerous polyclonal globular bodies DIF |
| S09-155 |
skin dorsal hand |
DH vs PCT vs factitial vs drug |
not factitial, PCT or DH
| some nonspecific BMZ DIF pos.; and H&E = scant spongiosis |
| S09-640 |
buccal mucosa |
79 F erosive LP? |
LP & autimmuno overlap syndrome
| vague wedged hypergranulosis by H&E plus DIF in-vivo IgG ANA plus numerous IgA & IgM globular or cytoid bodies |
| S09-1981 |
forearm lesion |
46 F |
unknown signif.
| H&E neg; 1+ venule endothelial fibrinogen positivity |
| S09-2138 |
wrist |
49 F |
probable dermatomyositis
| H&E hyperkeratosis & focal interface dermatitis; DIF = clusters of numerous cytoid bodies as in LP & Gottron's lesions of DM |
| S09-2512 |
abdomen |
56 M |
r/o pemp. vulg.
| H&E subepidermal blister & some eos. & IgG & C3 BMZ linear DIF positive = BP & NOT PV |
| S09-11046 |
perinium |
51 F |
r/o HSV, Behcets, cic. pemphigoid, chancroid, & syphillus
| negative for pemphigoid |
| S10-3299 |
esophagus |
32F |
blistering esophagus?
| IgG & C3 pericellular positive |
| S10-1431 |
sigmoid colonic |
15M |
IgA deficiency?
| lamina propria cells weakly IgA pos. |
| S10-4995 |
forearm |
72M |
BP vs. DH vs ?
| weak granular BMZ (evidence of some sort of background connective tissue disease vs. actinic effect; and fluffy, compacted dermal IgM deposits of actinic elastosis vs. "macroglobulinemia cutis". |
| S10-11310 |
buccal mucosa |
50F |
erosive LP?
| strong fibrinogen classical shaggy BMZ positivity (of LP, lichenoid drug, and licenoid photodermatitis) |
| S11-5039 |
esophageal mucosa by endoscopic biopsy |
56M |
linear IgA?
| biopsy only had the epithelial layer |
| L11-11282 |
chest skin and deltoid muscle |
|
dermatomyositis?
| skin: IgG in vivo ANA
muscle: early perifascic. changes,
all c/w early dermato. |
