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Skin Biopsy Specimen

Pathology Report

This site is designed to guide interpretation of the pathology laboratory report which accompanies this patient biopsy specimen.  

Before proceeding, place the biopsy slide (available for check out; contact Dr. King for more information) on the stage of your microscope.

Proceed.


 

In the following report, click on a highlighted word or phrase for further information, questions, and images.  Use your browser's "Back" button to return.  To e-mail questions to Dr. King, scroll to the bottom of the page (or press the "Ctrl-End" keys) and click on the "comments and questions" link.

Gross Description
Submitted in formalin is a punch biopsy of the skin 0.5 cm in diameter. This is bissected and all is taken.

Histology
In the histologic preparation the epidermis is unremarkable.  The papillary dermis is essentially unremarkable, however in the reticular dermis there are swollen collagen bundles which have increased eosinophilia.  There is a mild perivascular chronic inflammatory infiltrate in the dermis. The changes are consistent with scleroderma. Clinical correlation is recommended.

Diagnosis
Skin of the right breast below nipple, punch biopsy:  changes consistent with scleroderma, clinical correlation recommended.

Additional Features
Normal skin may include a variety of features which are not explicitly mentioned in this laboratory report.  Which of the following features can you find and recognize on the specimen?  (Each link will take you to a micrograph which includes the listed feature.)

keratinized stratified squamous epithelium
simple cuboidal epithelium
fibroblasts
lymphocytes
melanocytes
sweat gland
nerve
adipose cells
venule
arteriole


 

The statement that the observed changes are "consistent with scleroderma" means exactly what it says, and no more.  

"Clinical correlation is recommended" means that other evidence for scleroderma should be sought.

In other words, this specimen by itself is NOT definitively diagnostic for scleroderma, only consistent with such a diagnosis.  Although scleroderma might yield specimens such as this, so might any number of other conditions.  We are therefore advised to seek additional evidence.

Clear clinical reasoning is called for here.  There is a significant distinction between consistency with a hypothesis and confirmation of a hypothesis.  Essentially, the distinction hinges on alternative hypotheses.  Did the differential diagnosis include any hypotheses which can be rejected on the basis of this biopsy?  Could a diagnosis of scleroderma have been rejected, if the biopsy results were any different?

 

 

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What is the use of formalin in this context?

 

 

 

 

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Find epidermis on the specimen. 

What are the characteristics of "unremarkable" epidermis?

 

 

 

 

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Find papillary dermis on the specimen.  

What are the characteristics of "unremarkable" papillary dermis?

Where is papillary dermis in relation to reticular dermis?

How does the texture of papillary dermis differ from that of reticular dermis?

 

 

 

 

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Find reticular dermis on the specimen.  

Where is reticular dermis in relation to papillary dermis?

How does the texture of reticular dermis differ from that of papillary dermis?

 

 

 

 

 

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"Mild perivascular chronic inflammatory infiltrate" describes evidence of inflammation.

Can you find examples of inflammatory infiltrate on the specimen.?

How does the microscopic appearance of a chronic inflammatory infiltrate differ from that of an acute inflammatory infiltrate?

 

 

 

 

 

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Find examples of "swollen collagen bundles" on the specimen.

(Note that assessing the size of collagen bundles and the degree of eosinophilia both require judgment based on considerable experience.)

 

 

 

 

 

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Eosinophilia is affinity for the dye eosin, i.e., intense coloration by this dye.

What color is eosin?  

Hint:  The name is derived from Eos, the Greek goddess of the rosy-colored dawn.

Which of the terms, acidophilic or basophilic, can be used as a more general synonym for "eosinophilic"?

 

 

 

 

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Comments and questions: dgking@siu.edu

SIUC / School of Medicine / Anatomy / David King

http://www.siumed.edu/~dking2/intro/skinbiop/du1path.htm
Last updated:  11 December 2007  / dgk