Histological interpretation of frozen sections made during Mohs' micrographic surgery may be difficult, depending on the morphological and staining characteristics of the tumour and on the nature of the associated inflammatory infiltrate. We have employed an adaptation of micrographic surgery in which horizontal, formalin-fixed, paraffin-embedded sections were used to improve histological assessment in the excision of 18 non-melanoma skin tumours in which frozen sections had been or were likely to be unsatisfactory. We describe our experience of this method in the management of squamous cell carcinomas (11), extramammary Paget's disease (two), microcystic adnexal cell carcinomas (two), dermatofibrosarcoma protuberans (two), and primary cutaneous neuroendocrine carcinoma (Merkel cell carcinoma) (one). The use of horizontal paraffin-embedded sections lengthens the duration of the procedure but facilitates accurate assessment of histological sections in selected tumours.
Immunofluorescence studies were carried out on 47 patients with primary localized cutaneous amyloidosis. The majority had the macular, maculopapular or papular forms of lichen amyloidosus, although 3 patients had the nodular type. All biopsies fluoresced positively for immunoglobulins or complement, particularly IgM and C3. Staining for kappa and lambda light chains was positive. The consistent immunofluorescent patterns observed were similar in some respects to lichen planus, suggesting that colloid bodies and amyloid may share similar properties in acting as a filamentous sponge on to which immunoglobulins and complement are absorbed. The pathogenesis of lichen amyloidosus is compared with that of lichen planus.
The expression of keratins was investigated immunohistochemically on formalin-fixed and snap-frozen primary cutaneous amyloidosis tissue with a panel of monospecific and polyspecific antikeratin antibodies, with recognized keratins K1, K5, K6, K7, K8, K10, K14, K16, K17, K18 and K19. Amyloid deposits in frozen sections of seven cases of macular amyloidosis and lichen amyloidosus always reacted with antibodies LP34 (labelling K5, K6 and K18), MNF 116 (labelling K5, K6, K8, K10, K17 and K18), and RCK 102 (labelling K5 and K8); frozen sections in one case each of the seven cases also reacted with antibodies LL001 (labelling K14), LP1K (labelling K7 and K17), and LP2K (labelling K19). In formalin-fixed sections of 13 cases of macular amyloidosis and lichen amyloidosus, amyloid deposits were labelled with LP34 in three sections, MNF 116 in four sections, LL020 (labelling keratins K5 and K6) in one section, and LP2K in two sections. In nodular primary cutaneous amyloidosis, amyloid deposits were not labelled with any antikeratin antibodies. These data confirm that amyloid in macular amyloidosis and lichen amyloidosus contains keratin epitopes, and suggests derivation of the fibrillar component from keratin intermediate filaments. Several different keratins appear to undergo conversion to amyloid. LP34, MNF 116 and RCK 102 antibodies, which have in common the labelling of keratin K5, may be useful in the diagnosis of macular and papular amyloidosis with frozen tissue sections.
Four cases of herpes gestationis are reported and the immunopathological findings in these patients described. Complement deposition at the basement membrane zone of the patients' peri-bullous skin was seen in all patients, immunoglobulin deposition in two. A circulating factor capable of fixing complement on the basement membrane zone of normal human skin was present in three patients. These findings are discussed and compared with the immunopathological findings in bullous pemphigoid.
Summary Sera from 50 untreated patients with bullous pemphigoid were examined by both the customary method of indirect immunofluorescence using anti IgG conjugate and by indirect complement immunofluorescence using anti C3 conjugate to detect circulating antibasement membrane zone antibodies. A circulating antibasement membrane zone antibody could be detected by the IgG method in 58% and by the C3 method in 76%. Sera from six patients with cicatricial pemphigoid examined in the same way showed a circulating antibasement membrane zone antibody in one by the IgG method but in three by the C3 method of indirect immunofluorescence. Sera from ten patients with active herpes gestationis contained anti‐basement membrane zone antibody demonstrable by the C3 method in every case and by the IgG method of indirect immunofluorescence in one of these. Basement membrane zone bound IgG, or more commonly C3 in a linear pattern, was shown by direct immunofluorescence in all patients with bullous or cicatricial pemphigoid from whom adequate biopsy material was obtained. The immunopathological similarities of bullous pemphigoid, cicatricial pemphigoid and herpes gestationis are stressed, and the usefulness of indirect complement immunofluorescence in their diagnosis is emphasized.
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