Ten years after the onset of hydroa vacciniforme (HV), a 16-year-old boy developed edema and red induration of the face, ears, and dorsa of the hands. Aggravation of cutaneous manifestations was associated with general malaise, headache, fever, lymphadenopathy, hepatosplenomegaly, and an increase of several serum enzymes. The vesicle was situated intraepidermally with thrombosis and hemorrhage underneath. This confirmed the diagnosis of HV. In addition, dense cell infiltrate was seen in deep dermis and subcutaneous tissue. Histologic and immunohistochemical studies of the dermal cell infiltrate and lymph node showed an infiltrate of helper T lymphocytes with an atypia and histiocytic cells (S100[-], alpha-subunit[+]). Hence, we concluded HV and malignant lymphoma coexisted in this patient.
The distribution of immune deposits in the skin of reversed passive Arthus reaction was investigated using horseradish peroxidase (HRP) as antigen. Free and non‐reacted HRP, after leaking from small vessels, spreads widely in connective tissue, in epidermis, and in hair follicles in a diffuse and homogeneous pattern. When a specific antibody is administered, HRP appears as granular deposits, which can be considered to be immune deposits, and they adhere to the tissues. When sufficient amounts of antibody is intracutaneously administered, these granular deposits are seen at the wall of venules or in the vicinity of the venules, but when a small amount of antibody is injected, the deposits are seen widely in the connective tissue and are apt to be accumulated at the basement membrane of the dermo‐epidermal junction and of hair follicles. Free HRP passes the basement membrane easily, but the immune complexes are considered unable to pass it and are deposited under it.
A remarkable infiltration of eosinophils was observed in skin biopsy specimens in two cases of Sweet's syndrome. One patient was a 29-year-old woman, whose clinical and histological features included associated asthma, a prior respiratory tract infection, red plaques, blood eosinophilia, and a dense dermal infiltrate of neutrophils and eosinophils, without evidence of vasculitis. The other patient was a 61-year-old man characterized by a fever, red plaques, erythema nodosum-like lesions, hepatic dysfunction, a dermal infiltrate of neutrophils accompanied by eosinophils, and a subcutaneous prominent infiltrate of eosinophils. Clinical and histological evidence supported the diagnosis of Sweet's syndrome in both of these patients. While the literature describes eosinophil infiltration in this disease, extreme eosinophil infiltration could be misleading in the diagnosis.
Using horseradish peroxidase (HRP) as antigen, reversed passive Arthus reactions were carried out on the skin of rabbits, in which HRP-anti HRP immune deposits were observed as brownish granules in sections treated with diaminobenzidine and peroxide. Some immune deposits, presumably insoluble immune complexes, were found to be taken up by neutrophilic leukocytes in the subepidermal papillary layer, then pushed up into the epidermal layer and subsequently eliminated from the epidermal surface as small crusts.In the course of this trans-epidermal elimination, intra-epidermal and subcorneal microabscesses were observed. Most of the neutrophilic leukocytes in the micro-abscesses were shown to contain peroxidase-positive granules. The trans-epidermal elimination of immune deposits 'I.m ight represent a way of biological clearance of immune deposits occurring in the~ub-epidermal papillary layer or within the epidermis..
A tumor on the face showing follicular and apocrine differentiation is described. The coexistence of the two features suggests that the hair follicle has the potential to develop an apocrine gland tumor.
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