Spongiotic intra-epidermal blister: A pitfall in the histopathologic diagnosis of bullous pemphigoid

Joshi, Rajiv

doi:10.4103/0019-5154.117355

Cited by 5 publications

(5 citation statements)

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“…[2][3][4] Recently, another rare histopathologic pattern showing prominent spongiosis without subepidermal clefting was noted in a few case reports. 5,6 A similar pathological pattern was noted especially in patients with dyshidrosiform bullous pemphigoid. 7,8 Dyshidrosiform bullous pemphigoid involves the palmoplantar aspects of the hands and feet, which is similar to dyshidrotic dermatitis (pompholyx).…”

Section: Introductionsupporting

confidence: 62%

“…The immunofluorescence remained the most important diagnostic tool to confirm the diagnosis. The similarities in the clinical and histopathological presentation of patients with spongiform pemphigoid and dyshidrotic dermatitis may cause a diagnostic pitfall and affect treatment outcomes …”

Section: Discussionmentioning

confidence: 99%

“…The similarities in the clinical and histopathological presentation of patients with spongiform pemphigoid and dyshidrotic dermatitis may cause a diagnostic pitfall and affect treatment outcomes. 3,5,12 Dyshidrosiform pemphigoid is a rare clinical variant of pemphigoid with a localized vesiculobullous eruption on the palms or soles. 6,13 This clinical variant may occasionally present histopathologically with a spongiotic pattern of bullous pemphigoid.…”

Section: Discussionmentioning

confidence: 99%

“…However, a few uncommon histopathologic variants have been reported, such as urticarial pemphigoid, pemphigoid nodularis, and erythrodermic pemphigoid . Recently, another rare histopathologic pattern showing prominent spongiosis without subepidermal clefting was noted in a few case reports . A similar pathological pattern was noted especially in patients with dyshidrosiform bullous pemphigoid .…”

Section: Introductionmentioning

confidence: 92%

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Spongiform pemphigoid: A case series of an uncommon histopathologic pattern

Merton

2019

J Cutan Pathol

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Introduction Bullous pemphigoid is an autoimmune bullous disease characterized by subepidermal separation. We encountered cases of bullous pemphigoid confirmed by direct immunofluorescence study but demonstrating spongiotic dermatitis without subepidermal clefting. Many of them occurred in volar sites, mimicking dyshidrotic dermatitis. Methods We retrospectively collected patients who were pathologically and/or immunopathologically diagnosed with bullous pemphigoid from 2002 to 2017. Patients who presented with prominent spongiosis without subepidermal clefting were included and compared with patients who were diagnosed with dyshidrotic dermatitis. Results A total of nine cases of spongiform pemphigoid out of 385 bullous pemphigoid patients (2.3%) were identified and compared with 15 patients with dyshidrotic dermatitis. Average age of spongiform pemphigoid patients (76 years) was much older than that of the control group (34 years). Microvesicles in the mid‐ to lower epidermis (P < 0.001), eosinophils exocytosis (P < 0.001), and eosinophils microabscess (P < 0.001) in both the epidermis and papillary dermis were more common in spongiform pemphigoid. Conclusion Spongiform pemphigoid mimics spongiotic dermatitis may result in a pathological diagnostic pitfall. The presence of eosinophil microabscess and exocytosis in the epidermis and papillary dermis were important clues. Immunofluorescence studies should be conducted to confirm the diagnosis of bullous pemphigoid.

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Section: Introductionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 92%

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Spongiform pemphigoid: A case series of an uncommon histopathologic pattern

Merton

2019

J Cutan Pathol

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“…Although the histopathologic findings of the urticarial phase of BP are well-described in the literature, re-epithelialization as a diagnostic pitfall is not sufficiently emphasized. 8 Re-epithelialization, which can appear as early as 48 hours after wound formation, 9 occurs at the blister edge. In addition, islands of re-epithelialization appear at hair follicle infundibula inhabited by stem cells.…”

Section: Bp Presenting As An Intraepidermal Blistermentioning

confidence: 99%

The spectrum of histopathologic findings in pemphigoid: Avoiding diagnostic pitfalls

et al. 2018

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While re-epithelialization of subepidermal blisters is a commonly accepted phenomenon, there are no published data demonstrating its incidence. Because only half of the biopsies showed the classic subepidermal blister, it is important to be aware of the spectrum of histopathologic findings that occur in this disease. Specifically, the presence of an intraepidermal blister and/or epidermal necrosis on routine H&E-stained specimens does not preclude the diagnosis of pemphigoid.

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