The Diagnostic Yield of Histopathologic Sampling Techniques in PAN-Associated Cutaneous Ulcers

Abstract

Table 1. No statistically significant differences were found between scans evaluated by the 2 investigators about wound area and volume. The relative errors and the intraclass correlation coefficients are reported in Table 2. The ICC values were excellent for both intrarater and interrater reproducibility with a very low relative error value. The mean ± SD time for a full scan acquisition on the wound area and volume was 3.6 ± 1.4 minutes.Comment. The laser scanner system used in this study enables users to accurately acquire 3-dimensional digital models of various types of skin wounds. Since the final users will be physicians and not computer experts, a user-friendly system is believed to be a fundamental parameter for its success.The accuracy of scanning systems has improved in the past few years, and prices have also decreased, making these devices affordable for a wider community of potential users. 6 The integration into a single system of capabilities that can capture the shape and surface reflection characteristics makes 3-dimensional scanning an invaluable resource in all those applications where it is necessary to sample both surface attributes.

Lymphocytic Arteritis in Epstein–Barr Virus Vulvar Ulceration (Lipschütz Disease)

“…All but one woman healed within 3 weeks; the exception was an RTR with persistent ulceration, underscoring the role of host immunity in the pathogenesis of EBVVU. The almost 100% prevalence of arteritis, histopathology that correlates with punched-out ulcers, 8,31,32 further highlights the existence of immunopathology and incriminates EBV as the putative target of the host immune response.…”

“…Timing of biopsy and failure to include the deep submucosa-subcutis can explain a lower frequency of vasculitis, more specifically arteritis, reported in the literature. 8,31,32 Detection of EBV DNA by PCR was found in 4 of 6 biopsies tested (67%). 5,16,19,20,23,25 In 3 of 4 specimens showing vasculitis, PCR detected EBV DNA.…”

“…Indeed, the classic description of RNSRAGU 3 is one of an abrupt onset of deep, painful, tender, sharply demarcated, "punched-out" ulcers with eschar and red-purple margins that implicate arteritis. 7,8 To date, numerous reports of Lipschütz disease have been directly linked to EBV, making EBV one of the most frequently reported cause of RNSRAGU (10%-30%). [2][3][4]9 However, few cases are biopsied, in part, because of the belief that the histopathologic findings are nonspecific and that biopsy is not indicated for the evaluation of a single episode of acute genital ulceration.…”

Pathology of the Cutaneous Vasculitides: A Comprehensive Review

“…The final stage, healed granulation tissue stage, is characterized by acellular scar tissue replacing the arterial wall and perivascular fibroblastic proliferation (Arkin, 1930). When an ulcerated lesion is present, a biopsy including adequate subcutis central to the ulcer border is essential to optimize the diagnostic yield (Ricotti et al, 2007). Biopsy of ulcerated lesions will demonstrate a vasculitis of medium sized vessels at the dermal subcutaneous junction with associated neutrophilic infiltration, leukocytoclasia, and endothelial swelling with overlying dermal fibrosis and necrosis and epidermal ulceration (Ricotti et al, 2007).…”

“…When an ulcerated lesion is present, a biopsy including adequate subcutis central to the ulcer border is essential to optimize the diagnostic yield (Ricotti et al, 2007). Biopsy of ulcerated lesions will demonstrate a vasculitis of medium sized vessels at the dermal subcutaneous junction with associated neutrophilic infiltration, leukocytoclasia, and endothelial swelling with overlying dermal fibrosis and necrosis and epidermal ulceration (Ricotti et al, 2007). Lesions which present as subcutaneous nodules show a neutrophilic vasculitis of medium sized muscular vessels with a predilection for areas where arteries bifurcate (Carlson & Chen, 2007).…”