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Path Report |
Skin Biopsy Specimen
Pathology Report
This site is designed to guide interpretation of a pathology laboratory report which accompanies a clinical case.
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.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?
- Compare papillary and reticular dermis.
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Find reticular dermis on the specimen.
- View reticular dermis in a micrograph from the specimen.
Where is reticular dermis in relation to papillary dermis?
How does the texture of reticular dermis differ from that of papillary dermis?
- Compare papillary and reticular dermis.
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"Mild perivascular chronic inflammatory infiltrate" describes evidence of inflammation.
- "Perivascular" simply means "around the blood vessels". "Inflammatory infiltrate" consists of white blood cells which enter the tissue as part of the inflammatory response.
- Although it is not practical to identify reliably most individual cells in this region, the numerous small, roundish, intensely basophilic nuclei seen in this region are characteristic of lymphocytes.
- The inflammatory infiltrate is characterized as "mild" based on the relatively low numbers of white blood cells which appear here. This appearance should be contrasted with a more severe inflammatory infiltrate observable in other slides of inflamed tissue.
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.
- View swollen collagen bundles in a micrograph from the specimen.
- Compare swollen and normal collagen bundles from reticular dermis.
- Compare collagen fibers in papillary and reticular dermis.
(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
https://histology.siu.edu/skinbiop/du1path.htm
Last updated: 3 October 2021 / dgk