Fung Maxwell A, Murphy Michael J, Hoss Diane M, Berke Adrienne, Grant-Kels Jane M
Department of Dermatology, University of Connecticut School of Medicine, Farmington, USA.
Am J Dermatopathol. 2003 Aug;25(4):287-90. doi: 10.1097/00000372-200308000-00002.
Caterpillar bodies are eosinophilic, elongated, segmented bodies located within the roofs of blisters and are considered to represent a specific histopathologic feature of porphyric bullous eruptions, including porphyria cutanea tarda and erythropoietic protoporphyria. The possibility that similar or identical bodies may be present in other disorders prompted further study exploring the specificity of caterpillar bodies in the differential diagnosis of subepidermal vesiculobullous disorders. Seventy-six cases exhibiting subepidermal clefting were reviewed by light microscopy. "Classic" caterpillar bodies were present in porphyria cutanea tarda (6 of 14) and 1 case representing either venous stasis-associated bulla or possibly bullosis diabeticorum. Caterpillar body-like clusters were present in porphyria cutanea tarda (5 of 14), erythropoietic protoporphyria (1 of 3), bullous pemphigoid (7 of 24), and junctional or dystrophic epidermolysis bullosa (3 of 5). In some cases, classic caterpillar body and caterpillar body-like clusters coexisted in a blister roof. Caterpillar bodies or caterpillar body-like clusters were not identified in any cases of dermatitis herpetiformis, linear IgA bullous dermatosis, bullous erythema multiforme, epidermolysis bullosa acquisita, or wound-healing reactions. In contrast to caterpillar bodies, caterpillar body-like clusters were negative for PAS or Type IV collagen stains. In conclusion, caterpillar bodies appear to represent a specific feature of porphyria cutanea tarda (specificity, 98%) but were present in less than half of those cases in this study (sensitivity, 43%). Caterpillar body-like clusters are less specific and may be present in porphyria cutanea tarda, erythropoietic protoporphyria, pseudoporphyria, bullous pemphigoid, epidermolysis bullosa, and epidermolysis bullosa acquisita.
毛虫体是嗜酸性、细长、分节的物体，位于水疱顶部，被认为是卟啉性大疱性皮疹的一种特定组织病理学特征，包括迟发性皮肤卟啉病和红细胞生成性原卟啉病。其他疾病中可能存在相似或相同物体的可能性促使进一步研究，以探索毛虫体在表皮下水疱性疾病鉴别诊断中的特异性。通过光学显微镜对76例表现为表皮下裂隙的病例进行了回顾。“典型”毛虫体存在于迟发性皮肤卟啉病（14例中的6例）以及1例代表静脉淤滞相关性大疱或可能为糖尿病性大疱病的病例中。毛虫体样簇存在于迟发性皮肤卟啉病（14例中的5例）、红细胞生成性原卟啉病（3例中的1例）、大疱性类天疱疮（24例中的7例）以及交界性或营养不良性大疱性表皮松解症（5例中的3例）。在某些病例中，典型毛虫体和毛虫体样簇共存于水疱顶部。在疱疹样皮炎、线状IgA大疱性皮病、大疱性多形红斑、获得性大疱性表皮松解症或伤口愈合反应的任何病例中均未发现毛虫体或毛虫体样簇。与毛虫体相反，毛虫体样簇对PAS或IV型胶原染色呈阴性。总之，毛虫体似乎是迟发性皮肤卟啉病的一种特定特征（特异性为98%），但在本研究中不到一半的病例中出现（敏感性为43%）。毛虫体样簇特异性较低，可能存在于迟发性皮肤卟啉病、红细胞生成性原卟啉病、假性卟啉病、大疱性类天疱疮、大疱性表皮松解症和获得性大疱性表皮松解症中。
