Hodge Bonnie D, Roach Jenna, Reserva Jeave L, Patel Tejal, Googe Amber, Schulmeier Jennifer, Brodell Robert T
University of Mississippi Medical Center School of Medicine, Jackson, Mississippi.
Department of Dermatology, Texas Tech Health Science Center, Lubbock, Texas.
J Cutan Pathol. 2018 Nov;45(11):831-838. doi: 10.1111/cup.13343. Epub 2018 Sep 19.
Bullous pemphigoid (BP) is an autoimmune vesiculobullous dermatitis that primarily affects the elderly and presents with tense, fluid-filled blisters. The histological hallmark on routine hematoxylin & eosin (H&E)-stained specimens is a subepidermal blister with luminal eosinophils. However, there are histologic variants than can produce diagnostic confusion.
All immunofluorescence reports from an independent certified dermatopathology laboratory (2006-2015) were inspected, and those with findings consistent with an autoimmune subepidermal blistering process were selected. Seventy-seven cases were identified, and the corresponding H&E-stained specimens were reviewed by two dermatopathologists who tabulated the histopathologic findings.
Just over half of biopsies showed subepidermal clefting (54%). The histologic variants included: urticarial or eczematous findings (17%), partial or complete re-epithelialization (28%), and epidermal necrosis (7%).
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.
大疱性类天疱疮（BP）是一种自身免疫性水疱大疱性皮肤病，主要影响老年人，表现为紧张的、充满液体的水疱。常规苏木精和伊红（H&E）染色标本的组织学特征是表皮下水疱伴腔内嗜酸性粒细胞。然而，存在一些组织学变异型可能会导致诊断混淆。
检查了一家独立的认证皮肤病理学实验室（2006 - 2015年）的所有免疫荧光报告，选择了那些与自身免疫性表皮下水疱形成过程一致的结果。共识别出77例病例，两位皮肤病理学家对相应的H&E染色标本进行了复查，并将组织病理学结果制成表格。
略多于一半的活检显示表皮下裂隙形成（54%）。组织学变异型包括：荨麻疹样或湿疹样表现（17%）、部分或完全再上皮化（28%）以及表皮坏死（7%）。
虽然表皮下水疱的再上皮化是一种公认的现象，但尚无已发表的数据表明其发生率。由于只有一半的活检显示典型的表皮下水疱，因此了解该疾病中出现的组织病理学结果范围很重要。具体而言，常规H&E染色标本上出现表皮内水疱和/或表皮坏死并不排除类天疱疮的诊断。
