Conventional microscopy: signs that stamp pigmented melanocytic nevi as benign.
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Biomedical subjects
Publications and source records attributed to A B Ackerman.
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A 73-year-old man had developed a 27 x 60-mm seborrheic keratosis on his trunk. Some months previously, an 18 x 19-mm cauliflower-like area had developed within this seborrheic keratosis. Histologic examination showed a papillated squamous cell carcinoma in situ arising in a seborrheic keratosis. Seborrheic keratoses are the most common cutaneous neoplasms in man. Malignant changes are most unusual but should be suspected in lesions of unusual clinical appearance.
Two hundred specimens from lesions of lichen planus were studied by conventional light microscopy in order to assess their evolution, maturation, and regression. The most important finding was that Langerhans' cells appear in increased numbers in the epidermis very early in the disease, even preceding the experience of lymphocytes there and then that the appearance of lymphocytes is followed by destruction of keratinocytes in the lower portion of the epidermis and by general epidermal hyperplasia, including hypergranulosis and hyperkeratosis. Wedge-shaped hypergranulosis develops around intraepidermal adnexal structures, namely, acrosyringia and acrotrichia. Finally, long-enduring inflammatory-cell infiltration in the papillary dermis was found to result in eventual fibrosis there, an evidence of resolution. With time the inflammatory-cell infiltrate disappears and the epidermis regains its normal configuration. Bullous lichen planus, hypertrophic lichen planus, atrophic lichens planus, and lichen planopilaris are variants of the same pathological process, modified by intensity and location of process.
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Cornoid lamellation is a constant histologic marker of porokeratosis in its many variants. This histologic appearance, heretofore thought to be pathognomonic of and restricted to porokeratosis alone, has also been found by us in a variety of other conditions. Cornoid lamellation is, therefore, analogous to the histologic findings of focal acantholytic dyskeratosis, epidermolytic hyperkeratosis, and follicular mucinosis as a distinctive histologic reaction pattern that reflects disordered progression of epidermal cells to cornification.