Case Number : Case 2637 - 14 August 2020 Posted By: Dr. Richard Carr

perivascular and periadnexal lymphocytes, ? mucin-dermis

LE

1 hour ago, Krishnakumar subramanian said:

perivascular and periadnexal lymphocytes, ? mucin-dermis

LE

Agree, and there is also a periadnexal thickening of the basement membrane in fig 5.

The B biopsy shows lichen planus like features. Thought of LE/LP overlap syndrome

I think this is lupus.

Agree with LE

Yes I reported this as suggesting discoid lupus erythematosus. We can see rather subtle basement membrane thickening on the PAS exclusive to the follicles. In this case mucin is inconspicuous and it's usually my experience that I "spot" the features of DLE at low power (fairly dense perivascular & periadnexal infiltrates with atrophic lichenoid pattern to the epidermis) and then notice mucin as a secondary phenomenon that rarely makes the diagnosis  On the other hand in cases like this where the disease is predominantly affecting the follicles and mimicking licheno planopilaris I do look closely for basement membrane thickening and will request a PAS if it's equivocal on H&E as in this instance.

Thanks a lot sir for key points

On 17/08/2020 at 10:53, Dr. Richard Carr said:

Yes I reported this as suggesting discoid lupus erythematosus. We can see rather subtle basement membrane thickening on the PAS exclusive to the follicles. In this case mucin is inconspicuous and it's usually my experience that I "spot" the features of DLE at low power (fairly dense perivascular & periadnexal infiltrates with atrophic lichenoid pattern to the epidermis) and then notice mucin as a secondary phenomenon that rarely makes the diagnosis  On the other hand in cases like this where the disease is predominantly affecting the follicles and mimicking licheno planopilaris I do look closely for basement membrane thickening and will request a PAS if it's equivocal on H&E as in this instance.

Beautiful! I follow the same approach!