Histopathology and immunohistochemistry of dermatoborrelioses

english

2001

volume 10, issue 4

Združenje slovenskih dermatovenerologov
(Obvezni izvod spletne publikacije)

There are three different dermatological manifestations of LB (dermatoborrelioses, DB), erythema rnigrans (EM), borrelial lymphocytoma (BL),and acrodermatitis chronica atrophicans (ACA). The diagnosis of all threeof these DB is primarily made on clinical grounds. Analysis of serum antibodies to B. burgdorferi is often unreliable and direct diagnostic methods(Cultivation and PCR) are available in specialized laboratories only. Histopathologic examination of biopsy samples from lesional skin of patients with suspected DB is a very helpful adjunct to the diagnosis. The most important finding in EM is a patchy mononuclear superficial (and deep); perivascular (and interstitial) infiltrate that is composed predominantly of lymphocytes and histocytes with a variable admixture of plasma cells. There are two histopathologic types of BL, with (follicular type) or without (diffuse/nodular type) follicular structures, resembling the germinal centers of lymph nodes. BL can be confused with well-differentiated nodular lymphoma histologically, but BL is always a pseudolymphoma, thus representing a benign lesion with a polyclonal proliferation of B and T cells. ACA develops clinically from an acute inflammatory phase into a chronic atrophic phase, which is reflected by different histopathologic features with a predominance of infiltrative changes in the early stage and cutaneous atrophy in the late stage. A significant finding in ACA is a patchy to band-like mononuclear infiltrate that is pronounced in the superficial dermis but also present in the deep portion of the dermis. The infiltrate is concentrated around blood vessels, which are often dilated. Immunohistochemical investigation reveals inall forms of DB a mixed mononuclear infiltrate, in which CD8+cells always outnumber CD4+cells. Macrophages are found significantly more often in EM patients with associated features than in those without. (Abstract trunacted at 2000 characters).

16.09.2022