Zehn Clues zur histopathologischen Diagnose von infektiösen Hautkrankheiten

Zusammenfassung

Spezifische Diagnosen von infektiösen Hautkrankheiten können in der Dermatohistopathologie unter anderem auch durch Clues erlangt werden. Zehn im dermatohistopathologischen Alltag wichtige Clues werden präsentiert. Clue 1 (Spinnenbiss): Veränderungen eines angiozentrisch/angiodestruktiven Lymphoms im Zentrum einer “V”-förmig nekrotischen Insektenstichreaktion; Clue 2 (Skabies): Parakeratose mit stachelförmigen Abdrücken oberhalb einer Insektenstichreaktion; Clue 3 (Pilzsepsis): blass-eosinophil gefärbter Schnitt einer Hautbiopsie mit ausgeprägten Fibrinthrombi und mächtigen Erythrozytenextravasaten; Clue 4 (septische Vaskulitis): Mikroorganismen bei Veränderungen einer leukozytoklastischen Vaskulitis; Clue 5 (frische herpetische Infektion): stahlgraue Kerne mit Margination des Karyoplasmas in Keratinozyten; Clue 6 (Zytomegalievirusinfektion): Eulenaugenzellen; Clue 7 (Amöbiasis): Nachweis von vegetativen Formen von Entamoeba histolytica in perianalen bis perinealen Ulzera; Clue 8 (Larva migrans): rund-oval bis rechteckig geformte Hohlräume im Stratum spinosum der Epidermis oberhalb einer Insektenstichreaktion. Clue 9 (sekundäre Syphilis): Makrophagen und Plasmazellen in einer Biopsie mit ansonsten charakteristischen Veränderungen einer Pityriasis lichenoides; Clue 10 (Acrodermatitis chronica atrophicans): lichenoides Infiltrat aus Lymphozyten und Plasmazellen.

Abstract

Specific diagnoses of infectious skin diseases can be established in dermatopathology by several methods: by algorithms based on pattern analysis, by differential diagnosis of clinicopathologically similar disorders, by attention to pitfalls, by exceptions to the rules and finally, very elegantly by clues. Ten clues to specific diagnoses of infectious skin diseases which are of importance in routine practice are presented. Clue 1: Features of an angiocentric angiodestructive lymphoma in the centre of a wedge-shaped necrotic insect bite reaction are a clue to a bite by a spider. Clue 2: Parakeratosis with spiky imprints on the surface above features of an insect bite reaction are a clue to scabies. Clue 3: A faintly eosinophilic section of a skin specimen with prominent fibrin thrombi and extravasated erythrocytes are a clue to a septic fungal vasculitis. Clue 4: Infectious agents in association with otherwise typical features of leukocytoclastic vasculitis are a clue to septic vasculitis. Clue 5: Steel-grey nuclei with marginated nucleoplasm of keratinocytes are a clue to the diagnosis of early infection by herpes virus. Clue 6: Owleye-like cells are a clue to infection by cytomegalovirus. Clue 7: Detection of Entamoeba histolytica in perianal and perineal ulcers are a clue to amebiasis. Clue 8: Round-oval to rectangular spaces within the stratum spinosum of the epidermis are a clue to larva migrans. Clue 9: Macrophages and plasma cells in association with otherwise typical features of pityriasis lichenoides are a clue to secondary syphilis. Clue 10: A lichenoid infiltrate of lymphocytes and plasma cells are a clue to acrodermatitis chronica atrophicans.