Concordance of Clinical, Histologic and Direct Immunofluorescence Findings in Patients with Autoimmune Bullous Dermatoses in Vietnam
Abstract
:1. Introduction
2. Methodology
- (a)
- Adequate clinical history and description of lesions;
- (b)
- Skin and/or mucosal biopsies were sent to the pathology laboratory of the University of Medicine and Pharmacy at Ho Chi Minh City with proper preservation and transportation for the DIF assays;
- (c)
- Hematoxylin and eosin (H and E) stained slides of the skin biopsies were available for evaluation;
- (d)
- DIF-stained slides of the skin biopsies were available for evaluation;
- (e)
- Cases with a missing epidermis on the DIF and/or H and E slides were excluded from the study. Also excluded were cases with negative DIF results, including cases with prior treatments, and therefore may have had negative DIF results.
3. Results
3.1. Spectrum of Autoimmune Bullous Dermatoses
3.2. Concordance between the Clinical, Histopathological, and Direct Immunofluorescence Stains in ABD
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Histological Criteria | Histological Diagnoses |
---|---|
Suprabasilar acantholysis of the epidermis and/or the follicular epithelium | Deep pemphigus (PV and PNP) |
Subcorneal or intragranular acantholysis of the epidermis and/or the follicular epithelium | Superficial pemphigus (PF, PE, PH, and the subtype of IAP) |
Intraepidermal blister with an uncertain level of splitting and/or without acantholysis | Unclassified intraepidermal blister |
Subepidermal, unilocular blister with eosinophilic infiltration | BP |
Subepidermal, multilocular blister with predominantly neutrophilic infiltration | LAD/BSLE/MMP/anti-p200 pemphigoid/inflammatory EBA |
Subepidermal blister with predominantly neutrophilic infiltration and microabscesses of the dermal papillae | DH |
Subepidermal without histological characteristics of BP, LAD, and DH | Unclassified subepidermal blister |
Type of Immunoglobulin | Site of Immunoglobulin Deposition | Pattern of Immunoglobulin Deposition | Intensity of Immunoglobulin Deposition | DIF Diagnosis |
---|---|---|---|---|
IgG +/− C3 | Epidermal cells; no BMZ staining | Linear/fine granular | Throughout the entire epidermis or more intense in the lower layer | PV |
IgG +/− C3 | Epidermal cells; no BMZ staining | Linear/fine granular | Throughout the entire epidermis or more intense in the upper layer | PF |
IgG +/− C3 | Epidermal cells and BMZ | Linear/fine granular | - | PNP/PE |
IgA | Epidermal cells | Linear/fine granular | - | IAP |
IgA | Dermal papillae | Fine granular | - | DH |
IgG + C3 | BMZ | N-shaped linear pattern | C3 > IgG | BP/PG |
IgG with/without other types of immunoglobulins | BMZ | U-shaped linear pattern | IgG > C3 | EBA/BSLE |
IgA | BMZ | Linear | Mainly IgA | LAD |
Group | Disease | Number of Cases (%) (Total Cases = 92) | Age Range (Years) | Median Age (Years) | Female-to-Male Ratio |
---|---|---|---|---|---|
Intraepidermal group | PV | 41 (44.6%) | 11–77 | 52 | 2.7:1 |
PF | 13 (14.1%) | 22–82 | 48 | 2.2:1 | |
IAP | 1 (1.1%) | 11 | - | 1 Male | |
Subepidermal group | BP | 27 (29.4%) | 10–95 | 65 | 0.9:1 |
LAD | 8 (8.7%) | 14–72 | 33.5 | 1:1 | |
BSLE | 1 (1.1%) | 16 | - | 1 Female | |
DH | 1 (1.1%) | 54 | - | 1 Male |
Intraepidermal Blister Subgroup (N = 55) | Histological Diagnosis | Clinical Diagnosis (N and %) | Total | |
(+) | (−) | |||
(+) | 45 (81.8%) | 8 (14.6%) | 53 (96.4%) | |
(−) | 1 (1.8%) | 1 (1.8%) | 2 (3.6%) | |
TOTAL | 46 (83.6%) | 9 (16.4%) | 55 (100%) | |
DIF Diagnosis | Clinical Diagnosis (N and %) | Total | ||
(+) | (−) | |||
(+) | 46 (83.6%) | 7 (12.8%) | 53 (96.4%) | |
(−) | 0 (0%) | 2 (3.6%) | 2 (3.6%) | |
TOTAL | 46 (83.6%) | 9 (16.4%) | 55 (100%) | |
DIF Diagnosis | Histological Diagnosis (N and %) | Total | ||
(+) | (−) | |||
(+) | 51 (92.8%) | 2 (3.6%) | 53 (96.4%) | |
(−) | 2 (3.6%) | 0 (0%) | 2 (3.6%) | |
TOTAL | 53 (96.4%) | 2 (3.6%) | 55 (100%) | |
Subepidermal Blister Subgroup (N = 37) | Histological Diagnosis | Clinical Diagnosis (N and %) | Total | |
(+) | (−) | |||
(+) | 18 (48.6%) | 6 (16.3%) | 24 (64.9%) | |
(−) | 12 (32.4%) | 1 (2.7%) | 13 (35.1%) | |
TOTAL | 30 (81.1%) | 7 (18.9%) | 37 (100%) | |
DIF Diagnosis | Clinical Diagnosis (N and %) | Total | ||
(+) | (−) | |||
(+) | 25 (67.6%) | 6 (16.2%) | 31 (83.8%) | |
(−) | 5 (13.5%) | 1 (2.7%) | 6 (16.2%) | |
Total | 30 (81.1%) | 7 (18.9%) | 37 (100%) | |
DIF Diagnosis | Histological Diagnosis (N and %) | Total | ||
(+) | (−) | |||
(+) | 19 (51.4%) | 12 (32.4%) | 31 (83.8%) | |
(−) | 5 (13.5%) | 1 (2.7%) | 6 (16.2%) | |
Total | 24 (64.8%) | 13 (35.2%) | 37 (100%) |
Pair of Diagnostic Methods | Number of Cases with Matching Diagnoses (Total N = 92) | Percentage of Matching Diagnoses | Mid-p-Value (Mid-p-McNemar’s Test, α = 0.05) |
---|---|---|---|
Clinical/Histology | 63 | 68.5% | 0.851 |
Clinical/DIF | 71 | 77.2% | 0.064 |
Histology/DIF | 70 | 76.1% | 0.134 |
Pair of Diagnostic Methods | Number of Cases with Matching Diagnoses (Total N = 55) | Percentage of Matching Diagnoses | Mid-p-Value (Mid-p-McNemar’s Test, α = 0.05) |
---|---|---|---|
Clinical/Histology | 45 | 81.8% | 0.021 |
Clinical/DIF | 46 | 83.6% | 0.008 |
Histology/DIF | 51 | 92.7% | 1.000 |
Pair of Diagnostic Methods | Number of Cases with Matching Diagnoses (Total N = 37) | Percentage of Matching Diagnoses | Mid-p-Value (Mid-p-McNemar’s Test, α = 0.05) |
---|---|---|---|
Clinical/Histology | 18 | 48.7% | 0.167 |
Clinical/DIF | 25 | 67.6% | 0.774 |
Histology/DIF | 19 | 51.4% | 0.096 |
Case No. | Clinical Diagnosis | Histological Diagnosis | DIF Diagnosis | Final Diagnosis |
---|---|---|---|---|
58 | Linear IgA dermatosis | Bullous pemphigoid (BP) | BP | BP |
64 | Herpes-associated erythema multiforme | BP | BP | BP |
71 | Linear IgA dermatosis | Unclassified pemphigoid | BP | BP |
72 | Dermatitis herpetiformis | BP | BP | BP |
73 | Linear IgA dermatosis | BP | BP | BP |
79 | Pemphigus vulgaris | BP | BP | BP |
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Tran, G.H.; Le, N.T.A.; Dang, M.H.; Doan, T.T.P.; Phung, T.L. Concordance of Clinical, Histologic and Direct Immunofluorescence Findings in Patients with Autoimmune Bullous Dermatoses in Vietnam. Dermatopathology 2023, 10, 30-40. https://doi.org/10.3390/dermatopathology10010004
Tran GH, Le NTA, Dang MH, Doan TTP, Phung TL. Concordance of Clinical, Histologic and Direct Immunofluorescence Findings in Patients with Autoimmune Bullous Dermatoses in Vietnam. Dermatopathology. 2023; 10(1):30-40. https://doi.org/10.3390/dermatopathology10010004
Chicago/Turabian StyleTran, Giang Huong, Nhan Thi Ai Le, Minh Hoang Dang, Thao Thi Phuong Doan, and Thuy L. Phung. 2023. "Concordance of Clinical, Histologic and Direct Immunofluorescence Findings in Patients with Autoimmune Bullous Dermatoses in Vietnam" Dermatopathology 10, no. 1: 30-40. https://doi.org/10.3390/dermatopathology10010004