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Volume 10, Number 11—November 2004

Research

Histopathologic Improvement with Lymphedema Management, Léogâne, Haiti

Susan F. Wilson*, Jeannette Guarner*, Alix L. Valme†, Jacky Louis-Charles†, Tara L. Jones*, and David G. Addiss*Comments to Author 
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †Hôpital Ste. Croix, Léogâne, Haiti

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Table 1

Histopathologic features evaluated in skin biopsy specimens from patients with lymphedema of the leg, Léogâne, Haiti

Location, feature Comments
Epidermis
  Hyperkeratosis Thickening of horny layer, with disappearance of basket-weave pattern.
  Hypergranulosis Basophilic pyknotic nuclei in keratin layer.
  Acanthosis Increase in thickness of the stratum malpighii.
Superficial dermis
  Fibrolamellar hyperplasia Distinct collagen bundles parallel to basal epidermal layer.
  Condensed collagen Thickened and closely packed collagen bundles with deep eosinophilic staining pattern.
  Perivascular fibrosis Condensed collagen concentric to vessels.
  Perivascular infiltrate Cellular infiltrate surrounding vessels, defined as either acute (presence of neutrophils or eosinophils) or chronic (presence of mononuclear inflammatory cells, including lymphocytes and macrophages).
Intensity of chronic infiltrate was noted as mild (average of <5 lymphocytes or macrophages observed in 40x magnification viewing field of perivascular spaces) or pronounced (average of >5 lymphocytes or macrophages), based on examination of several fields per slide.
Plasma cells noted.
Deep dermis and subcutaneous tissue
  Perivascular fibrosis Same as in superficial dermis.
  Perivascular infiltrate Same as in superficial dermis.
  Periadnexal infiltrate Cellular infiltrate around hair, sweat, and sebaceous glands. Type and intensity were noted as previously defined for the superficial dermis.
  Infiltrate in subcutaneous tissues Cellular infiltrate in fibrous septa among adipose tissue. Type and intensity were noted as previously defined for superficial dermis.

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