How can immunohistochemistry improve the diagnosis of pemphigus foliaceus?

Purpose: Pemphigus foliaceus (PF) is a rare, autoimmune blistering disorder characterized by the production of autoantibodies against desmoglein 1. The mainstay for diagnosis is the demonstration of immune complex deposition by direct immunofluorescence (DIF) in fresh tissue samples. Immunohistochem...

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Main Authors: Denise Miyamoto, Celina Maruta, Claudia Santi, Pablo Zoroquiain, Ana Beatriz Dias, Ligia Fukumori, Alexandre Perigo, Valeria Aoki, Miguel Burnier, Jr
Format: Article
Language:English
Published: Elsevier 2018-06-01
Series:Human Pathology: Case Reports
Online Access:http://www.sciencedirect.com/science/article/pii/S2214330017300925
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spelling doaj-bb1bf732368d400c8188d57d434cf7d12020-11-24T21:49:03ZengElsevierHuman Pathology: Case Reports2214-33002018-06-0112C1810.1016/j.ehpc.2017.12.001How can immunohistochemistry improve the diagnosis of pemphigus foliaceus?Denise Miyamoto0Celina Maruta1Claudia Santi2Pablo Zoroquiain3Ana Beatriz Dias4Ligia Fukumori5Alexandre Perigo6Valeria Aoki7Miguel Burnier, Jr8University of São Paulo Medical School, Department of Dermatology, Av. Dr. Enéas de Carvalho Aguiar, 255 3° andar #3016, São Paulo, SP 05403-000, BrazilUniversity of São Paulo Medical School, Department of Dermatology, Av. Dr. Enéas de Carvalho Aguiar, 255 3° andar #3016, São Paulo, SP 05403-000, BrazilUniversity of São Paulo Medical School, Department of Dermatology, Av. Dr. Enéas de Carvalho Aguiar, 255 3° andar #3016, São Paulo, SP 05403-000, BrazilMUHC-McGill University Ocular Pathology Laboratory, 1001 Boul Decarie, Block E E02.2389, Montreal, QC H4A 3J1, CanadaMUHC-McGill University Ocular Pathology Laboratory, 1001 Boul Decarie, Block E E02.2389, Montreal, QC H4A 3J1, CanadaUniversity of São Paulo Medical School, Department of Dermatology, Av. Dr. Enéas de Carvalho Aguiar, 255 3° andar #3016, São Paulo, SP 05403-000, BrazilUniversity of São Paulo Medical School, Department of Dermatology, Av. Dr. Enéas de Carvalho Aguiar, 255 3° andar #3016, São Paulo, SP 05403-000, BrazilUniversity of São Paulo Medical School, Department of Dermatology, Av. Dr. Enéas de Carvalho Aguiar, 255 3° andar #3016, São Paulo, SP 05403-000, BrazilMUHC-McGill University Ocular Pathology Laboratory, 1001 Boul Decarie, Block E E02.2389, Montreal, QC H4A 3J1, CanadaPurpose: Pemphigus foliaceus (PF) is a rare, autoimmune blistering disorder characterized by the production of autoantibodies against desmoglein 1. The mainstay for diagnosis is the demonstration of immune complex deposition by direct immunofluorescence (DIF) in fresh tissue samples. Immunohistochemistry (IHC) recognizes autoantibodies in formalin-fixed paraffin-embedded specimens, but studies regarding its use in PF are scarce. This study aims to evaluate immunoglobulin and C3 deposition using IHC in patients with confirmed PF by DIF and indirect immunofluorescence (IIF). Material and methods: Six biopsies obtained from five patients with PF and six healthy individuals were included in this study. Anti-C3c, -IgG, -IgM, and -IgA antibodies were used for DIF and automated IHC. After digitalizing the slides, staining was classified as negative (0) or positive (1 = mild/2 = intense). Results: DIF revealed intraepidermal intercellular deposition of IgG and C3c (n = 6), without deposits in dermal structures. IHC was positive in the intercellular spaces between keratinocytes with anti-IgG (n = 6) and anti-C3c antibodies (n = 6); no intercellular immune complexes deposition was observed in healthy individuals. In patients with PF, inflammatory cells were tagged by anti-IgG and anti-C3c (n = 6), anti-IgM (n = 1), and anti-IgA (n = 1); and immune complexes at vessel walls were detected with anti-C3c, anti-IgG, anti-IgA (n = 6), and anti-IgM (n = 5) antibodies. Adnexal positivity occurred with anti-C3c and anti-IgG (n = 6), anti-IgM (n = 1), and anti-IgA (n = 3). Healthy individuals also presented positivity in inflammatory cells with anti-IgG and anti-C3c (n = 4), anti-IgM (n = 1), and anti-IgA (n = 3); vessels were stained with anti-IgG and anti-C3c (n = 5), anti-IgM and anti-IgA (n = 4); adnexa were not represented in all samples obtained from healthy individuals. Conclusion: IHC may serve as a reliable method to assess PF diagnosis. Immune deposits in dermal structures suggest their participation in autoimmune/inflammatory processes in PF. IHC may contribute to evaluate disease mechanisms, prognostic factors, and target-oriented treatment in PF.http://www.sciencedirect.com/science/article/pii/S2214330017300925
collection DOAJ
language English
format Article
sources DOAJ
author Denise Miyamoto
Celina Maruta
Claudia Santi
Pablo Zoroquiain
Ana Beatriz Dias
Ligia Fukumori
Alexandre Perigo
Valeria Aoki
Miguel Burnier, Jr
spellingShingle Denise Miyamoto
Celina Maruta
Claudia Santi
Pablo Zoroquiain
Ana Beatriz Dias
Ligia Fukumori
Alexandre Perigo
Valeria Aoki
Miguel Burnier, Jr
How can immunohistochemistry improve the diagnosis of pemphigus foliaceus?
Human Pathology: Case Reports
author_facet Denise Miyamoto
Celina Maruta
Claudia Santi
Pablo Zoroquiain
Ana Beatriz Dias
Ligia Fukumori
Alexandre Perigo
Valeria Aoki
Miguel Burnier, Jr
author_sort Denise Miyamoto
title How can immunohistochemistry improve the diagnosis of pemphigus foliaceus?
title_short How can immunohistochemistry improve the diagnosis of pemphigus foliaceus?
title_full How can immunohistochemistry improve the diagnosis of pemphigus foliaceus?
title_fullStr How can immunohistochemistry improve the diagnosis of pemphigus foliaceus?
title_full_unstemmed How can immunohistochemistry improve the diagnosis of pemphigus foliaceus?
title_sort how can immunohistochemistry improve the diagnosis of pemphigus foliaceus?
publisher Elsevier
series Human Pathology: Case Reports
issn 2214-3300
publishDate 2018-06-01
description Purpose: Pemphigus foliaceus (PF) is a rare, autoimmune blistering disorder characterized by the production of autoantibodies against desmoglein 1. The mainstay for diagnosis is the demonstration of immune complex deposition by direct immunofluorescence (DIF) in fresh tissue samples. Immunohistochemistry (IHC) recognizes autoantibodies in formalin-fixed paraffin-embedded specimens, but studies regarding its use in PF are scarce. This study aims to evaluate immunoglobulin and C3 deposition using IHC in patients with confirmed PF by DIF and indirect immunofluorescence (IIF). Material and methods: Six biopsies obtained from five patients with PF and six healthy individuals were included in this study. Anti-C3c, -IgG, -IgM, and -IgA antibodies were used for DIF and automated IHC. After digitalizing the slides, staining was classified as negative (0) or positive (1 = mild/2 = intense). Results: DIF revealed intraepidermal intercellular deposition of IgG and C3c (n = 6), without deposits in dermal structures. IHC was positive in the intercellular spaces between keratinocytes with anti-IgG (n = 6) and anti-C3c antibodies (n = 6); no intercellular immune complexes deposition was observed in healthy individuals. In patients with PF, inflammatory cells were tagged by anti-IgG and anti-C3c (n = 6), anti-IgM (n = 1), and anti-IgA (n = 1); and immune complexes at vessel walls were detected with anti-C3c, anti-IgG, anti-IgA (n = 6), and anti-IgM (n = 5) antibodies. Adnexal positivity occurred with anti-C3c and anti-IgG (n = 6), anti-IgM (n = 1), and anti-IgA (n = 3). Healthy individuals also presented positivity in inflammatory cells with anti-IgG and anti-C3c (n = 4), anti-IgM (n = 1), and anti-IgA (n = 3); vessels were stained with anti-IgG and anti-C3c (n = 5), anti-IgM and anti-IgA (n = 4); adnexa were not represented in all samples obtained from healthy individuals. Conclusion: IHC may serve as a reliable method to assess PF diagnosis. Immune deposits in dermal structures suggest their participation in autoimmune/inflammatory processes in PF. IHC may contribute to evaluate disease mechanisms, prognostic factors, and target-oriented treatment in PF.
url http://www.sciencedirect.com/science/article/pii/S2214330017300925
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