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Examination of cutaneous macroglobulinosis by immunoelectron microscopy
Author(s) -
LIPSKER D.,
CRIBIER B.,
SPEHNER D.,
BOEHM N.,
HEID E.,
GROSSHANS E.
Publication year - 1996
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/j.1365-2133.1996.tb01163.x
Subject(s) - immunoelectron microscopy , dermis , pathology , immunogold labelling , dermoepidermal junction , ultrastructure , electron microscope , biology , anatomy , medicine , immunohistochemistry , physics , optics
Summary Cutaneous macroglobulinosis is a rare cutaneous manifestatiou of Waldenstrom's disease. Lesions are thought to result from accumulation of macroglobulin in the dermis and are therefore called IgM storage papules. Ultrastructural findings in the previously reported cases were contradictory and the nature of the deposits was not established by electron microscopy. The purpose of this study was to analyse such deposits by the use of immunoelectron microscopy. A 60‐year‐old woman had multiple erythemalous papules for 1 year. The histopathological changes consisted of plasmocytic infiltration of the dermis and eosinophiiic deposits. The skin changes and other investigations led to a diagnosis of Waldenstrom's disease. Samples from normal and diseased, skin were analysed by electron microscopy and by immunogold labelling with anti‐IgM antibodies, after Lowicryl K4M embedding. An extracellular electron dense granular and filamentous material was observed in the mid‐ and upper dermis, between and within the collagen bundles. No periodicity was noted and no deposits were seen at the dermoepidermal junction. Immunoelectron mieroscopy showed a positive labelling located only on these deposits, in both normal‐appearing skin and in lesions. In this patient, immunoelectron microscopy clearly demonstrated the presence of large amounts of IgM in the dermis, which were found in the lesions of cutaneous macroglobulinosis and in normal skin. These results suggest that the IgM storage papules result from a greater density of deposits rather than a site‐specitic accumulation.