case_images: PMC4386117_01
case_images: a, b Waxy, whitish papules on the left side of the abdomen. c Multiple sclerosing plaques were scattered on the extremities. d A biopsy specimen from the left abdomen revealed hyperkeratosis with follicular plugging, atrophy of the stratum malpighii with hydropic degeneration of basal cells, and pronounced edema and homogenization of the collagen. Original magnification: x200. e A specimen from the right knee revealed interstitial lymphoplasmacytic infiltrates among the slightly thickened collagen bundles in the reticular dermis. Original magnification: x200.
case_images: cde-0007-0039-g01.jpg
case_images: PMC4386117_01_cde-0007-0039-g01.jpg
case_images: F1
case_images: On her initial visit, physical examination revealed asymptomatic, waxy, whitish papules on the left side of the abdomen (fig. 1a, b). In addition, multiple sclerosing plaques were scattered on the extremities (fig. 1c). A biopsy specimen from the left abdomen revealed hyperkeratosis with follicular plugging, atrophy of the stratum malpighii with hydropic degeneration of basal cells, and pronounced edema and homogenization of the collagen (fig. 1d). In contrast, a specimen from the right knee revealed interstitial lymphoplasmacytic infiltrates among the slightly thickened collagen bundles in the reticular dermis (fig. 1e).
case_images: Paraffin-embedded tissue samples from the abdomen (a, c, e, g, i) and the right knee (b, d, f, h, j) were deparaffinized and stained with anti-periostin antibody (a, b), anti-MMP-7 antibody (c, d), anti-MMP-28 antibody (e, f), anti-CD163 antibody (g, h) or anti-CD206 antibody (i, j). The sections were developed with liquid permanent red. Original magnification: x100 (a, b, h, j), x200 (c, d, e, f, g, i).
case_images: cde-0007-0039-g02.jpg
case_images: PMC4386117_01_cde-0007-0039-g02.jpg
case_images: F2
case_images: IHC staining. IHC staining for periostin revealed dense deposits of periostin in areas with dermal fibroblasts (fig. 2a, b). Moreover, MMP-7 (fig. 2c, d) and MMP-28 (fig. 2e, f) staining revealed that both MMP-7 and MMP-28 were highly expressed at the basal layer by spindle cells in the dermis in the lesional skin of LSA and morphea. IHC stainings, we semiquantitatively analyzed the intensity of IHC staining by scoring on a semiquantitative scale as previously reported. In addition, IHC staining for CD163 (fig. 2g, h) and CD206 (fig. 2i, j) revealed prominent CD163+CD206+ macrophages infiltrating around the perivascular and interstitial areas of the lesions from LSA and morphea.