Scrape cytology of oral pemphigus - Report of a case with immunocytochemistry and light, scanning electron and transmission electron microscopy

BACKGROUND: Pemphigus vulgaris is a disseminated disease of the skin and mu cous membranes characterized by recurrent vesicular and bullous lesions due to the autoantigen belonging to the cadherin type of cell adhesion molecul es. The presence of acantholysis associated with immunoglobulins in the int ercellular spaces and on the cell membrane are diagnostic features. However , the appearance of smears from the oral cavity by scanning (SEM) and trans mission electron microscopic (TEM) study as well as immunocytochemistry of cadherin does not appear to have been previously reported. CASE: A 67-year-old female developed erosion on her gingiva with severe pai n. On oral examination, there were ulcerations on the palate, and the Nikol sky sign was positive. The characteristic cytologic findings from oral scra pes were high cellularity, a bloody background and a predominant cell popul ation consisting of polygonal basal and parabasal cells with pronounced nuc leoli. Also present were degenerative cell changes: e.g., cytoplasmic vacuo les and a homogeneous nuclear appearance. Immunocytochemical staining for I gG and cadherin gave a positive reaction in the intercellular spaces and on the cell membranes. The surface of cells in pemphigus vulgaris by SEM show ed somewhat irregularly distributed microridges, and TEM revealed desmosoma l attachments, degenerated tonofilaments with pronounced nucleoli and heter ochromatin. As a result of cytodiagnosis, additional appropriate specimens were obtained at the time of the scraping for confirmatory immunocytochemis try for cadherin, SEM and TEM studies. CONCLUSION: The results demonstrate that a precise diagnosis of pemphigus v ulgaris can be rendered on cellular material and cadherin immunocytochemist ry obtained by scrape from the oral mucosa.