A 40-year-old woman with systemic sclerosis develops severe Raynaud's phenomenon with digital ulcers. Her serology shows anti-topoisomerase I (anti-Scl-70) antibody. Regarding her cutaneous sclerosis, the histopathological feature in late-stage scleroderma is:
- A Dense homogenized collagen bundles in the reticular dermis replacing adnexal structures ✓
- B Vacuolar interface change with dermal mucin deposition
- C Perivascular plasma cell infiltrate with obliterative vasculopathy
- D Palisading granuloma with central fibrinoid necrosis
Correct answer: A. Dense homogenized collagen bundles in the reticular dermis replacing adnexal structures
Explanation
Late-stage systemic sclerosis (scleroderma) histopathology shows dense, hyalinized, homogenized collagen bundles in the reticular dermis with replacement/entrapment of adnexal structures (hair follicles, sweat glands) by fibrosis. Early stages show edema and perivascular lymphocytic infiltrate. Anti-Scl-70 (anti-topoisomerase I) is associated with diffuse cutaneous SSc and higher risk of ILD. Interface dermatitis with mucin is seen in lupus erythematosus. Palisading granuloma is seen in rheumatoid nodule or granuloma annulare.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
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