it's not on this it's not on the list oh i deleted it again i don't think it's on the list no no it's not no no sorry then we go to another slide we go to the b1255 um so i had a look at that one okay we can take any what do you see here i can't see your slide i don't know if you're supposed to be sharing yes i am i can't see it yep there we are i think it's loading um so on so i thought this was the head skin of a cow um yes because there were simple hair follicles and the um sweat glands are sort of yeah there's a large lumen within walled um on low power you can see multiple um oval cystic lesions um with sort of a ears in a philic ring around them that are predominantly in the superficial dermis but also um you can see in some areas on the left of the side extends down into the deeper dermis but predominantly in the superficial um and you can see still on low power that around just just sorry um in the cow we would call this part it's not a pediculus but we would call it hypodermis so it is something like a pediculus so i think the deep part just here that we you see the allergen follicle the bulb here so this is super dermis here until from here to here and all this here is hypodermis okay for the description yeah yeah yeah so extending into the hypodermis um yeah as well um and i'm saying still on low power you can see that around some of these um sort of cystic lesions there's infiltration of inflammatory cells that you can see um and then sort of onto the left of the slide there where there's a group of some of them you can see surrounding the cystic lesions um and on higher power around some of those areas you could see there was um histiocytes and eosinophils predominantly um was what i saw yeah i think those sort of larger ones there uh here we have some eosinophils i think most of them here are really lymphocytes but yes i would go here rather for eosinophils i agree lymphocytes there for sure also some histiocytes absolutely um yeah if you want to start this description you said multiple i think here really you should use the term abundant okay because i mean they are abundant it's not if you say multiple i think there is there are many but here and there but if if i mean here you it's most probably 50 percent of the dermis is replaced by these cysts yeah okay and then because this is the most important thing you should describe them a little bit better in terms of size and how they look like um i feel like i haven't measured them on size um but i suppose oval and there's kind of a amorphous basophilic um material in the center as you say with the eosinophilic ring and then there's sort of like little um dark purple sort of on the rim of the cyst this little dark purple um sort of longitudinal yeah little areas i don't know how to describe them you mean these um so kind of just those yeah on the outside okay i mean from size wise we know what it is and but if you are not sure you could always take a lymphocyte as a measure with eight nine microns so we i mean and then you can compare a bit but these are around between 200 and 800 micron it's in size that's okay what is how they are published and then you have to describe that they have this pale eosinophilic ring you said that you know what it is um i can't pronounce it but the best the in cows the best noitiosis i don't i can't pronounce it that's right yeah no no but i mean this um there's no other parasite cysts that it has this size really they are so big but note if you these pale eosinophilic do you know what this is around the cysts um no i don't know what the it's really compressed connective tissue of the dermis okay and then we have a compressed wall of the host cell or the host cell and with the cytoplasm and then we have this uh you could say uh banana shaped also uh bradisoids of the parasite so these are hundreds of these bradisoids from the best noitia which we see here two of them each of them is a bradiside of the parasite and then yes we have the inflammation sometimes surrounding it but in comparison i think to what we have as parasites here is really not not much because they are intracellular it's not much because they are in the dermis and it's not much because we are in the dermis yeah so this was just one example of this parasite cysts within the dermis as a foreign not foreign body but as is yeah any questions to this one i don't think so but anyway if you see a parasite you should try to at least measure it somehow in size okay and describe it a little bit and here we know that these bradisoides they are around yeah five six seven um microns in size probably a little bit smaller in length than a link inside here yeah just i have a question did you say that it was just fibrosis around the kissed the uh it's it's it's compressed uh fibrous connective tissue yeah okay and then we have i mean this is how this uh build up then we have this cell side the plasma is also compressed and then we have the bradiside yeah in the in the center the the power side the only ditya and the rest is host tissue mm-hmm okay and then we just have i think one more the 32 is there anyone who wants to go for that one you see it the slide we see it yeah sorry can you hear me yeah so 32 in the dermis I said that there are large nodular structures that you can see everywhere that are composed of degranulated eosinophils and collagen fibers yeah and that are flame figures yeah and everywhere around I said that there is a severe diffuse infiltrate composed mainly of eosinophils and some macrophages mainly yeah yeah extending from the superficial to deep dermis and sometimes and sometimes to the paniculus I think actually more or less it extends really to the paniculus if we have it yeah I mean here it's really deep but yes but yes we have multifocal coalescing nodular structures you can call it correct or eosinophilic structures and then we can discuss if these are degenerate collagen fibers or not depending whom you believe I think it's both it's also degenerate collagen fibers here because I mean these abundant eosinophils they have so many proteases collagen has to be degenerate but anyway what is the term here which we have to use is flame figures and that is exactly so what we do not see here yet is it's it's really flame figures and it's they are surrounded by these eosinophils you described it nicely we do not have yet the caseicides really surrounding it so that we could call it eosinophilic collagenous granuloma eosinophilic granuloma we still would call this how would you call it I said eosinophilic granuloma so just it's the eosinophilic granuloma complex I agree there but this I think you would rather describe clinically as a plug eosinophilic plug because we see the diffuse eosinophilic infiltrate but we do not see yet the the histicides surrounding the flame figures making them the granuloma here we have some histicides probably coming up but most we do not see neither the langerhand cells going around it or the epithelioid macrophages you know around if they are there then we would call it a granuloma but here we have mostly eosinophilic so I would still call it a plug okay there were places in the deep dermis with some red blood cells so I'm not sure I think in some places it was just maybe because of the biopsy and just artifacts my slide is gone again I don't know what just hang on oh it's coming ahead good now sorry to interrupt you you see here that's what I was meaning these are the epithelioid macrophages which are surrounding this flame so in this area and this is probably a lesion which is just at the border between just eosinophilic plug and the true collagenolytic granuloma because here we see signs of granuloma formation multinucleated giant cells or epithelioid macrophages here surrounding this flame figure so again sorry and you saw what red blood cells in the deep damis in some places but I'm not sure because there were not many blood cells so I'm not sure if it is really MRIH or if it is because of the biopsy and the artifact sure it's probably a biopsy artifact I don't see them or it you know where it was yes on left to the on on your right the rest of your cursor there is a basophil nodule just around it here yes here yeah I think this is a biopsy artifact yeah okay yeah and here we have we have we have a little lymph form composed of this lymphocyte as a reaction to the inflammation at Bach okay okay manika can I ask you a question yeah when this is a plaque shouldn't we see more spongiosis than in the epidermis in the epidermis not necessarily no I mean we have it but why do you think you see more spongiosis in the eosinophilic plaque than in a collagen and what should be the rationale behind it I don't know I have it in my notes that's why I had in my mind that that could be a way to differentiate them from each other but then I guess it's not no no no way sorry okay thank you no no I mean you may have spongiosis in any reaction pattern of the dermis no matter if it's a true granuloma or if it's a block or we saw it before in a musculopathy so anything you may solve in spongiosis so there's no way to distinguish that based on that okay thank you I mean I don't know Bob Dunstan once told me if it's true or not I don't know either or he taught it during a CL Davies meeting that if we have this more bluish type color these are the degenerate ears in the fields and if we have more red type color these are just degenerate collagen fibers there is a Spanish group that said the collagen is always normal in these cases which I personally do not believe but yeah I have never studied it myself so I cannot say anything to it but that's what Bob Dunstan always claimed that here where you see remnants of nuclei these are the eosinophils and where it's more eosinophilic that's just collagen from there's a predominant of degenerate collagen fibers and is this palisading and then why is it palisading palisading at edge here you mean yeah yeah I mean this is probably because the eosinophils that would be logical to me there's a piling up around this pre locus already but the term palisading you use rather for the hensiocytes which go around it yeah but it looks a bit the same it looks a bit the same that's true but probably it's really a lesion that builds up you know this time so you have a little focus and then the eosinophils come and come and degenerate there in this area and then it looks a little bit palisading or radiating okay thank you any other questions then I'm sorry for yeah just a quick thing about the elastosis so if I get it correctly they have to be very very thin strands anything thicker than what you should and bluish and bluish in the blue book in the Thelma book it is written the spaghetti of Walder they are called because Emily Walder described them first and they called she calls them Walder's spaghetti so you really can think about spaghetti spaghetti not blue usually but thin and long thin and long okay okay thank you but perhaps I will find eventually but I really looked at least at 20 or 30 slides which I got from abroad to look for the elastin fibers nice elastin fibers and I know I have one slide I don't know where it is if I once find them where it's really clear I shared with you okay thank you you're welcome any questions answered for now in April we continue with the dermal changes we go then more to the depositions now we had rather the changes in the extracellular matrix and yeah okay and sorry for the interruptions here the technical issues I don't know what happens I think it always happens only to me doesn't it anyway bye have a nice evening thank you thank you very much bye bye bye Thank you.