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32 Conclusions . . . . . . . . . . . . . . 32 Acknowledgements . . . . . . . . . . 33 Q HS is a follicular disease Q Apocrine gland involvement appears to be secondary to follicular events 4 References . . . . . . . . . . . . . . . 1 Introduction There has been significant debate around the pathological features of hidradenitis suppurativa (HS) over the years. This debate focuses on whether the primary event relates to an inflammatory process of the apocrine duct or whether follicular occlusion is integral to the initiating process.
The early inflammatory event is perifolliculitis with neutrophils, lymphocytes and histiocytes leading to rupture of follicular epithelium. In a recent study using immunohistochemistry with six antikeratin antibodies it has been demonstrated that CK expression in PS is similar to that in HS, suggesting that the epithelium may be fragile, hyperproliferative and undiffer- Differentiating HS from Crohn’s disease merits attention. At times these diseases can be clinically indistinguishable and authors have emphasized that although foreign body granulomas are a common finding in HS, the presence of discrete epithelioid granulomas in the dermis away from the site of active inflammation is unusual and should alert the pathologist to the possibility of systemic granulomatous disease such as Crohn’s or sarcoidosis .
2 Atypical Localizations – Other Zones May Be Involved The buttocks are one of the most frequent of these “atypical localizations” especially in men. The clinical aspect is sometimes very peculiar: the deep-seated abscesses and sinus are closely associated in a unique lesion slowly extending at the periphery over a period of years (see Fig. 18). The lesions may be very large, solitary and very deep. Such single macro lesions may be mistaken for regular abscesses of the muscle or even bone-derived lesions.