Blumberg et al reported a histopathologic score for evaluating a biopsy from a venous ulcer. This can be used to guide management of the ulcer. The authors are from New York University in New York City.
Patient selection: chronic venous ulcer
Biopsy: Taken from wound base
Microscopic exam: field using a 20x objective
Parameters:
(1) noninflammatory cellularity (includes fibroblasts, fibrocytes, macrophages)
(2) inflammation
(3) vascular proliferation
(4) pre-existing dense fibrosis (dense acellular mature collagen with minimal vascularity)
(5) collagen maturity
|
Parameter |
Finding |
Points |
|
noninflammatory cellularity |
< 25 per field |
1 |
|
|
25 to 100 per field |
2 |
|
|
> 100 per field |
3 |
|
inflammation |
< 5 inflammatory cells per field |
1 |
|
|
5 to 100 per field |
2 |
|
|
> 100 inflammatory cells per field |
3 |
|
vascular proliferation |
normal (< 3 capillaries) per field |
1 |
|
|
3 to 10 capillaries per field |
2 |
|
|
> 10 capillaries per field |
3 |
|
pre-existing dense fibrosis |
present |
1 |
|
|
absent |
2 |
|
collagen |
mature |
1 |
|
|
immature |
2 |
where:
• Mature collagen shows dense, acellular, eosinophilic discrete bundles lying parallel to each other with few interspersed fibrocytes.
• Immature collagen shows small, wavy eosinophilic bands mixed with fibroblasts and macrophages.
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 5
• maximum score: 13
• A score < 10 was associated with a non-healing ulcer.
Specialty: Cardiology
ICD-10: ,
