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Pathology · single question

What is the most appropriate biopsy technique/site for a suspected case of pemphigus vulgaris?

  1. Biopsy taken directly from the center of an open, ulcerated lesion
  2. A biopsy that includes perilesional, clinically intact mucosa adjacent to a fresh (early) lesion — important for both routine histology and direct immunofluorescence
  3. Biopsy of completely normal, distant mucosa only
  4. Cytologic smear alone, without tissue biopsy
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Correct answer: B. A biopsy that includes perilesional, clinically intact mucosa adjacent to a fresh (early) lesion — important for both routine histology and direct immunofluorescence

Biopsying perilesional, intact-appearing tissue (rather than an already-ulcerated/necrotic lesion center, which may show only nonspecific changes) preserves the diagnostic intraepithelial split and allows for direct immunofluorescence, which is essential to confirm the autoimmune (IgG against desmoglein) basis of pemphigus.

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