Help Understanding Scalp Biopsy Results

[LuluBucks]

My dermatologist preformed a scalp biopsy a few weeks ago and she told me that I was diagnosed with early stage female pattern alopecia. However when I read the pathology report it does not seem clear to me. In fact it seems somewhat contradictory. Any help is welcome!

Results

REPORT                                                             Corrected    

**** THIS IS AN AMENDED REPORT ****

CLINICAL DATA: ? TELOGEN EFFLUVIUM VS ANDROGENETIC ALOPECIA

SPECIMEN: L SCALP PUNCH

DIAGNOSIS:

SKIN, LEFT SCALP, TRANSVERSELY-SECTIONED 4-mm PUNCH BIOPSY:

BORDERLINE TERMINAL-VELLUS RATIO OF 3.2:1, SUGGESTIVE OF EARLY

FEMALE

PATTERN ALOPECIA (ANDROGENETIC ALOPECIA). SEE NOTE.

AMENDED REPORT NOTE: This report has been amended at the request of

Arali at Dr. Zavod's office received via a Report Change Request form to

correct the referring physician listed on the original report. The

original report listed "Monica Lawry, M.D.," as the referring physician.

The correct physician is "Meghan B. Zavod, M.D.," as stated on the

requisition. This report reflects this correction, and the remainder of

the report is unchanged. (jd; 05/22/17)

NOTE: These are not the changes of alopecia areata. There is no evidence

of a

scarring or inflammatory alopecia: the overall hair count is 57 (at

the upper end of the reference range for a 4-mm punch biopsy specimen),

folliculosebaceous architecture is preserved, and there is no extensive

or significant deep inflammation.

The main histopathologic finding is of mild miniaturization reflected in

a terminal-vellus ratio of 3.2:1 (but the terminal-vellus ratio falls to

2:1 when all of the indeterminate hairs are counted as miniaturized

hairs). This is suggestive – but not definitively diagnostic – of an

early stage of female pattern alopecia (FPA), which in classic or

fully-developed cases shows terminal-vellus ratios that are often well

below 2:1.

The catagen-telogen count is approximately 9%, a relatively low value

that could be either normal or possibly mildly elevated for this patient

(the patient's baseline catagen-telogen count is not known), but this

value alone does not provide definitive evidence for telogen effluvium;

therefore, clinical

  correlation is recommended regarding possible

etiologies for telogen effluvium, especially if low-grade telogen

effluvium (chronic telogen effluvium) is suspected.

GROSS DESCRIPTION: MTD:gg

Received in formalin in a container labeled with the patient's name and

"L scalp" is a single 0.4 x 0.4 cm circular tan rough portion of skin

with a depth of 0.3 cm. The base of the specimen is inked blue and

entirely submitted ink side down between sponges in one cassette.

MICROSCOPIC DESCRIPTION:

A total of 24 horizontal sections were examined on this 4-mm diameter

punch biopsy specimen from the level of the eccrine glands in the deep

reticular dermis to the level of the uppermost reticular dermis,

papillary dermis and portions of the epidermis. There is focal mild

chronic inflammation and slight perifollicular fibrosis involving the

superficial infundibulum of at least one hair follicle (a common

non-specific histologic finding in androgenetic alopecia), but

there is

no extensive or deep inflammation, and no follicular dropout or

significant fibrosis is evident such that there is no evidence of an

inflammatory or scarring alopecia. At the level of the subcutis, there

are lower portions of 27 terminal anagen hairs, 2 terminal

catagen-telogen hairs, 1 indeterminate hair, and a few fibrous

streamers. No peribulbar lymphocytic infiltrates are identified.

Additional hairs are identified at more superficial levels so that 57

hairs are identified overall: 35 terminal anagen hairs, 2 terminal

catagen hairs, 1 terminal telogen hairs, 9 indeterminate anagen hairs, 2

indeterminate catagen hairs, and 8 vellus hairs. After reassigning

one-half of the indeterminate anagen hairs (4.5 hairs) to the terminal

anagen hairs, one-half of the indeterminate anagen hairs (4.5 hairs) to

the miniaturized group, one-half of the indeterminate catagen hairs (1

hair) to the terminal catagen hairs, and one-half of the indeterminate

catagen hairs (1 hair)

to the miniaturized group, the terminal-vellus

ratio is calculated at 3.2:1, and the anagen-telogen ratio for terminal

hairs is calculated at 91%:9% (prior to this reassignment, the

terminal-vellus ratio would have been 2:1, and the anagen-telogen ratio

for terminal hairs would be 92%:8%).