Apoptosis. Its nature and implications for dermatopathology

Apoptosis is a distinctive mode of cell death with characteristic morphologic features which serves as a balance to mitosis in regulating the size of animal tissues. In contrast to coagulative necrosis, the cytologic features of apoptosis suggest active self-destructive rather than progressive disintegration. It typically affects scattered individual cells which condense and bud to produce many membrane-bounded fragments in which organelles appear intact when viewed by the electron microscope. These apoptotic bodies are then phagocytosed and digested by cells resident in the tissue. Apoptosis, unlike coagulative necrosis, does not itself evoke an inflammatory response. Apoptosis is a feature of such diverse processes as deletion of phylogenetic vestiges during normal embryonic development, involution of endocrine-dependent organs after withdrawal of trophic hormones, cell-mediated immune attack on tissues, and therapeutically induced regression of neoplasms. Apoptosis has received scant attention in dermatopathology. However, it is now known to be an important feature of lichen planus, certain drug eruptions, the skin lesions of graft-versus-host reactions, the regression of plane warts, and the effects of ultraviolet damage. It is also involved in the kinetics of cutaneous neoplasms. In some of these situations, apoptotic bodies have, in the past, been given names such as Civatte bodies, colloid bodies, single-cell necrobiosis, sunburn cells, and dyskeratotic cells without their basic nature having been recognized.