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Pathology II - Derm 1
Terms in this set (223)
what will provide UV protection in the epidermis of the skin?
what provides mechanical barrier from pathogens in the epidermis layer?
Responsible for thermoregulation and electrolyte balance; Delivering drugs to skin, wound healing
Secretion is sterile and odorless --> at surface microorganisms liberate an odorous component
what are the layers of the epidermis
stratum corneum (keratin on top)
what is the portion of epidermis separating the dermal papillae
what is the function of the melanocytes
produce melanin, which protects against non-ionizing ultraviolet irradiation
What do Langerhans cells look like histologically?
clear cells in the suprabasal epidermis with kidney shaped nucleus
On EM what do Langerhans cells look like
Cerebriform nucleus with Birbeck granules
what is the function of the subcutaneous tissue
thermal regulation, insulation, provision of energy protection mechanical injuries
what is the normal flora of the follicular infundibulum
yeasts of Pityrosporum
Demodex folliculorum mite
where would you find free sebaceous glands unassociated with hair follicles?
areola and nipple = Montegomery's tubercles
Where are apocrine glands located?
Axillae, anogenital region, external auditory canal and areola
What area of the body would you have a high percentage of sebaceous glands?
what are some pathologies we would see with the stratum corneum layer of the Epidermis
hyperkeratosis (parakeratosis and orthokeratosis)
what are some pathologies we could see with the stratum granulosum layer
what are some pathologies we could see of the stratum spinosum
Preservation of nuclei in the stratum corneum with decreased granular layer
Thickened granular layer
increased proliferation of the spinous layer
discohesion of individual keratinocytes within the stratum spinosum
Faulty keratinization of keratinocytes; pyknotic nuclei
Full thickness loss of the epidermis
infiltration of inflammatory cells into the epidermis
Intra or intercellular formation of the vacuoles
Flat, circumscribed area <5mm; distinguished from surrounding by color
Large Macule; >5 mm
Elevated, flat topped scale or lichenification
thickened and rough skin, result of repeated rubbing
dry, horny, platelike
Elevated, solid <1 cm
elevated, solid; larger than a papule >1 cm
Fluid-filled <5 mm
Larger than a vesicle; Fluid-filled > 5mm
bulla are commonly referred to as blisters; if filled with pus it is referred to as
Pruritic, erythematous, elevated area
Linear scratch; often self induced
Loss of nail integrity
Acute inflammatory dermatoses is considered to be differentiated as eczematous or spongiotic by what?
eczematous = clinically
Spongiotic = histologically
what is the definition of spongiotic acute dermatosis
accumulation of edema fluid between keratinocytes (wet)
what are the three subclassifications of acute dermatoses?
Acute: wet and crusting erythematous papules and vesicles
Chronic: scaly plaques
Allergic contact dermatitis would look like what on the histology
"basket weave" stratum corneum
absence epidermal hyperplasia
what is spongiosis
intraepidermal and intracellular edema (widened intracellular spaces; elongation intercellular bridges)
what would the histopathology of subacute spongiotic dermatitis look like?
Acanthosis (overlap with psoriasiform pattern)
Serum crust (if affected with impetigo, neutrophilic crust)
what is the prototype of chronic spongiotic dermatitis
lichen simplex chornicus
what is the histopathology of Chronic spongiotic dermatitis
Marked hyperkeratosis (compact orthokeratosis, parakeratosis)
clinical subtypes of ___________ are histologically indistinguishable
Where would atopic dermatitis be found in adolescents and adults?
predilection flexural areas arms and legs
where would you find atopic dermatitis in infants and children?
favors face, extensor surfaces
what are the clinical features of atopic dermatitis?
chronic pruritc, erythematous, scaly relapsing papular dermatitis
History of atopy (asthma, allergic, rhinitis, allergies)
what type of hypersensitivity is allergic contact dermatitis?
type IV delayed hypersensitivity reaction
Pruritic edematous erythematous papules, plaques with or without vesicles
may have linear pattern depending on exposure method
Allergic contact dermatitis
what will be seen histopathologically for allergic contact dermatitis?
typical spongiotic dermatitis
+/- intraepidermal Langerhans cell microabscesses
Direct toxic effect of irritant substance resulting in an acute or chronic form
irritant contact dermatitis
what are the clinical features of acute irritant contact dermatitis?
erythema, scaling, papules, vesicles, and erosions at site of contact with irritant
what are the clinical features of chronic irritant contact dermatitis?
dryness, chapping and absence of vesicles
One of the most common forms of eczema that is biopsied usually found on the extensor surfaces of extremities
Clinical: intensely pruritic round to oval scaly patches and plaques
symmetric involvement of palms and/or soles and lateral aspects of digits
what is the clinical feature of acute dyshidrotic eczema?
recurrent, pruritic, deep-seated vesicles
what is the clinical feature of chronic dyshidrotic eczema?
scaling and fissuring
what is the histopathology of dyshidrotic eczema?
Acral skin and spongiotic dermatitis
Widespread dissemination of previously localized "eczematous process" or generalized vesicular dermatitis developing in association with a defined infection
what are the triggers of an Id reaction
what is the etiology of lichen simplex chronicus
scratching and rubbing (patients with other primary pruritc dermatosis)
where would you see lichen simplex chronicus?
neck, extremities and genitalia (anywhere someone can reach)
what is the most common site of lichen simplex chronicus
what are the clinical features of lichen simplex chronicus?
pruritic, thickened, hyperpigmented, localized plaques with accentuated skin markings
what is the histopathology of lichen simplex chronicus?
chronic spongiotic dermatitis features of excoriation
What would you see clinically with stasis dermatitis?
hyperpigmented eczematous plaques on bilateral lower extremities
may have ulcers
where does stasis dermatitis classically present?
what is the etiology of stasis dermatitis?
result of venous insufficiency
what is the histopathology of stasis dermatitis in the epidermis
what is the histopathology of stasis dermatitis in the dermis
lobular proliferation of thick walled blood vessels
what is the clinical features of seborrheic dermatitis?
erythema, greasy scales
what is the location of seborrheic dermatitis?
scalp, ears, eyebrows, nasolabial areas, and central chest
what is the histopathology of Seborrheic dermatitis?
variable epidermal hyperplasia
scale crust with neutrophils and parakeratosis around the follicular ostia
What are some causes of urticaria?
foods, drugs, insect venom, contact allergens, physical stimuli, pressure, vibration
what are the clinical features of urticaria?
abrupt-onset transient and recurrent wheals
what is the histopathology of urticaria?
interstitial dermal edema
dilated venules with endothelial swelling
sparse superficial perivascular lymphocytic infiltrate
Margination neutrophils +/- eosinophils
what are the clinical features of morbilliform drug eruptions/viral exanthems
symmetric, widespread macular or papular eruption
what is the histopathology of morbilliform drug eruptions/viral exanthems
+/- mild vacuolar change
+/- mild dyskeratosis
plus: dermal hypersensitivity reaction (blood vessel ectasia, superficial perivascular infiltrate of lymphocytes and occasional eosinophils)
what is the clinical features of pigmented purpuric dermatoses?
cayenne pepper macules on lower extremities
what is the histopathology of pigmented purpuric dermatoses?
superficial perivascular lymphocytic infiltrate (but no true destruction of vessel wall)
Extravasation of RBC's
where would you find psoriasis vulgaris?
extensor surfaces; elbows, knees, scalp, trunk, gluteal cleft, umbilicus, sites of trauma
what are the clinical features of psoriasis vulgaris?
well circumscribed erythematous dry plaques with silvery white scale; Auspitz signs (picking scale causes bleeding)
Arthritis: terminal interphalangeal joints
Nail changes: pitting, onycholysis
what are the clinical features of psoriasis guttate?
abrupt onset small pink scaly papules on trunk
in Younger patients
Associated with acute group A beta hemolytic streptococcoal infections
what is the histopathology of psoriasis vulgaris?
elongated and club shaped rete ridges
Diminished/absent granular layer
Suprapapillary plate thinning with underlying dilated papillary dermal vessels
collections of neutrophils in the stratum corneum in psoriasis vulgaris is called?
collections of neutrophils in the stratum spinosum in psoriasis vulgaris is called
what are the clinical features of lichen planus?
erythematous to violaceous (purple polygonal flat topped pruritic papules)
what is the histopathology of lichen planus?
dense band like lymphohistiocytic infiltrate obscuring dermal epidermal junction
basal vacuolization (dyskeratotic keratinocytes0
irregular "saw tooth" epidermal hyperplasia
what are the clinical features of pemphigus vulgaris?
painful oral erosions (large flaccid cutaneous blisters --> erosions)
+ nikolsky sign (rubbing forms blisters)
top layers of the skin slip away from the lower layers when slightly rubbed
what is the histopathology of pemphigus vulgaris?
suprabasilar acantholysis (tombstoning of basal keratinocytes, involves follicular epithelium)
Inflammation with eosinophils
upon direct immunofluorescence of Pemphigus vulgaris what do you find?
Intercellular IgG > C3 in chicken wire or fish net pattern
what is the localization of dermatitis herpetiformis
extensor surfaces (elbows and knees), buttocks, scalp, scapula
what are the clinical features of dermatitis herpetiformis
severely pruritic symmetric groups papulovesicles secondary features of excoriation
what disease associations do we see of dermatitis herpetiformis
celiac disease/gluten sensitive enteropathy
What are the clinical features of erythema nodosum?
acute, painful, erythematous nodules
poorly defined/localized bc the inflammation is deep and limited to the subcutaneous adipose tissue
where is the most likely location for erythema nodosum?
anterior lower extremities
what will you see histologically with erythema nodosum
inflammation (if chronic: lymphohistiocytic, granulomatous)
immediately adjacent fat lobule involvement
common, contagious epithelial tumors caused by human papillomaviruses
what are the different types of verruca
what is the transmission of verrucas?
what is the etiology of verruca vulgaris?
clinical features of verruca vulgaris
hard, rough surfaced papule(s)
new warts may arise at sites of trauma
what is the histopathology of verruca vulgaris
marked hyperkeratosis and acanthosis
columns parakeratosis with hemorrhage above papillomatous projections
hypergranulosis with coarse clumped keratohyaline granules
large vacuolated cells with pyknotic nuclei
what is the epidemiology of verruca plantaris?
most common in children and young adults
most frequent over pressure points
what are the clinical features of verruca plantaris?
sharply defined, round lesions with rough keratotic surface surrounded by a thickened horn
covered black dots representing thrombosed capillaries
do NOT retain normal fingerprint
what is the histopathology of verruca plantaris?
endophytic epidermal hyperplasia
eosinophilic intracytoplasmic inclusions
covered by thickened keratin with nuclei retained in stratum corneum as basophilic round bodies with clear halo
what is the pathogenesis of Verrruca Plantaris?
what is the etiology of Verruca plana
HPV type 3
what are the clinical features of verruca plana?
small skin colored smooth and flat papules
what is the histopathology of Verruca Plana
Epidermal hyperplasia with typical viral cytopathic changes
What are the clinical features of Molluscum Contagiosum?
Common, self limited
Children, young adults
Multiple lesions; trunk, anogenital region
Pruritic pink to skin colored umbilicated papules
what is the etiology of Molluscum Contagiosum?
viral disease of skin (Pox virus)
spread by direct contact
what is the histopathology of molluscum Contagiosum?
Invaginated cup shaped verrucous epidermal hyperplasia
Molluscum bodies (large, elliptical homogenous, eosinophilic cytoplasmic inclusions)
interdigital skin, palms, wrists, periareolar skin, genital skin
Erythematous papules and linear defined streaks
what is the etiology of Scabies
caused by sarcoptes scabiei
what is the histopathology of scabies?
burrow appears as a cleft in the stratum corneum
Adjacent epidermis is acanthotic, parakeratoic and spongiotic
Eosinophils are present in the dense extensive subjacent dermal inflammatory infiltrate
what is the pathogenesis of prurigo nodularis
result of chronic rubbing/scratching
what are the clinical features of prurigo nodularis
pruritic nodules on the neck, extremities and genitalia (anywhere the patient can reach)
what are the associations of Prurigo nodularis?
what dermatologic disorder will present with a hairy palm sign?
what is the histopathology of prurigo nodularis?
Hairy palm sign
Fibrosis of the papillary dermis
What is a hairy palm sign?
hyperkeratosis, epidermal hyperplasia + hair follicles
what are the clinical features of acanthosis nigricans?
velvety hyperpigmented plaques
where would you find Acanthosis nigricans on the body
axilla, neck folds, groin, anogenital region
benign type acanthosis nigricans would present in
Malignant type acanthosis nigricans would present in
what would be underlying a condition of acanthosis nigricans if it was in the elderly?
adenocarcinoma especially gastric adenocarcinoma
what is the histopathology of acanthosis nigricans?
undulating epidermis (papillomatosis)
Hyperkeratosis (No acanthosis nor basal cell layer hyperpigmentation)
what is a fibroepithelial polyp known as?
what is the localization of fibroepithelial polyp
neck, trunk, face and intertriginous zones
clinically what would you see with fibroepithelial polyp?
flesh colored, bag like tumor
attached to the surface by small, slender stalk
what is the histopathology of fibroepithelial polyp?
benign squamous epithelium, some with hyperplasia
prominent fibrovascular core (may infarct)
absence of adnexa
benign solitary clonal proliferation keratinocytes
what are the clinical features of seborrheic keratosis?
"stuck on" well circumscribed, most commonly oval, brown-black greasy/waxy papules and plaques
(if irritated with crust and hyperkeratosis may present pink to red and scaly)
what are the different types of seborrheic keratosis?
benign pigmented solitary proliferation keratinocytes on sun exposed skin
T/f solar lentigo is a disorder of melanocytes
where is the localization of solar lentigo?
sun exposed skin; spares palms and soles, relative sparing sun protected areas
Clinically and macroscopic features of solar lentigo
well-circumscribed uniformly pigmented macules
what is the histopathology of solar lentigo
elongation of the rete ridges (rete ridges = bulb like)
marked solar elastosis
what is the prognosis of solar lentigo?
benign: may evolve into reticulated seborrheic keratosis
what are the clinical features of keratoacanthoma
solitary nodules with central keratin plug
grow rapidly 1-2 months --> spontaneous involution 3 to 6 months
what is the histopathology of keratoacanthoma?
exoendophytic squamoproliferation with central keratin plug and epidermal collaret
keratinocytes pale eosinophilic cytoplasm
mixed inflammatory infiltrate
what is the most reliable feature when looking at the histopathology of keratoacanthoma
less than full thickness keratinocyte atypia caused by sun damage
what are the clinical features of actinic keratosis?
usually multiple asymptomatic irregular erythematous plaque with fine scale on sun-exposed areas
what is the histopathology of actinic keratosis?
less than full thickness atypia (confined by basement membrane)
parakeratosis and hypogranulosis (alternating between spared acrotrichia and acrosyringia with orthokeratosis)
what is the prognosis of actinic keratosis?
8 to 20% progress to invasive SCC
what is it called when you have full thickness keratinocyte atypia?
What is the epidemiology of Bowen disease?
older fair skinned caucasian; M>F
involves both exposed and non exposed skin
what is the etiology of Bowen disease?
numerous factors: sun damage, arsenic, HPV, immunodeficiencies, trauma, chronic irritation, tobacco exposure
what is the histopathology of Bowen disease?
full thickness (confined by basement membrane)
Abnormal keratinocyte maturation (loss polarity and progression)
and atypia (hyperchromatism, pale staining to vacuolated cells)
Dermal changes: solar elastosis
Malignant neoplasm of keratinocytes with variable squamous differentiation
Squamous cell carcinoma
what is the etiology of Squamous cell carcinoma?
UVB - most important
others: carcinogen exposure, tobacco, chronic ulcers, arsenic, ionizing radiation
what are the clinical features of squamous cell carcinoma?
shallow ulcers with keratinous crust and elevated, indurated periphery on sun exposed areas and vermillion border of lower lip
surrounding areas show changes of actinic damage
what is the histopathology of squamous cell carcinoma?
invasion of keratinocytes through basement membrane into dermis
Squamous cell carcinoma with loosening intercellular bridges
localization to the head and neck region particularly the ears
Thought to be more aggressive than conventional SCC
Acantholytic Squamous cell carcinoma
what is the histopathology of Acantholytic Squamous Cell carcinoma?
Irregular islands of atypical keratinocytes infiltrating dermis
prominent suprabasilar/intratumoral acantholysis
poorly differentiated SCC with spindle cell morphology
similar to conventional SCC
May be associated with aggressive behavior
Spindle cell squamous cell carcinoma
What is the histopathology of Spindle Cell squamous cell carcinoma?
Infiltrating proliferation of atypical spindle cells
Hints: may have small component of more conventional SCC
may be attached to overlying SCCIS component
Malignant cutaneous tumor with lobules, columns, bands or cords of basaloid (germinative) cells
Basal cell carcinoma
what is the most common cutaneous tumor
Basal cell carcinoma
What is the etiology of Basal cell carcinoma?
UVB - most important
others: carcinogen exposure, tobacco chronic ulcers, arsenic, ionizing radiation
what are the clinical features of Basal cell carcinoma?
Solitary pearly nodule with rolled border
Are there genetics involved with developing basal cell carcinoma?
yes - mutation of the PTCH1 gene which encodes inhibitor of hedgehog signaling pathway
What is the pathology associated with Basal cell carcinoma?
various growth patterns (often mixed)
all proliferation of basaloid cells with peripheral palisade
all surrounded by fibromucinous stroma
mitotic figures and apoptotic cells
clefting artifact between tumor and stroma
what is the histopathology of Superficial basal cell carcinoma?
superficial lobules of basaloid cells (usually confined to papillary dermis)
projecting from epidermis or adnexa
what is the most common pattern of basal cell carcinoma
nodular basal cell carcinoma
what are the clinical features of nodular basal cell carcinoma?
Elevated pearly nodules
Associated with telangiectasia
what is the histopathology of nodular basal cell carcinoma?
Large lobules of basaloid cells (project into reticular dermis/deeper
what is the most common site for micronodular basal cell carcinoma?
what is the histopathology of micronodular basal cell carcinoma
Small lobules of basaloid cells (project into reticular dermis/deeper
Why is the prognosis/predictive factors of micronodular basal cell carcinoma usually worse?
because surgical margins often underestimate depth of tumor growth
what are the clinical features of infiltrating basal cell carcinoma?
pale, indurated poorly defined plaque
paraesthesia/loss of sensation
what is the histopathology of infiltrating basal cell carcinoma?
infiltrative strands, cords or columns of basaloid cells (project into reticular dermis/deeper)
peripheral palisade and retraction may be absent
frequent perineural invasion
what are the clinical features of fibroepithelial basal cell carcinoma?
elevated flesh colored/erythematous nodules
what is the histopathology of fibroepithelial basal cell carcinoma
arborizing network of cords of basaloid cells
what is the clinical features of nevoid basal cell carcinoma syndrome
multiple BCC at early age (2 y/o)
begin on nape neck; most involve face and upper chest
lesion with increased basal pigment, but no increase melanocytes
what is the most common pigmented lesion of childhood
Small tan-red brown macules
first appear after sun exposure
fade, reappear and darken cyclically and with exposure
what is the histopathology of ephelis?
increased melanin pigment with basal keratinocytes
normal number of melanocytes
what are the three different types of common acquired nevus?
what is the histopathology of junctional common acquired nevus
nests of melanocytes confined to lower epidermis
what is the histopathology of compound common acquired nevus?
nests melanocytes present in both: epidermis (lower) and dermis (maturation)
what is the histopathology of intradermal common acquired nevus
nests melanocytes confined: dermis
intradermal proliferation pigmented dendritic spindled melanocytes separated by thick collagen
F>M; young adults
Common blue nevus
what are the clinical features of common blue nevus?
acquired, asymptomatic, solitary blue to black papule
what is the histopathology of Common blue nevus?
symmetrical, variable cellular proliferation pigmented dermal dendritic melanocytes
increased melanocytes along basal layer
small, round, uniform, brown/black, sharply circumscribed macule; most often on trunk and extremities
Histopathology of simple lentigo?
increased melanocytes in basal layer (disposed as solitary units)
Solitary or multiple nevi, variable in color, border and size with perferential location on the upper trunk and extremities. Dysplastic nevi occur as sporadic lesions and in a familial setting. They may progress to malignant melanoma
What are the histopathologic features of dysplastic nevus?
bridging of rete pegs
benign melanocytic proliferations palms and soles; Localization more so on the plantar surface and occurs on both pressure bearing and pressure sparing surfaces
small light to dark brown macule
what is the histopathology of acral nevus
benign proliferation large spindled/epithelioid melanocytes that begins epidermis and evolves into compound/intradermal stages
Clinical features: initial period of rapid growth --> stabilization (classic: pink red dome shaped papule)
what is the histopathology of a spitz nevus?
vertically oritented fascicles of spindled to epithelioid melanocytes at DEJ and papillary dermis (cleft artifact between nests and keratinocytes)
Kamino bodies= eosinophilic globules of basement membrane material
what are Kamino bodies
eosinophilic globules of basement membrane material
Clinical: nevus surrounded symmetrical area depigmentation
histology: brisk lymphocytic infiltrate and loss of pigment in adjacent epidermis
what is the histopathology of halo nevus
Banal nevus + dense lymphocytic infiltrate
halo region = reduction/absence melanocytes
what is the ABCD rule for clinical presentation of melanoma
what is the most powerful predictors of survival for melanoma?
Brewlow's depth category - measured from top of granular layer of the epidermis (of if the surface is ulcerated, from the base of the ulcer to the deepest invasive cell across the broad base of the tumor
more reproducible and more accurately predicts subsequent behavior of malignant melanoma in lesions larger than 1.5 mm in thickness
melanoma with radial growth phase comprised large neoplastic melanocytes with pagetoid spreading amongst keratinocytes
Superficial spreading melanoma
what is the clinical features of superficial spreading melanoma?
irregularly variably pigmented macule --> plaque --> papule (vertical growth phase)
what is the histopathology of superficial spreading melanoma in situ?
pagetoid spread atypical melanocytes limited epidermis (buckshot scatter)
what is the histopathology of superficial spreading melanoma invasion type
atypical melanocytes within dermis (lack maturation)
subtype of malignant melanoma exclusively in vertical growth phase; 2nd most common melanoma subtype
Clinically: rapidly expanding large well circumscribed and symmetrical papule/plaque
what is the histopathology of Nodular melanoma?
No radial growth phase
epidermis is thin and may be ulcerated
dermal component consists of a cohesive nodule of tumor cells with pushing borders
cells are most commonly epithelioid, may be spindled
form MIS characterized linear and nested proliferation atypical melanocytes along DEJ and involving adnexal structures
what is the localization of Lentigo Maligna?
chronically sun exposed skin, mainly face
what is the clinical features of lentigo maligna?
irregular variably pigment macule with ill defined border
severe solar damage
5% of lentigo maligna will go on to develop?
Lentigo maligna melanoma
Non-hair bearing skin of palms/ soles with characteristic histologic appearance similar to Lentigo maligna melanoma
what is the clinical features of the acral lentiginous melanoma?
Palmar/Plantar: Macule --> papule/nodule
Subungual: brown/black discoloration nail --> bands/ streaks pigmentation (longitudinal melanonychia) --> hutchinson's sign
what is an important clinical clue to subungual melanoma?
Hutchinson's nail sign
what is the hutchinson's nail sign?
extension of brown or black pigment from the nail bed, matrix and nail plate to the adjacent cuticle and proximal or lateral nail folds
what are the different histopathology characteristics of acral lentiginous melanoma compared to lentigo maligna
Epidermal acanthosis, hyperkeratosis
no solar elastosis
T-cell lymphoproliferative disorder confined to the skin
clinically: elderly patients, evolution (scaly, red-brown patches), often confused with eczema, psoriasis, raised scaly plaques, Multiple large nodules
what is the pathology of Mycosis fungoides?
band-like aggregates of atypical T cells in superficial dermis
invasion into epidermis as single cells/clusters
folded nuclear membranes
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