51 - 100 Flashcards
Treatment of postmenopausal women with systemic conjugated estrogens has demonstrated:
1 Increased cellular atypia
2 Decreased mitotic activity of keratinocytes
3 Increased dermal collagen content
4 Decreased sebaceous gland activity
5 Increased skin laxity
Increased dermal collagen content
Systemic use of conjugated estrogens in postmenopausal women increases total skin thickness, dermal collagen content and mitotic activity of keratinocytes. In addition, there is a reduction of dry skin, slackness and increased hydration.
Osteoclast-like giant cells are characteristic of:
1 Giant cell fibroblastoma
2 Reticulohistiocytoma
3 Necrobiosis lipoidica diabeticorum
4 Giant cell tumor of the tendon sheath
5 Necrobiotic xanthogranuloma
Giant cell tumor of the tendon sheath
Osteoclast-like giant cells are seen in giant cell tumor of the tendon sheath. Osteoclast-like giant cells have eosinophilic cytoplasm with haphazardly arranged nuclei. Reticulohistiocytoma is characterized by giant cells with an oncocytic glassy pink cytoplasm.
This biopsy was obtained from an annular pigmented plaque on the trunk, what is this neoplasm?
1 Targetoid hemosiderotic hemangioma
2 Glomeruloid hemangioma
3 Angiosarcoma
4 Kaposi’s sarcoma
5 Tufted hemangioma
Targetoid hemosiderotic hemangioma
Targetoid Hemosiderotic Hemangioma: Occurs most commonly on young adult males on the trunk and named for its clinical appearance. The lesion typically appears as a plaque with concentric rings, there is violaceous central region surrounded by a ring of pallor which is then surrounded by an erythematous or brown rim. Histologically in the superficial dermis there are dilated blood vessels, some of which have plump hobnailed endothelial cells. In the deeper dermis the vessels have a narrower lumen and dissect between the collagen bundles. Often within the lesion there are extravasated red blood cells and hemosiderin.
Target Sign
The pigment deposits in ochronosis are accentuated with:
1 Cresyl violet
2 Methyl-green pyronin
3 Silver nitrate
4 Bodian
5 Cresyl violet and silver nitrate
Cresyl violet
Cresyl violet stains the pigment deposits in ochronosis black. Methylene blue will also stain the pigment black. This pigment does not stain with silver nitrate. The Bodian stain is for nerves. Methyl-green pyronin stains RNA and DNA.
Crysel violet ear ring hook on bananas!
This presented as a papule with a tuft of hair on the face, what is this neoplasm?
1 Trichofolliculoma
2 Trichoepithelioma
3 Fibrous Papule
4 Acrochordon
5 Fibrofolliculoma
Trichofolliculoma
Trichofolliculoma: Most often occurs on the face as a papule with a tuft of hair. Histologically composed of a central dilated large follicle (Mama hair), from which many secondary smaller hair follicles radiate (Baby hairs), with the entire unit often enveloped in a vascularized fibrotic stroma. If sebaceous glands are associated with the hair follicles then the term used is a sebaceous trichofolliculoma or a Folliculosebaceous cystic hamartoma. Within the mesenchymal stroma there are increased CD34 and factor XIIIA fibroblasts and Merkel cells as is seen in the ORS of the follicles.
Psoriasis has been shown to be genetically linked to:
1 Pityriasis rubra pilaris
2 Clear cell acanthomas
3 Epidermodysplasia verruciformis
4 Verruciform xanthomas
5 Poromas
Epidermodysplasia verruciformis
Mutations have been found in the EVER1 and EVER2 genes in epidermodysplasia verruciformis; these genes are on 17q25, the location of the PSORS2 gene (one of the genes implicated in the inheritance of psoriasis).
Multiple pilomatricomas are seen in:
1 Myotonic dystrophy
2 Cowden’s
3 Turner’s
4 Gorlin’s
5 Myotonic dystrophy and Turner’s
Myotonic dystrophy and Turner’s
Multiple pilomatricomas are seen in Rubinstein-Taybi, Gardner’s (cyst-like pilomatricomas), myotonic dystrophy, Turner’s, sarcoidosis, sternal cleft and coagulation defects.
Tina Turner & Hawaii Ironman Super Dad & Son
All of the following markers can be helpful in differentiating basal cell carcinoma from trichoepithelioma except
1 CD10
2 CD31
3 CD34
4 Bcl-2
5 Stromelysin-3
Diffuse staining with this marker is suggestive of BCC rather than trichoepithelioma:
1 CAM 5.2
2 Bcl-2
3 PTAH
4 CEA
5 Cytokeratin 8
Bcl-2
Trichoepitheliomas stain with bcl-2 on the periphery of individual tumor islands.
BCL connector
Diffuse = BCC
PERIPHERAL = Trichoepithelomas
Clinically, a nondescript hyperkeratotic papule on the ulnar side of the base of the fifth finger is most likely:
1 Acquired digital fibrokeratoma
2 Accessory digit
3 Cutaneous horn
4 Digital fibromatosis
5 Glomus tumor
Accessory digit Accessory digits (supernumerary digits) are usually found at the base of the fifth finger, often bilaterally.
Cicatricial pemphigoid antibodies directed against this are associated with high frequency of malignancy:
1 Laminin 5
2 Laminin 6
3 Beta4-integrin
4 BPAg2
5 All of these answers are correct
Laminin 5
Anti-laminin 5 cicatricial pemphigoid (CP) is also known as anti-epiligrin CP. Anti-epiligrin CP is associated with an increased frequency of internal adenocarcinomas. Laminin 5 is composed of three chains (heterotrimer), alpha3, beta3, gamma2. Antibodies are frequently directed against the alpha3 chain, and so cross-reactivity can be observed with laminin 6, as laminin 6 (alpha3beta1gamma1) has the alpha3 chain as well. Beta4-integrin antibodies have been associated with ocular CP. BPAg2 antibodies are seen in CP patients that have mucosal as well as skin disease.
What is this neoplasm?
1 Sclerotic fibroma
2 Angiofibroma
3 Keloid
4 Neurofibroma
5 Dermatofibroma
Sclerotic fibroma Sclerotic Fibroma (circumscribed storiform collagenoma): This can occur as an isolated lesion n the head or neck or upper extremities, but multiple lesions are associated with Cowden's disease which is an AD disorder linked to a mutation of PTEN on chromosome 10p. Histology: Dome shaped papule with an overlying attenuated epidermis. A well-circumscribed nodule composed of thickened homogenous collagen that is arranged in whorls with a thumbprint or grains of wood appearance is seen in the dermis. Overall the lesion exhibits low cellularity and the elastic fibers are absent. The tumor stains positively with vimentin, Factor XIIIA and focally for CD34.
What is this neoplasm?
1 Trichoadenoma
2 Trichoblastoma
3 Trichoepithelioma
4 Basal cell carcinoma
5 Nevus comedonicus
Trichoadenoma
Trichoadenoma: A nodule on the face or butt that is slightly depressed. Typically confined to the upper dermis and composed of multiple milia or infundibular-like cysts that have a squamous epithelial lining associated with a granular layer and central flakey keratin in the lumen. The stroma can be sclerotic. The lesion is composed primary of cysts with a few thin strands of basaloid cells; if basaloid strands predominate with only a few cysts then lesion is a trichoepithelioma.
John Lennon Glasses
Which of the following body contains calcium:
1 Negri body
2 Lipschutz body
3 Michaelis-Gutman body
4 Guarnieri body
5 Negri body and Michaelis-Gutman body
Michaelis-Gutman body
The Michaelis-Gutman body is a concentrically laminated spherical inclusion that contains calcium that is seen within macrophages in malakoplakia. Other inclusion bodies that contain calcium are Schaumann bodies and psammoma bodies. The Negri body is seen in rabies. The Lipschutz body is an intranuclear inclusion seen in herpes. It is considered synonymous with the Cowdry A body. The Guarnieri body is seen in smallpox.
FIG CODE:
BIG MAC = Macrophage
Cow = Calcium
George Michael Wham = Michaelis-Gutman Malakoplakia
Malakoplakia is a rare inflammatory condition which makes its presence known as a papule, plaque[disambiguation needed] or ulceration that usually affects the genitourinary tract.[1]:274 However, it may also be associated with other bodily organs. It was initially described in the early 1900s as soft yellowish plaques found on the mucosa of the urinary bladder. Microscopically it is characterized by the presence of foamy histiocytes with basophilic inclusions called Michaelis-Gutmann bodies.
It usually involves gram negative bacteria.[2]
Malakoplakia is thought to result from the insufficient killing of bacteria by macrophages. Therefore, the partially digested bacteria accumulate in macrophages and leads to a deposition of iron and calcium. The impairment of bactericidal activity manifests itself as the formation of an ulcer, plaque or papule.
Malakoplakia is associated with patients with a history of immunosuppression due to lymphoma, diabetes mellitus, renal transplantation, or because of long-term therapy with systemic corticosteroids.
Treatment
Today, antibiotics are used for treatment of malakoplakia.
This keratin is associated with hair and nail:
1 Keratin 6
2 Keratin 8
3 Keratin 10
4 Keratin 16
5 Keratin 17
Keratin 17
Keratins 6 and 16 are found in the nail. Keratin 17 is seen in the nail as well as in the hair follicle, and patients with pachyonychia congenital type 2, in which there is a mutation of keratins 6b and 17, have nail findings as well as steatocysts.
Subcutaneous panniculitis-like T-cell lymphoma with an indolent course is positive for which of the following?
1 CD4
2 CD8
3 CD10
4 CD45
5 CD57
CD8
There seems to be two subsets of subcutaneous panniculitis-like T-cell lymphoma. One has an indolent course, and is often CD8-positive and is positive for the alpha-beta T-cell receptor. The other has an aggressive course, sometimes with evidence of systemic hemophagocytosis and high mortality. This subset is CD56-positive and positive for the gamma-delta T-cell receptor.
Histologic examination of cutaneous metastases from breast cancer is likely to demonstrate:
1 Dense lymphocytic infiltration
2 Tumors cells perivascularly
3 Eosinophilia
4 Tumor cells in the lymphatics
5 Band-like dermal infiltrate
Tumor cells in the lymphatics
Histologic appearance of metastatic breast carcinoma to the skin typically shows tumor cells in linear arrangement in so-called “Indian-filing” pattern. These tend to occur in the dermis and subcutaneous lymphatics. Extensive lymphatic dissemination may be caused by retrograde lymphatic spread. The tumor cells are large, pleomorphic with hyperchromatic nuclei.
This is an H and E stained slide, what is the organism?
1 Exophiala jeanselmei
2 Chromomycosis
3 Nocardia
4 Zygomycosis
5 Mucormycosis
Exophiala jeanselmei
Phaeohyphomycotic cyst: Typically the result of an opportunist infection caused by being impaled by a splinter contaminated with a dematiaceous or pigmented fungus. Most commonly seen on distal extremities and results in a dermal abscess with fibrous tissue and granulomas within which are pigmented hyphae and yeast. The most common organism is Exophiala jeanselmei (yellow-brown septae hypha) and Wangiella dermatitidis. Histology: Circumscribed cyst with a fibrous wall within which is a chronic granulomatous reaction or dermal abscess, a splinter is sometimes seen along with the brown filamentous hyphae and yeast.
Phaeohyphomycosis
Description:
A mycotic infection of humans and lower animals caused by a number of dematiaceous (brown-pigmented) fungi where the tissue morphology of the causative organism is mycelial. This separates it from other clinical types of disease involving brown-pigmented fungi where the tissue morphology of the organism is a grain (mycotic mycetoma) or sclerotic body (chromoblastomycosis). The etiological agents include various dematiaceous hyphomycetes especially species of Exophiala, Phialophora, Wangiella, Bipolaris, Exserohilum, Cladophialophora , Phaeoannellomyces, Aureobasidium, Cladosporium, Curvularia and Alternaria. Ajello (1986) listed 71 species from 39 genera as causative agents of phaeohyphomycosis.
Clinical manifestations:
Clinical forms of phaeohyphomycosis range from localized superficial infections of the stratum corneum (tinea nigra) to subcutaneous cysts (phaeomycotic cyst) to invasion of the brain. Ideally, individual disease states involving an invasive fungal infection by a dematiaceous hyphomycete should be designated by a specific description of the pathology and the causative fungal genus or species (where known); for example “pathology A” caused by “fungus X”.
- Subcutaneous phaeohyphomycosis:
Subcutaneous infections occur worldwide, usually following the traumatic implantation of fungal elements from contaminated soil, thorns or wood splinters. Exophiala jeanselmei and Wangiella dermatitidisare the most common agents and cystic lesions occur most often in adults. Occasionally, overlying verrucous lesions are formed, especially in the immunosuppressed patient.
The promontory sign is seen in:
1 Tufted angioma
2 Glomeruloid hemangioma
3 Spindle cell hemangioendothelioma
4 Acroangiodermatitis of Mali
5 Kaposi’s sarcoma
Kaposi’s sarcoma
The promontory sign refers to the formation of new vessels around existing vessels and adnexal structures. This is seen in Kaposi’s.
What is the best diagnosis?
1 Psoriasiform
2 Dermatitis Herpetiformis
3 Angiolymphoid Hyperplasia with Eosinophilia
4 Lichen Nitidus
5 Ochronosis
Angiolymphoid Hyperplasia with Eosinophilia
Angiolymphoid Hyperplasia with Eosinophilia(EPITHELIOID HEMANGIOMA) consists of solitary or multiple benign cutaneous nodules comprised of immature and mature vascular structures intermingled with endothelial cells and a varied infiltrate of eosinophils, histiocytes, lymphocytes, and mast cells.
The most common cause of a longitudinal groove of the nail plate is:
1 Myxoid cyst
2 Verruca vulgaris
3 Psoriasis
4 Onychomycosis
5 Paronychia
Myxoid cyst
A myxoid cyst is not a true cyst as it is devoid of cyst lining. They usually occur in an acral location and are the most common cause of a longitudinal groove of a nail plate.
The deficiency in familial multiple cutaneous leiomyomatosis is:
1 Arginase
2 Adenosine deaminase
3 Endoglin
4 MC1R
5 Fumarate hydratase
Fumarate hydratase
Fumarate hydratase is deficient in familial multiple cutaneous leiomyomatosis. This same enzyme is deficient in familial uterine leiomyomatosis associated with renal cell cancer. Arginase is deficient in arginemia. Adenosine deaminase is deficient in autosomal recessive severe combined immunodeficiency disease (SCID). Endoglin is deficient in some patients with Osler-Weber-Rendu. MC1R (melanocortin 1 receptor) shows sequence variation in people with red hair.
Psoriasis vulgaris may demonstrate all except one of the following histopathologic changes.
1 Munro microabscesses
2 Clubbing of the rete ridges
3 Spongiform pustules of Kogoj
4 Hypergranulosis
5 Suprapapillary thinning
Hypergranulosis
Histopathological features of psoriasis: Hyperkeratosis with confluent parakertosis associated with a thin to absent granular layer, Uniform elongation of rete ridges and they are expanded at their tips (Clubbing of rete ridges), papillary dermal edema with dilated toruous capillaries, thinned suprapapillary plates, neutrophils within stratum corneum (Munro’s micorabscesses), neutrophils within the spinous layer (spongiform pustule of Kogoj), and superficial perivascular lymphocytic infiltrate.
What is this neoplasm?
1 Poroma
2 Eccrine acrospiroma
3 Sebaceous adenoma
4 Basal Cell Carcinoma
5 Trichoblastoma
Poroma
Poroma: Palmar/plantar skin, trunk and lower extremities. Named based upon location, If purely intraepidermal called a hidroacanthoma simplex, if only in the dermis it is a dermal duct tumor, but more commonly seen both in the epidermis and dermis and then it is given general classification as poroma. Associated with Schopf-Schultz-Passarge syndrome and Clouston’s syndrome. Histologically composed of a proliferation of small uniform cuboidal basaloid cells that are PAS+DS (i.e. contains glycogen). The cells are smaller than neighboring keratinocytes. The tumors can be pigmented and there can be necrosis en mass. The latter finding is an exception to the general rule that benign tumors do not show necrosis en mass.
This is a culture of a fungus what is it?
1 Rhizopus
2 Phaeohyphomycosis
3 Aspergillosis
4 Mucor
5 Absidia
Rhizopus
Mucormycosis: Rhizopus the roots are directly under sporangia. This is # 1 cause of localized and systemic disease due to mucormycosis. Absidia the roots are on either side or the sporangia. Causes localized infections such as in burns, under dressings and also seen in IV drug users. Mucor the roots are absent. Mucor more frequently causes disseminated lesions such as rhinocerebral infections in diabetics with ketoacidosis or in patients with leukemia or neutropenia. These organisms result in a necrotizing cellulitis or a plaque or nodule with a necrotic eschar. The organisms invade the wall of blood vessels resulting in thrombosis and infarction. The organism in tissue displays irregular branching at 90 degree (right angle) and the hyphae are broad ribbon-like with no septae. The organism can be seen on H & E, but better with GMS
What is this neoplasm?
1 Mastocytoma
2 Poroma
3 Glomus tumor
4 Langerhans cell histocytosis
5 Nevus
Mastocytoma
Approximately 10% cases of mastocytosis present as a solitary lesion, otherwise known as a mastocytoma. Typically they present in childhood on trunk or wrist and usually are self limited and spontaneously resolve. Histologically the epidermis overlying the mast cell proliferation is often hyperpigmented. Within the dermis there are increased numbers of “fried egg†mast cells. Often the mast cells are primarily located in the upper dermis where they fill and expand the dermal papillae. Frequently admixed among the mast cells there are increased numbers of eosinophils.
Granular cell tumors are derived from:
1 Connective tissue
2 Smooth muscle
3 Vascular tissue
4 Neural tissue
5 Adipose tissue
Neural tissue
40% of granular cell tumors occur on the tongue. They appear well-circumscribed, raised, firm nodules. Histologically, the cells are plump and polygonal arranged in nests and cords. Cells are filled with fine granules representing lysozymes. The tumors are neurally derived and stain with S-100 and PAS.
What is the diagnosis?
1 Calciphylaxis
2 Polyarteritis nodosa
3 Leukocytoclastic vasculitis
4 Erythema nodosum
5 Cryoglobulinemia
Calciphylaxis
Calciphylaxis: seen in patients with elevated Ca-PO4 product and secondary hyperparathyroidism most commonly patients in renal failure. Calcification occurs within the media of vessels in the lower dermis resulting in intimal hyperplasia and secondary intraluminal thrombi. Vascular occlusion then results in epidermal/dermal infarction.
This biopsy was obtained from an immunosuppressed patient with multiple bruise like lesions on arms and legs. What is this neoplasm?
1 Kaposi’s sarcoma
2 Lobular hemangioma
3 Targetoid hemosiderotic hemangioma
4 Tufted hemangioma
5 Angiosarcoma
Kaposi’s sarcoma
Kaposi’s Sarcoma: The vascular proliferation in all subtypes of Kaposi’s sarcoma are associated with an infection with HHV-8. Histologically early on there is a subtle proliferation of irregular angulated slit like blood vessels in dermis that dissects the collagen. When these new blood vessels encase preexisting blood vessels it’s called a promontory sign. In the stroma there is a lymphoplasmacytic infiltrate, extravasated red blood cells and hemosiderin.
What is this condition?
1 Gouty Tophus
2 Sarcoid
3 Keratin granuloma
4 Rheumatoid Nodule
5 Granuloma annulare
Gouty Tophus
Gouty Tophi occur due to an accumulation of monosodium urate in the tissues. Deposits in the dermis act as a foreign body and granulomas form around these deposits. Unless the tissue is fixed with alcohol (Carnoy’s fixative), the yellow brown crystals of gout are not well visualized on H and E. When the tissue is submitted in formalin the tophus appears pink and amorphous.
