adnexal

Question 1

sebaceous adenoma

Answer 1

• Distinctly circumscribed lobular tumor
• mature sebaceous cells (sebocytes >50% ) and basaloid (germinative) cells
• Minimal cytologic atypia, mitoses may be prevalent

Question 2

Hidradenom​a papillifer​um

Answer 2

• Circumscribed tumor in dermis
• maze-like glandular spaces, apocrine differentiation, papillary folds
• no epidermal connection
• minimal inflammation around

Question 3

Syringoma

Answer 3

• Proliferation tadpole-like eccrine ducts dermi
• No aggressive infiltration of the deeper dermis\
• Horn cysts
• Stroma fibrotic sclerotic

Question 4

Syringocys​tadenoma papillifer​um

Answer 4

-Papillomatous epidermis connecting to underlying tumor ,Papillary projections into cystic space
-Cystic space within tumor opens to surface of skin
- lined by upper portion squamous epithelium
lower portion lined by sweat glandular epithelium
- Apocrine decapitation secretion
-Plasma cell infiltrate
-Nevus sebaceus

Question 5

DFSP

Answer 5

-Epidermis normal, atrophic, or ulcerated
- cellular proliferation small bland spindled fibroblasts and collagen in the dermis, extending into the subcutaneous fat
-Cartwheel pattern/ storiform
- no foamy cells or multinucleated giant cells
- fascicular or honeycomb Infiltration of fat
-Cytologic atypia mild to moderate,few mitoses
L

Question 6

DFSP STAIN

Answer 6

CD34+, stromelysin-3neg, factor XIIIaneg, D2-40neg (all four opposite of dermatofibroma). S-100 is negative

Question 7

NF

Answer 7

• Well circumscribed non encapsulated dermal nodule
• thin fascicles spindle cells wavy nuclei
• Pale “bubblegum” pink fibrillary collagenous stroma, mucinous or myxoid
• increased Mast cells, small blood vessels

Question 8

NF stains

Answer 8

-acid mucopolysaccharides( Mucinous stroma)
-+ S-100, CD34, PGP9.5, factor XIIIa,
+ Bodian, myelin basic protein

Question 9

Nodular hidradenom​a

Answer 9

• Nodular tumor dermis /subcutaneous tissue
• one cell type of basaloid cells,focal connection to epidermis
• Sweat duct lumina , eccrine differentiation, Hyalinized collagen, Keratinous cysts

Question 10

Eccrine poroma

Answer 10

• sharp demarcation,acanthotic epidermis
• Tumor basaloid “poroid” cells(- clear :glycogen accumulation (PAS positive, diastase labile)
• extending into dermis
• Small sweat ducts usually present within tumor

Question 11

Blue nevus

Answer 11

-Poorly circumscribed proliferation pigmented dendritic melanocytes within dermis
-dispersed haphazard arrangements
-melanocytes heavily laden melanin granules melanophages
Epidermis normal

Question 12

Nevus sebaceus

Answer 12

• Epidermal hyperplasia ,papillomatosis

- many normal or enlarged sebaceous/ apocrine glands, unassociated with mature hair shafts.

Question 13

Nevus sebaceus Cx

Answer 13

BCC, less than 5%
trichoblastoma
syringocystadenoma papilliferum
trichilemmoma

Question 14

Leiomyoma

Answer 14

• Circumscribed non encapsulated tumor
• Fascicular patterm Interlacing bundles smooth muscle cells
• blunt ended cigar-shaped spindle cell nuclei and abundant pink cytoplasm ( longitudinal section), round nuclei with vacuoles( cross-section)
• Hair follicle association

Question 15

Dermatofibroma

Answer 15

Poorly circumscribed dermal proliferative lesion
Merges surrounding dermis
Histiocytes fibroblasts dense interwoven collagenous network
Small blood vessel proliferation
Periphery: Xanthomatized cells, MNCGC, collagen entrapment
Epidermis hyperplastic hyperpigmented

Question 16

Stains leiomyoma

Answer 16

SMA diffuse positive, trichrome Positive, immunostaining desmin

Question 17

Pilomatricoma

Answer 17

-Lobular proliferation lower dermis
-2 distinct cell type
A)peripheral: basophilic matrical cells, hyperchromatic nuclei
B)central: transition eosinophilic cells ghost outlines
-calcification, foreign body granulomas

Question 18

Spitz nevus

Answer 18

• Regular Symmetry, sharp circumscription
• Uniform nevus Nests no pagetoid spread, Bland cytological morphilogy, lack deep mitoses
• large epitheloid cells along DEJ smaller proportion spindle cells
• Dermal component compound raining down appearance
• Kamino bodies- amorphous eosinophilic aggregates papillary dermis

Question 19

Dysplastic nevus

Answer 19

-elongated, clubbed rete ridges
-Poorly circumscribed larger irregular melanocytic nests cells fine dusty melanin granules
-Single melanocytes predominant DEJ bridging between rete ridges, Dispersed sides tips , fusion adjacent nests, shoulder phenomenon- Junctional melanocytes extend beyond dermal melanocytes at periphery
-Maturation of nests
-Lamellar papillary fibrosis variable cytological atypia
Perivascular lymphocytic infiltrate

Question 20

Schwannoma

Answer 20

• Lobulated Encapsulated subcutaneous tumor
• fasciculated arrangement schwann cells
• cellular areasSpindle cells (Antoni A tissue) and/or edematous myxoid areas (Antoni B tissue)
• Antoni A nuclei arranged in pallisades/rows ,separated by areas without nuclei (Verocay bodies)
• Mucinous stroma stains positive for acid mucopolysaccharides
• Mast cells common
• Tumor may be attached to large nerve

Question 21

Schwannoma stains

Answer 21

Positive staining S-100 myelin basic protein (MBP) Antoni A areas, negative neurofilaments
Bodian stain negative

Question 22

DFSP pathogenesis

Answer 22

fusion of COL1A1 gene with the PDGFB gene

ring chromosomes r(17;22) or linear t(17;22)(q22;q13)

Question 23

DFSP managememt

Answer 23

wide excision or Mohs surgery

tyrosine kinase inhibitor drug, imatinib,

Question 24

Mets breast CA

Answer 24

Infiltrative tumor islands atypical cells with glandular differentiation within dermis
Epidermotropsim, glandular formation
Thin infiltrative cords tumor ells dissecting coklagen bundles indian filing pattern
Tumor aggregates in dilated lymphatics, BV

Question 25

trichoepithelioma

Answer 25

• cribiform basaloid islands( resemble poorly dev hair follicles) with palisading without peritumoral retraction clefting but peristromal clefting
• papillary mesenchymal bodies and horn cysts
• loose stroma many fibroblasts