Benign tumors Flashcards
What are seborrheic keratoses?
Round, flat, coin-like plaques that vary in diameter
seborrheic keratoses are rare before what age?
30
What is the treatment for seborrheic keratoses?
Surgery
Chemical peeling agents
Electro or cryotherapy
true or false: seborrheic keratoses are generally well circumscribed, unlike melanomas
True
True or false: seborrheic keratoses usually occur as a single lesion, unlike melanomas
Double false– seborrheic keratoses occur in multiples, and melanomas occur as singletons
What is the Leser-Trelat sign, and what might it indicate?
the explosive onset of multiple seborrheic keratoses[1] (many pigmented skin lesions), often with an inflammatory base. This can be an ominous sign of internal malignancy as part of a paraneoplastic syndrome
What are the histological findings of seborrheic keratoses?
Well defined papillations of keratin confined to the epidermis, with microcysts within them
What are the histological findings of pigmented seborrheic keratoses?
Same as seborrheic keratoses, but with a lot of pigment within the keratinocytes
What defines the difference in pigmentation between people
Difference in pigmentation in the keratinocytes–NOT in the number of melanocytes
True or false: the number of melanocytes does not vary much between people
True
What are fibroepithelial polyp acrochordon? What usually causes these?
- Polyps on the skin that have a fibrovascular core, covered by a benign epithelium
- Chronic rubbing of the skin
Polyps on the skin that have a fibrovascular core, covered by a benign epithelium = ?
Fibroepithelial polyp-acrochordon
What are the four major types of epithelial cysts?
- Epidermal inclusion cysts
- Pilar or trichilemmal cysts
- Dermoid cysts
- Steatocystomas
What is the classic appearance of epidermoid cysts?
Deep nodules with a central punctum
Deep nodule with a central punctum = ?
Epidermoid cysts
What is a follicle?
a small secretory cavity, sac, or gland, in particular.
What is an infundibulum?
a funnel-shaped cavity or structure.
What are epidermoid cysts filled with?
Loose Keratin
Sebaceous cysts = ?
Epidermoid cysts
What are trichilemmal cysts?
a common cyst that forms from a hair follicle. They are most often found on the scalp. The cysts are smooth, mobile and filled with keratin
What are dermoid cysts?
a teratoma of a cystic nature that contains an array of developmentally mature, solid tissues. It frequently consists of skin, hair follicles, and sweat glands
What is the classic presentation of a dermoid cyst?
Single SQ nodule present at birth on the lateral aspect of the upper eyelid
What are the histological characteristics of a dermoid cyst?
Like epidermoid cyst, but with dermal tissue components
What are steatocystomas?
AD mutation in keratin 17, resulting in multiple cysts on the body, usually in the sternal, axillae, and groin
What are the histological characteristics of steatocystomas?
Jagged area of keratin, with sebaceous structures attached to it
What are trichilemmomas?
a benign cutaneous neoplasm that shows differentiation toward cells of the outer root sheath
What is Cowden’s disease?
AD mutation in PTEN gene that predisposed for breast and thyroid CA. Presents are multiple, hamartomas, as well as trichilemmomas
Multiple trichilemmomas = what disease?
Cowden’s disease
What are the characteristics of trichilemmomas?
Lighter, clear sheets of cells with a thick BM
Lighter, clear sheets of cells with a thick BM = ?
Trichilemmomas
What are pilomatricomas? Where are they most commonly found on the body?
Benign skin tumor derived from the hair matrix
-head (cheek) and neck region, but also on UE and trunk
What genetic disease is associated with pilomatricomas?
Turner’s syndrome
What is the genetic mutation associated with pilomatricomas?
APC mutation, resulting in high beta catenin
What are the histological features of pilomatricomas?
anucleate squamous cells (called “ghost cells”), benign viable squamous cells and multi-nucleated giant cells. The presence of calcifications is common.
What percent of pilomatricomas occur before age 20?
60%
anucleate squamous cells (called “ghost cells”), benign viable squamous cells and multi-nucleated giant cells = ?
Pilomatrixoma
What is Birt-Hogg-Dube syndrome? Genetic cause?
AD mutation to BHD gene on chr 17, which encodes the protein folliculin.
-Causes susceptibility to a wide variety of cancers, and fibrofolliculomas
What are fibrofolliculomas? What syndrome are they seen in?
2 to 4 mm in diameter, dome-shaped, yellowish or skin-colored papules usually located on the head, neck, and upper trunk. They are characteristically seen in Birt–Hogg–Dubé syndrome
What are the two diseases in particular that Birt-Hogg-Dube syndrome is associated with?
- Renal tumors
- Spontaneous pneumothorax
What are the gross characteristics of fibrofolliculomas?
Small white papules, usually located along the face
What are the gross characteristics of trichodiscomas?
Small white papules, usually located along the face
What are the histological characteristics of fibrofolliculomas?
Abortive and squeezed off follicular structures surrounded by fat cells
Abortive and squeezed off follicular structures surrounded by fat cells = ?
Fibrofolliculomas
What are the two skin lesions associated with Birt-Hogg-Dube syndrome?
Fibrofolliculomas
Trichodiscomas
What is a nevus sebaceous? Where on the body is it usually found? What age? Which gender?
- A congenital, hairless plaque that typically occurs on the face or scalp.
- Present at birth, affecting males and females of all races equally. The condition is named for an overgrowth of sebaceous glands in the area of the nevus.
What is the prognosis for nevus sebaceous?
In itself is benign, but secondary tumors may arise from it–usually BCC
True or false: all nevi are melanocytic proliferaitons
False–nevus sebaceous is not
What are the gross findings of nevus sebaceous?
Localized area of alopecia, with a waxy, papule
What are the histological findings of nevus sebaceous?
Abortive hair follicles, with a whole bunch of sebaceous glands attached to them
Localized area of alopecia, with a waxy, papule + Abortive hair follicles, with a whole bunch of sebaceous glands attached to them on histology = ?
Nevus sebaceous
How common is sebaceous hyperplasia? What causes it? What is it often misdiagnosed as?
Common on faces of adults from sun damage that is usually misdiagnosed as BCC
What are the gross characteristics of sebaceous hyperplasia?
Yellowish dome shaped papules
What are the histological characteristics of sebaceous hyperplasia?
Tons o’ sebaceous glands
Yellowish dome shaped papules with a central punctum + tons o’ sebaceous glands on histology = ?
Sebaceous hyperplasia
What are sebaceous adenomas? What condition are they associated with? Where on the body are they usually found?
- Rare, benign tumor of sebaceous glands
- Muir–Torre syndrome
- face and scalp of old people
What is Muir–Torre syndrome? What is the genetic defect and inheritance pattern? What skin findings are associated with it?
a rare hereditary, autosomal dominant cancer syndrome that is thought to be a subtype of HNPCC.
- Individuals are prone to develop cancers and skin lesions, such as keratoacanthomas and sebaceous tumors.
- The genes affected are MLH1, MSH2, which are involved in DNA mismatch repair and microsatellite stability.
-Sebaceous adenomas
What are the histological characteristics of sebaceous adenomas?
Lots of sebaceous glands, but it not precipitating normal sebaceous lobules, and is well differentiated
Lots of sebaceous glands, but it not precipitating normal sebaceous lobules, and is well differentiated = ?
Sebaceous adenomas
What are sebaceomas? What does it look like grossly?
A sebaceous structure that is intermediate in malignancy, that appears as a yellow or orange papule
What are the histological characteristics of sebaceomas?
Somewhat differentiated sebaceous glands
What are the cutaneous findings of MTS?
Sebaceous tumors:
- Adenomas, sebaceomas
- Keratoacanthomas
What are the visceral malignancies associated with MTS?
- Colon
- Bladder
- Endometrium
- Breast
What is the immunostaining technique used to diagnose MTS? What is an abnormal result?
Stain for MLH1 and MSH2
Loss of stain = pathologic
What are cylindromas? Where do they most often occur on the body? What is the F:M?
- Sweat gland tumors that appear as pink/red nodules
- head and neck
- 9:1
What is Brooke-Spiegler syndrome? What are the tumors that can grow with this condition?
a condition involving multiple skin tumors including growths called spiradenomas, trichoepitheliomas, and cylindromas.
What is the genetic inheritance and mutation of Brooke-Spiegler syndrome?
AD CYLD gene on chr 16
Causes NF-kappa-B pathway overactivation
What are the histological findings of cylindromas?
Jigsaw puzzle
Jigsaw puzzle histology = ?
Cylindromas
What are xanthomas?
Benign aggregate of histiocytes with cytoplasmic lipids
What are the five main clinical types of xanthomas? Which is the only one that has normal serum lipid levels?
- Eruptive
- Tendinous
- Tuberous
- Planar
- Disseminated
What are xanthogranulomas? What age do they typically arise? What conditions are associated with this?
yellow/brown papules or nodules on the head and neck region that usually arise within the first 5 years of life
-CML and NF
What is the prognosis for xanthogranulomas?
They themselves are benign and spontaneously regress within several years, but may indicate underlying visceral pathology
What are histological findings of xanthogranulomas?
Histiocytes in the dermis and Touton giant cells
Histiocytes in the dermis and Touton giant cells = ?
JXG
What is the age and gender that is typically affected with reticulohistiocytomas?
Middle aged females
What are the two forms of reticulohistiocytomas?
Solitary
Multicentric
What are the histological findings of reticulohistiocytomas?
Ground glass histiocytes
Ground glass histiocytes = ?
reticulohistiocytomas
What are the associations of reticulohistiocytomas?
CT diseases
Vasculitis
What is the acute generalized form of LCH (letterer-Siwe disease), and who does it affect? How aggressive is it?
A rapidly progressing disease in which Langerhans Cell cells proliferate in many tissues, including internal organs. It is mostly seen in children under age 2, and the prognosis is poor: even with aggressive chemotherapy, the five-year survival is only 50%
What is the multifocal chronic form of LCH (Hand-Schuller-Christian disease)? Who is it usually seen in? S/sx?
Seen mostly in children, multifocal unisystem LCH is characterized by fever, bone lesions and diffuse eruptions, usually on the scalp and in the ear canals. 50% of cases involve the pituitary stalk, leading to diabetes insipidus.
The triad of diabetes insipidus, exophthalmos, and lytic bone lesions is known as the Hand-Schüller-Christian triad. Peak onset is 2–10 years of age.
What is the classic triad of symptoms for multifocal chronic LCH?
- Lytic skull lesions
- DI
- Proptosis
What is the treatment for multifocal LCH?
XRT and chemo
What is the unifocal version of LCH (eosinophilic granuloma)?
A slowly progressing disease characterized by an expanding proliferation of Langerhans Cells in various bones. It is a monostotic (involving only one bone) or polyostotic (involving more than one bone) disease. It typically has no extraskeletal involvement, but rarely an identical lesion can be found in the skin, lungs, or stomach.
What is the prognosis for unifocal LCH (eosinophilic granuloma)? Treatment?
most benign–relative good prognosis
Treatment = Excision or XRT
What are the LM and EM findings of LCH?
LM = Dermal infiltration of monocytes and giant cells. Crinkled appearance to nuclei EM = Birbeck granules
What is the immunostain for LCH?
CD1a
What is benign fibrous histiocytoma (dermatofibroma)?
Benign, tan-brown papules, with size varying over time. Related to dermal neoplasms of fibroblasts and histiocytes
What are the histological findings of dermatofibromas?
Spindle cells appearance that trap collagen bundles (“doughnut sign”)
What is the most common CT tumor?
Lipomas
What are pyogenic granulomas?
Hemangiomas
(This name is misleading as it is not a true granuloma. In actuality, it is a capillary hemangioma of lobular subtype which is the reason they are prone to bleeding.[4] Additionally, it is also not truly pyogenic, (“pus producing”) as the cause is hormonal or traumatic and has no association with infection or pus production.)
What are cavernous hemangiomas?
Big vessel proliferation
What are arteriovenous hemangiomas?
Mix of thin and thick walled vessels
What are traumatic neuromas? S/sx?
A type of neuroma which results from trauma to a nerve, resulting in a disorderly proliferation of bundle of peripheral nerves
-Usually painful nodule
-
What are the histological characteristics of traumatic neuromas?
haphazard neuron proliferation
What is Morton’s neuroma? S/sx?
A benign neuroma of an intermetatarsal plantar nerve, most commonly of the second and third intermetatarsal spaces, which results in the entrapment of the affected nerve.
-The main symptoms are pain and/or numbness that is exacerbated by walking.
True or false: Morton’s neuroma usually present with a large, palpable mass
False–usually no mass is palpable
what are the three diseases of MEN1?
- Pituitary adenomas
- Pancreatic tumors
- Parathyroid
What are the three diseases of MEN2a?
- Medullary thyroid CA
- Parathyroid hyperplasia
- Pheochromocytoma
What are the three diseases of MEN2b?
- Medullary thyroid CA
- Mucosal neuromas
- Pheochromocytoma
What are the histological findings of mucosal neuromas?
Mucosal nodules with tiny nerve-lets
what are palisaded encapsulated neuromas? what age range are they usually found in?
Solitary, painless nodules that are commonly found on the face.
middle aged to old
What are schwannomas? Where on the body are they more prevalent?
a benign nerve sheath tumor composed of Schwann cells, which normally produce the insulating myelin sheath covering peripheral nerves.
Is there an association of schwannomas with NF?
Per him, no, but in reality, yes.
What is the usual presentation of schwannomas? How often do they recur?
Solitary, painless SQ mass
Little capacity of recurrence
What is the antoni A type of schwannomas?
Cellular with nuclear palisading (verocay bodies)
What is the antoni B type of schwannomas?
Schwann cells, but hypocellular, with a myxoid matrix
Why are the blood vessels prominent with schwannomas?
Thick hyaline walls
Cellular with nuclear palisading (verocay bodies)
Antoni A
Schwann cells, but hypocellular, with a myxoid matrix
Antoni B
What are the characteristics of neurofibromas?
Solitary polypoid or nodular lesion with a wide distribution
What are the histological characteristics of neurofibromas?
Circumscribed, but unencapsulated, with a sheet like wavy nerve cells
Circumscribed, but unencapsulated, with a sheet like wavy nerve cells = ?
neurofibroma
What are plexiform neurofibromas?
a benign tumor of peripheral nerves (WHO grade I) arising from a proliferation of all neural elements, pathognomonic of neurofibromatosis type 1 (NF1). It involves single or multiple nerve fascicles that arises from major nerve branches.
plexiform neurofibromas = what disease
NF1
What are granular cell tumors?
a tumor that can develop on any skin or mucosal surface, but occurs on the tongue 40% of the time.
what are the histological characteristics of granular cell tumors?
Proliferation of cells with granular pink cytoplasm
Which gender usually gets granular cell tumors?
Females
Are granular cell tumors fast of slow growing? Recurrence rate? Treatment?
Slow growing
Low recurrence
Excise
What are the two versions of leiomyomas?
Pilar
Angio
What are giant cell tumors of the tendon sheath?
Uncommon and usually benign lesions that arise from the tendon sheath
Where are giant cell tumors of tendon sheaths usually found?
hand, feet, wrists, knees and other small joints
What is the prognosis for giant cell tumors of the tendon sheath? Treatment?
Benign, but can recur
excise
What are the histological findings of GCTTS?
Giant cells with PMNs in the background
What are ganglion cysts? Where are they usually found? What causes them? S/sx?
- Myxoid degeneration of a joint capsule, usually found in the wrist, hand, foot, and ankle.
- Caused by overuse
- Pain or weakness
What are the histological characteristics of ganglion cysts?
pseudocysts-no epithelial lining
Cystic space ling by histiocytes and granulation tissue with moderate inflammation
Cystic space ling by histiocytes and granulation tissue with moderate inflammation = ?
Ganglion cysts
What are superficial fibromatosis? (hand, plantar, penis)
Proliferation of spindle cells in tissue of various sites:
Hand = dupuytren’s contracture
Plantar = Ledderhose dz
Penile = peyrones disease
True or false: superficial fibromatosis usually has beta catenin mutaitons
False
