Ch. 13 - Alterations in collagen and elastin Flashcards
Lichen sclerosus et atrophicus
Compact stratum corneum, papillary dermal pallor, and blue band of lymphoid inflammation
(equivalent to BXO on glans penis)
Chronic radiation dermatitis
Papillary dermal pallor without lymphoid band or lymphoid band. Radiation elastosis and large stellate fibroblasts. Ectatic vessels.
Morphea/scleroderma
Thick, closely packed, hyalinized collagen with “trapped eccrine glands” (loss of adventitial fat). Sparse inflammation.
Sclerodermoid GVHD
Thickened and sclerotic dermis with destroyed adnexal structures and minimal basal vacuolization.
Eosinophilic fasciitis (Shulman’s syndrome)
Thick eosinophilic fascia due to fibrosis and hyalinization of collagen. Variable eosinophilic infiltrate.
Elastosis perforans serpiginosa
Tortuous channel through an acanthotic epidermis with large bulky red elastic fibers.
What is in the differential for a thickened sclerotic stroma?
Morphea/scleroderma
Chronic GVHD
Chronic radiodermatitis
Scar
Connective tissue nevi
Scleroderma
What diseases are associated with elastosis perforans serpiginosa?
Rothmund-Thompson syndrome
Acrogeria
Penicillamine
Marfan’s syndrome
Osteogenesis imperfecta
Pseudoxanthoma elasticum
Ehlers-Danlos syndrome
Down syndrome
Reactive perforating collagenosis
Broad vetical channel of degenerated basophilic collagen bundles (use Masson trichrome).
Hypertrophic scar
Fibroblasts with “east-west” orientation, blood vessels with “north-south” orientation. Nodules or whorls of thickened collagen and fibroblasts.
Keloid
Fibroblasts with “east-west” orientation, blood vessels with “north-south” orientation. Broad, hyalinized, eosinophilic “bubble gum” collagen fibers.
Acne keloidaris nuchae
Hypertrophic scar with suppurative folliculitis with hair shafts free in the dermis and plasma cell infiltrate.
Favre-Racouchot syndrome (nodular elastosis with cysts and comedones)
Dilated, keratin-filled follicles, small cysts, and solar elastosis.
Chondrodermatitis nodularis helicis
Ulcer/erosion with adjacent acanthosis overlying a zone of fibrin (flanked by granulation tissue).
Acrodermatitis chronic atrophicans
(cause?)
Early: “Polka dot” lymphoplasmacytic infiltrate
Late: Epidermal/dermal atrophy with attenuated wispy collagen.
(Lyme disease, tertiary)
Ochronosis (alkaptonuria)
Glassy yellow-brown banana-shaped deposits in the dermis
Colloid milium
Pale pink, fissured deposits of amorphous material.
Anetoderma
Normal H&E but sprase to absent elastic fibers on elastin stains.
Atrophoderma
Subtly reduced dermal thickness.
Connective tissue nevus
Collagenoma (haphazard broad collagen bundles) vs Elastoma (broad, branching elastic fibers).
Aplasia cutis congenita
Absent or thin epidermis with absent or rudimentary adnexae.
Lichen sclerosus et atrophicus
Chronic radiation dermatitis
Morphea / Scleroderma
Sclerodermoid GVHD
Eosinophilic fasciitis
Elastosis perforans serpiginosa
Reactive perforating collagenosis
Hypertrophic scar
Keloid scar
Acne keloidalis nuchae
Favre-rocouchot syndrome
Chondrodermatitis nodularis helicis
Acrodermatitis chronica atrophicans
Ochronosis
Colloid milium
Anetoderma
Collagenoma
