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Derm1 > Ch. 2 - Benign tumors & cysts of the epidermis > Flashcards

Ch. 2 - Benign tumors & cysts of the epidermis Flashcards

1
Q

What is an acanthoma?

How can it be distinguished from reactive acanthosis?

A

A benign cutaneous neoplasm characterized by an expansion of the epidermis.

Rete ridge pattern is ablated in acanthomas.

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2
Q

How does the stratum corneum appear in seborrheic keratoses? What if they are inflamed or irritated?

A

Loose lamellar “shredded-wheat” stratum corneum.

If inflamed, SC looks compact, brightly eosinophilic, and parakeratotic.

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3
Q

What IHC and molecular markers are typical of seborrheic keratoses?

A

May express BCL-2.

Activating point muations in FGFR3.

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4
Q

Acanthotic seborrheic keratosis

A

Broad sheets of small polygonal keratinocytes with intervening horn cysts and loose lamellar keratin.

Often pigmented. Can be irritated or inflamed.

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5
Q

Hyperkeratotic seborrheic keratosis

A

Tall stacks of loose lamellar keratin with papillomatosis (“church-spire” appearance).

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6
Q

Reticulated seborrheic keratosis (adenoid seorrheic keratosis)

A

Thin pigmented interlacing downward extensions of the epidermis with reticular configuration of epidermis and horn cysts.

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7
Q

Solar lentigo

A

Thin pigmented interlacing extension of the epidermis. Shorter and more bulbous than reticulated SK and without horn cysts.

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8
Q

Diagnose: Multiple foci of reticulated seborrheic keratosis “hanging off” hair follicles. Comedo-like follicular infundibula.

A

Downling-Degos disease / reticulated pigmented anomaly of the flexures

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9
Q

Clonal seborrheic keratosis

A

Clonal islands of small keratinocytes within the epidermis with bland nuclei and no duct differentaition. May have horn cysts. No atypia!

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10
Q

Hidroacanthoma simplex

A

Clonal islands of small keratinocytes similar to clonal seborrheic keratosis but ducts in the clonal islands.

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11
Q

Bowen’s disease

A

Clonal islands of atypical keratinocytes, with atypia, buckshot scatter, and apoptotic cells. Overlying stratum corneum becomes parakeratotic.

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12
Q

Pigmented seborrheic keratosis

A

Pigment within keratinocytes; the SK can be acanthotic, hypekeratotic, reticulated, or clonal (pigment-restricted!)

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13
Q

Irritated seborrheic keratosis

A

Formation of squamous eddies within epidermis and presence of spindled keratinocytes. Overlying stratum corneum can become compact, eosinophilic, and parakeratotic.

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14
Q

Inflamed seborrheic keratosis

A

Lymphocytes and spongiosis. Overlying stratum corneum can become compact, eosinophilic, and parakeratotic. Overlying crust and lichenoid interface dermatitis may be present.

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15
Q

Melanoacanthoma

A

Acanthoma composed of small keratinocytes and pigmented dendritic melanocytes (most pigment within dendrites). Overlying stratum corneum is compact eosinophilic and parakeratotic.

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16
Q

Clear cell acanthoma (pale cell acanthoma)

A

Discrete acanthoma with clear cells (phosphorylase deficiency), overlying parakeratosis and a distinct transition to normal in the stratum spinosum. Neutrophiils.

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17
Q

Large cell acanthoma

A

Discrete acanthoma composed of cells with large nuclei, with overlying lamellar hyperkeratosis. Represents a heterogeneous group of lesions…

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18
Q

Inverted follicular keratosis

A

Endophytic lesions resembling an expanded hair follicle, with squamous eddies. Unrelated to HPV but multiple may mean Cowden’s syndrome.

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19
Q

Warty dyskeratoma

A

Endophytic lesion with acantholytic dyskeratosis and overlying parakeratotic crust.

Features corps ronds (round halo’d dyskeratotic cells) and grains (flattened basophilic dyskeratotic cells)

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20
Q

Acantholytic acanthoma

A

Acanthoma composed of bland keratinocytes with acantholysis. Resembles “dilapidated brick wall” of Hailey-Hailey disease.

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21
Q

Epidermolytic acanthoma

A

Often crateriform epidermolytic hyperkeratotic lesion. Thick granular layer with irregular granules.

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22
Q

Common epidermal nevus

(linear?)

A

Resembles seborrheic keratosis; typically present at birth (multiple associated with eye/CNS/MSK abnormalities).

Linear: Follows Blaschko’s lines, represents mosaicism, LOH, lyonization of X chromosome, or post-zygotic somatic mutation.

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23
Q

Inflammatory linear verrucous epidermal nevus (ILVEN)

A

Linear epidermal nevus with variable acanthosis, alternating ortho/parakeratosis, and gross erythema (not actually inflamed?)

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24
Q

Blaschkoid epidermolytic hyperkeratosis (EKH)

A

Resembles epidermal nevus but with epidermolytic hyperkeratosis. Represents mosaicism for keratins 1/10 (implicated in epidermolytic ichthyosis).

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25
Q

Epidermoid cyst (epidermal inclusion cyst, infundibular cyst)

A

Lining of surface epidermis without adnexal structures. Loose lamellar “onion-skin” keratin.

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26
Q

Epidermoid cyst with pilomatricial differentiation

A

Epidermoid cyst with areas of ghost cell keratinization as in a pilomatricoma. Associated with Gardner’s syndrome.

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27
Q

Vellus hair cyst

A

Cyst with a wall resembling an epidermoid cyst. May have small vellus hairs within the cyst. Frequently arise in an eruptive fashion. Associated with Lowe syndrome.

28
Q

Dermoid cyst

A

Cyst resembling an epidermoid cyst but with adnexal structures within the cyst wall. Occur in embryonic fusion planes.

29
Q

Pilar cyst (trichilemmal cyst, isthmus catagen cyst)

A

(Often multiple) scalp cyst with abrupt keratinization without a granular layer, calcification.

30
Q

Proliferating pilar cyst

A

Cyst with “rolls and scrolls” of buckled epithelium. Can have small new cysts within. Trichilemmal keratinization (rule out trichilemmal carcinoma).

31
Q

Pilomatricoma

A

Has “rolls and scrolls” like proliferating pilar cyst and ghost cell keratinization.

32
Q

Branchial cleft cyst

A

Found in lateral neck; epidermoid or pseudostratified epithelium with lymphoid tissue. #1 cause of congenital neck mass.

33
Q

Bronchogenic cyst

A

Midline lesions, usually in suprasternal notch. Respiratory epithelium, goblet cells, cartilage, smooth muscle. Usually no lymphoid follicles.

34
Q

Steatocystoma (simple sebaceous duct cyst)

A

Usually inherited lesion with sebaceous cyst wall lining.Oily contents, frequently containing vellus hairs.

35
Q

Median raphe cyst

A

Ventral genital midline cyst in men. Filled with amorphous debris and variable lining.

36
Q

Cutaneous dilated cyst

A

Mullerian duct remnant usually found on legs of women. Variable debris and lining, like median raphe cysts.

37
Q

Thyroglossal duct cyst

A

Midline neck lesion lined by either respiratory or squamous epithelium. May have thyroid follicles and lymphoid aggregates.

38
Q
A

Acanthotic seborrheic keratosis

39
Q
A

Pigmented seborrheic keratosis

40
Q
A

Irritated acanthotic seborrheic keratosis

41
Q
A

Inflamed acanthotic seborrheic keratosis

42
Q
A

Reticulated seborrheic keratosis

43
Q
A

Solar lentigo

44
Q
A

Clonal seborrheic keratosis

45
Q
A

Hidroacanthoma simplex

46
Q
A

Clonal bowen’s disease

47
Q
A

Melanoacanthoma

48
Q
A

Clear cell acanthoma

49
Q
A

Large cell acanthoma

50
Q
A

Inverted follicular keratosis

51
Q
A

Warty dyskeratoma

52
Q
A

Acantholytic acanthoma

53
Q
A

Epidermolytic acanthoma

54
Q
55
Q
A

(ruptured, inflamed) epidermoid cyst

56
Q
A

Epidermoid cyst with pilomatricial differentiation

57
Q
A

Vellus hair cyst

58
Q
A

Dermoid cyst

59
Q
A

Pilar cyst

60
Q
A

Proliferating pilar cyst

61
Q
A

Pilomatricoma

62
Q
A

Branchial cleft cyst

63
Q
A

Branchial cleft cyst

64
Q
A

Steatocystoma

65
Q
A

Median raphe cyst

66
Q
A

Cutaneous ciliated cyst

67
Q
A

Thyroglossal duct cyst

Derm1 (30 decks)

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