Chapter 2 Pathology of Skin Lesions

Question 1

_______ biopsies are best for cases where most of the pathology is in the epidermis or superficial dermis

Answer 1

Shave

Question 2

For most inflammatory dermatoses, a _____ biopsy produces the best results.

_______ biopsies are used for complete removal of a cutaneous neoplasm as well as in cases of panniculitis or fasciitis where substantial deep tissue is needed

Answer 2

punch

Excisional

Question 3

For patients with unusual or persistent dermatoses, or if ________________ is suspected, more than one biopsy can be beneficial.

When a biopsy is performed for _______, two 4-mm punch biopsies are optimal: one for horizontal sections and one for vertical sections

Answer 3

cutaneous T-cell lymphoma

alopecia

Question 4

Enhanced cell proliferation accompanied by an enlargement of the germinative cell pool and increased mitotic rates lead to an increase of the epidermal cell population and thus to a thickening of the epidermis –> ___________

Answer 4

acanthosis

Question 5

___________ –> in which faulty and accelerated cornification leads to retention of pyknotic nuclei of epidermal cells at the epidermal surface

Answer 5

parakeratosis

Question 6

In some diseases, dyskeratosis is the expression of a genetically programed disturbance of keratinization as is the case in _________. Dyskeratosis may occur in _________ and ________.

Answer 6

Darier disease

actinic keratosis and squamous cell carcinoma

Question 7

The most common result of disturbed epidermal cohesion is the __________,

Answer 7

intraepidermal vesicle

Question 8

____________ is a primary loss of cohesion of epidermal cells

Answer 8

Acantholysis

Question 9

Dermal–epidermal attachment is enforced by ________________ that anchor basal cells onto the basal lamina

Answer 9

hemidesmosomes

Question 10

In bullous pemphigoid, cleft formation runs through the _________________ of the ______ membrane and is caused by autoantibodies directed against specific antigens on the cytomembrane of basal cells (junctional blistering)

Answer 10

lamina lucida of the basal

Question 11

In both interface and lichenoid processes, lymphocytes are present along the _________________ associated with vacuolar alteration of basal layer keratinocytes.
Examples of diseases?

Answer 11

dermal–epidermal junction
lichen planus
lupus erythematosus

Question 12

Angiocentric pattern:
infiltrate composed mostly of neutrophils associated with fibrin and hemorrhage is typical of _________________________ that presents clinically as palpable purpura.

In contrast, perivascular lymphocytes with hemorrhage is typical of __________________

Answer 12

small vessel or leukocytoclastic vasculitis

Schamberg’s pigmented purpuric dermatosis

Question 13

Periadnexal pattern:
Perieccrine inflammation is not specific, but it is often a clue that leads to a diagnosis of__________, ________, perniosis, or syringotropic mycosis fungoides

Answer 13

lupus erythematosus, neutrophilic eccrine hidradenitis

Question 14

Nodular or diffuse pattern:
Nodular collections of lymphocytes raise a differential diagnosis of _________, cutaneous lymphoid hyperplasia (pseudolymphoma), and angiolymphoid hyperplasia
If neutrophils predominate in a nodular infiltrate, one considers ___________, ________, follicular rupture, or abscess formation

Answer 14

cutaneous B-cell lymphoma

Sweet syndrome, pyoderma gangrenosum

Question 15

Palisading granulomas surround hypocellular areas of the connective tissue with histiocytes in radial alignment. _____________, _____________, and rheumatoid nodules belong to this group

Answer 15

Granuloma annulare, necrobiosis lipoidica

Question 16

The hallmark of scleroderma and morphea is the homogenization, thickening, and dense packing of the ___________, and a narrowing of the ___________ within the reticular dermis

Answer 16

collagen bundles

interfascicular clefts

Question 17

The fragmentation and curled and clumped appearance of elastic fibers are diagnostic in __________________

Answer 17

pseudoxanthoma elasticum

Question 18

______________ staining is often used to highlight presence, absence, or alteration of elastic fibers in the dermis

Answer 18

Verhoeff-van Gieson

Question 19

Verruca vulgaris:
___________ are identified by small round nuclei, perinuclear halos, and clumping of keratohyaline granules. They tend to be localized in the upper ___________ and ___________ in newer warts, and may be absent in more mature verrucae

Answer 19

Koilocytes

stratum spinosum and stratum granulosum

Question 20

Condyloma acuminatum:
While papillomatosis is a common feature, the surface of condyloma acuminata show rounded crests (so-called _________) as compared to verrucae vulgaris, which demonstrate elongated, pointed spires

Answer 20

knuckling

Question 21

____________ is reserved for SCC in situ of sun-protected anatomic sites such as the anogenital region

Answer 21

“Bowen disease”

Question 22

Multiple keratoacanthomas may arise spontaneously, in the context of genetic syndromes such as in _____________, or as a side effect of taking certain medications, notably the BRAF (v-raf murine sarcoma viral oncogene homolog B) inhibitors ________, _________, _________

Answer 22

Muir-Torre syndrome

sorafenib, vemurafenib, and dabrafenib

Question 23

BCC:
The lobules display palisading of columnar cells at the periphery. Within the lobules, mitotic figures and apoptotic cells (often referred to as ______________) are observed

Answer 23

single-cell necrosis

Question 24

____________ demonstrate lobules of basaloid cells in embedded in the dermis, which have a cribriform or lace-like appearance. ______ are often present within the basaloid lobules.

Answer 24

Trichoepitheliomas

Horn cysts

Question 25

A variant of a trichoepithelioma is the desmoplastic trichoepithelioma, which classically occurs on the _____ of young adult women. desmoplastic trichoepitheliomas show elongated thin islands of basaloid cells set within a _____________ stroma

Answer 25

face | fibrotic (desmoplastic)

Question 26

Trichoblastoma: Unlike BCC, however, ____________ are NOT commonly observed in trichoblastomas. Another distinguishing feature compared to BCC is the stroma surrounding the basaloid islands, which is richer in ______ and ______, lacking mucinous ground substance

Answer 26

epidermal connections | fibroblasts and compacted

Question 27

Dysplastic nevi: The “shoulder” refers to the junctional component of a nevus that extends at least _____________ beyond a central area of dermal nevus cells ______________ is a phenomenon in which nests of nevic cells from adjacent rete appear to grow toward each other and fuse. _______________ is commonly observed in dysplastic nevi, and indicates fibrosis in the papillary dermis that runs in parallel to areas of bridging in the epidermis

Answer 27

at least 3 rete pegs Melanocytic bridging Lamellar fibroplasia

Question 28

Spitz nevi: __________ are a characteristic feature of Spitz nevi. These are acellular, globular eosinophilic inclusions in the epidermis, which are thought to be derived from _________ material.

Answer 28

Kamino bodies | basement membrane

Question 29

melanoma: Solar elastosis is also frequently present, particularly in the ________ and ________ types The epidermis is ______ in superficial spreading melanoma and often ______ in lentigo maligna melanoma

Answer 29

superficial spreading and lentigo maligna thickened atrophic

Question 30

melonoma: Acral lentiginous and mucosal lentiginous melanomas, similar to lentigo maligna melanomas, show a predominance of _________ over nested growth along the dermal–epidermal junction

Answer 30

single melanocytes

Question 31

melanoma: desmoplastic melanomas have a distinct immunohistochemical staining profile com- pared to conventional melanomas; they are typically MART-1 negative and positive for _____ and _____ stains.

Answer 31

S-100 and SOX10

Question 32

Dermatofibromas are benign lesions, which tend to have a hyperplastic epidermis and hyperpigmented, flattened rete, which are described as “________.” “____________” is frequently seen, particularly at the periphery of dermatofibromas, in which spindle cells encircle collagen bundles

Answer 32

dirty feet | Collagen wrapping

Question 33

Dermatofibrosarcoma protuberans: The cells intercalate between adipocytes in the subcutaneous fat, resulting in a “_________” appearance. A ______ or ______ pattern of the cells is commonly observed in the dermal com- partment

Answer 33

honeycomb | storiform or whorled

Question 34

In contrast to dermatofibrosarcoma protuberans, atypical fibroxan- thomas (AFXs) demonstrate marked ___________ of spindled and epithelioid cells in the dermis

Answer 34

cytologic atypia

Question 35

Pyogenic granuloma: | Typically, there is an _________ around the dermal vascular proliferation

Answer 35

epidermal col- larette

Question 36

angiosarcoma: | The lesional cells are high- lighted by endothelial cell markers, including ____ and ____

Answer 36

CD31 and CD34

Question 37

____________ ? They are dermal tumors that consist of small, bland neural cells with wavy, S-shaped nuclei, set within a light pink stroma

Answer 37

neurofibroma

Question 38

Schwannoma: _______ areas are more cellular, with areas of palisading of nuclei in parallel to one another around a relatively an acellular extracellular matrix, also referred to as ________. _________ areas demonstrate spindled cells within a looser and often myxoid extracellular matrix

Answer 38

Antoni A Verocay bodies Antoni B

Question 39

The leiomyoma is a benign smooth muscle neoplasm, and in the skin is derived from either _______ (_______) or from _______________ (________)

Answer 39

``` pilar muscle (piloleiomyoma) vascular smooth muscle (angioleiomyoma) ```