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Book - Molavi > Chapter 27 - Skin > Flashcards

Chapter 27 - Skin Flashcards

1
Q

Describe the morphology of melanocytes

A

Neuralish, dendritic morphology and stain with S-100. Also produce melanin pigment but do not carry much themselves.

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2
Q

What is a melanophage?

A

A spindly mancrophage which appears melanotic because they are consuming melanin.

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3
Q

Desecribe the normal course of a melanocytic nevus.

A

Begins as a lentigo simplex at the dermoepidermal junction. Proliferates into nests (theques) as a junctional nevus. Then migrates into the dermis with loss of the junctional component (intradermal nevus).

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4
Q

What is a compound nevus?

A

A junctional nevus with a dermal component.

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5
Q

Recall some benign or reassuring features of nevi.

A

Symmetry

Size <3mm

Lateral borders consisting of nests (not individual cells)

Lack of atypia

Maturation into the dermis

Chunky brown-black pigment

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6
Q

What is a blue nevus?

A

A common nevus consisting of a diffuse scattering of dendritic single melanocytes mixed with melanophages.

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7
Q

What is a Spitz nevus?

A

A cirumscribed and symmetric nevus found on the head & neck of children.

Melanocytes may be large, spindled, pleomorphic, or even show mitoses. Look for eosinophilic Kamino bodies.

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8
Q

What are some features of acral & genital nevi?

Of congenital nevi?

A

Acral and genital nevi are allowed some atypical features (pagetoid spread, lengitinous growth), but no cytologic atypia.

Congenital nevi should track down the adnexal structures.

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9
Q

What are the four features of architectural disorder in dysplastic nevi?

A

Lentiginous spread of atypical melanocytes (along DEJ)

Shouldering (lentiginous component wider than dermal component)

Bridging of rete (nests attached to adjacent rete ridges fuse)

Fibroplasia (featuring of dermal collagen)

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10
Q

What are the four features of cytologic atypia in dysplastic nevi?

A

Hyperchromatic nuclei (increased N:C)

Large red nucleoli

Accumulation of dusty grey-brown melanin

Atypical mitoses

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11
Q

What is lentigo maligna?

What is Melanoma in situ?

A

Lentigo: Malignant melanocytes proliferating only along the DEJ.

In situ: Above, and percolating up through the epidermis in a pagetoid fashion

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12
Q

What feature is required to diagnose malignant melanoma?

Distinguish between superficial spreading and nodular melanomas.

A

Invasion through the DEJ into the dermis (and pagetoid epidermal spread)

Superficial spread grows horizontally but also involves the dermis. Nodular is primarily growing down into the dermis.

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13
Q

Recall some morphologic feature suspicious for melanoma.

A

Asymmetry

Discohesive nests

Discohesive cells & pagetoid spread

Band-like associated lymphocytes

Cytologic atypia

Lack of deep maturation

Melanocytic necrosis

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14
Q

What criteria must be included on sign out of a melanoma?

A

Depth (Breslow’s in hundredth of a millimeter, Clark’s related to the histologic levels)

Presence or absence of ulceration

Margin status

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15
Q

What are desmoplastic and spindle cell melanoma?

A

Melanoma with spindly/sarcomatoid melanocytes. Desmoplastic is also sparsely cellular in a dense fibrotic background. Look for clumps of lymphocytes…

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16
Q

What is acral lentiginous melanoma?

A

A melanoma that is characterized by prominent lengitinous growth, and can be hard to distinguish from an acral nevus.

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17
Q

What features of metastatic lesions suggest melanoma?

A

Alveolar (nested) architecture

Large cells with big nuclei and red nucleoli

Occasional melanin pigment

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18
Q

Recall the utility of S-100, HMB-45, and Melan-A in diagnosis of melanoma.

A

S-100 stains all melanomas. Not helpful in lymph nodes (FDCs)

HMB-45 does not stain spindled melanomas. Generally lost deep in a melanoma. Also stains PEComas & angiomyolipoma.

Melan-A does not stain spindled or desmoplastic melanomas.

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19
Q

What is solar elastosis?

Solar lentigo?

A

Elastosis: Accumulation of grey wispy damaged elastin in the dermis

Lentigo: A finger-like proliferation of hyperpigmented rete growing into the epidermis.

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20
Q

What are the defining features of actinic keratosis?

A

Squamous atypia of varying thickness

Keratin becomes pink and hyperkeratotic, with sparing of keratin above the hair follicles.

Underlying solar elastosis

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21
Q

What is bowenoid actinic keratosis?

A

Full-thickness atypia without invasion.

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22
Q

What dermal entities can be categorized as carcinoma in situ?

A

Actinic keratosis & bowenoid actinic keratosis

Bowen’s disease: In non sun-damaged skin and does not spare hair follicles

Bowenoid papulosis: HPV-related lesion of genital sites

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23
Q

What are the features of basal cell carcinoma?

A

Lobules of small, blue, basal-type keratinocytes with peripheral palisading

Formation of clefts between tumor nests and stroma

Desmoplasia, focal keratinization, or mucin production

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24
Q

Recall three or so subtypes of basal cell carcinoma.

A

Nodular: Usual type

Superficial multicentric: Hangs off epidermis like stalactites

Sclerosing: Prominent desmoplastic response

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25
Describe the usual morphology of seborrheic keratoses.
Hyperkeratotic, orthokeratotic lesion with a markedly thickened epidermis. Features **horn cysts** (whorls of orthokeratin) and some pigment and inflammation. No atypia.
26
Describe the morphology of *verruca vulgaris*.
Church-spire epidermal proliferation with overlying hyper/parakeratosis. Has koilocytes.
27
What are *eccrine poroma / acrospiroma / hidradenoma*?
Tumors of sweat ducts composed of keratinocyte-like cells tha tform ducts. Streamy, pale, and disorganized. Like usual ductal hyperplasia in breast.
28
What are *eccrine spiradenomas*?
"Blue cannonballs in the dermis", consisting of two basaloid cell lineages with noticeable cords and droplets of hyaline basement membrane substance
29
What is a *cylindroma*? What is a *syringoma*?
An adnexal tumor with basaloid nests in the dermis but a mosaic shape to the nests. A collection of round, dilated tubules with tadpole-like appearance
30
What is a *trichoepithelioma*? What is *microcystic adnexal carcinoma*?
A benign tumor of hair follicle that resembles BCC but with horn cysts, hair formation, fibrotic stroma and lack of clefting. A cancer of sweat gland that resembles syringoma but with deep infiltration into the dermis.
31
What is an *epidermoid cyst?* What is a *pilar cyst*?
Epidermoid: Lined by mature squamous epithelium with a granular layer and filled with flaky keratin. Pilar: Lined by plump keratinocytes with no granular layer filled with compact dense keratin.
32
Describe the normal morphology of *dermatofibroma.* What is its malignant counterpart?
Ill-defined blue haze in the dermis made of tiny swarming nondescript cells with overlying hyperpigmentation/hypertrophy. Dermatofibrosarcoma protuberans
33
Describe the normal morphology of neurofibromas.
Pale/grey nodules in the dermis composed of cells with wavy nuclei and wavy collagen.
34
Describe the normal morphology of *hemangiomas*. What is its malignant counterpart?
Proliferation of well-formed, dilated capillaries in teh dermis. Angiosarcoma, which is more cellular and has anastomosing channels lined with plump cells.
35
Describe the morphology of Kaposi's sarcoma. Of pyogenic granuloma?
Simulates hemangioma, very hard to spot in early stages. Lobular, circumscribed lesion that is very cellular and inflamed.
36
How does the epidermis appear folowing acute damage or inflammation?
Edema (spongiosis), which can be severe enough for form intradermal vesicles. Followed by hyperplasia (acanthosis) and possibly hyperkeratosis.
37
What is interface dermatitis, and what are its two patterns?
Inflammation of the basal keratinocyte layer. Lichenoid: Intense lymphocytic infiltrate at the DEJ. Vacuolar: Vacuolar degeneration of the basal cells
38
What is *acantholysis*?
Usually antibody-mediate destruction of the intercellular junctions. Results in coalescence of bullae.
39
What is the most simple pattern of dermal inflammation? What if it progresses and features neutrophils?
Perivascular lymphocytic inflammation Vasculitis
40
What is leukocytoclastic vasculitis?
Vessels show fibrinoid necrosis and nuclear debris
41
What do neutrophilic infiltrates, granulomas, or dense lymphocytic infiltrates in the dermis suggest?
Neutrophilic: eg Sweet's syndrome Granulomatous: Infection, foreign body response, sarcoidosis, *granuloma annulare* Lymphocytes: Consider cutaneous T-cell lymphoma
42
What are the two forms of panniculitis? Give examples.
Septal: Inflammation is mostly in the fibrous septae between fat. eg Erythema nodosum. Lobular: Fat itself is inflamed. eg Lupus profundus.
43
Normal skin 1. Normal melanocyte with clear halo of cytoplasm 2. Pigmented basal keratinocyte 3. Typical orthokeratin
44
Melanophages in an intradermal nevus Arrowhead: Nevus cells Arrow: Melanophages
45
Lentigo simplex in acral skin Arrows: Linear proliferation of melanocytes along DEJ.
46
Compound nevus Arrow: Nest of nevocellular cells at the DEJ Arrowhead: Maturing nevus cells in the dermis
47
Intradermal nevus More mature cells at base (arrowhead) than at surface (arrow).
48
Blue nevus Arrow: Elongated, fusiform cells scattered in dermal collagen
49
Spitz nevus Arrow: Large, spindled melanocytes at the DEJ Arrowhead: Pagetoid spread of melanocytes in the epidermis
50
Dysplastic nevus Arrow: Spindled melanocytes bridging the rete Arrowhead: Trailing of single melanocytes at the edges Inset: Cytologicallya typical melanocytes
51
Melanoma Top: Pagetoid spread of melanocytes (arrowheads) Bottom: Deep dermal melanocytes with cytologic atypia (arrowhead) and mitoses (arrow).
52
Desmoplastic melanoma Arrow: Appearance of hypocellular scar in dermis Arrowhead: Collection of lymphocytes Inset: Enlarged and hyperchromatic melanocytes within the "scar"
53
Solar elastosis Arrow: Collagen replaced by gray-blue strands of elastin
54
Solar lentigo Arrow: Prominent rete with increased basal pigmentation and underlying solar elastosis
55
Actinic keratosis 1. Disorganized and enlarged nuclei 2. Atypical mitoses 3. Overlying hyperkeratosis/parakeratosis 4. Underlying solar elastosis
56
Squamous cell carcinoma Left: Superficially invasive SqCC Arrow: Deep keratinization (invasive nest) Arrowhead: AK-like changes in the overlying epidermis Right: Same, high-power Asterisk: Keratin pearl Arrow: Infiltrating single cell
57
Basal cell carcinoma Arrow: Clefting of tumor cells from the stroma Arrowhead: Prominent palisading at periphery of nests
58
Seborrheic keratosis Arrow: Horn cysts (entrapped keratin) Arrowhead: Hyperkeratosis (but no parakeratosis!)
59
Verruca vulgaris Arrow: Epidermis heaped into tall spires, topped with hyperkeratosis and parakeratosis.
60
Poroma Arrow: Epidermis, continuous with lesion Arrowhead: Tumor cells that are uniform, small and round, sometimes with rudimentary duct spaces
61
Eccrine spiroadenoma "Cannonballs in the dermis" composed of small round bland cells. Cords of hyaline pink basement membrane material (arrow).
62
Syringoma Arrow: Small tubules with comma-like tails in the dermis
63
Microcystic adnexal carcinoma Arrow: Horn cysts Arrowheads: Small pale nests deeply infiltrating the dermis
64
Left: Trichilemmal cyst (no granular cell layer, dense "wet" keratin) Right: Epidermoid cyst (granular cell layer, flaky "dry" keratin)
65
Dermatofibroma Arrowheads: Poorly circumscribed blue haze of fibroblasts Arrow: Overlying prominent and hyperpigmented rete Inset: Infiltrating cells with small round-to-oval nuclei.
66
Dermatofibrosarcoma protuberans Note increased cellularity and prominent storiform architecture
67
Neurofibroma Arrowhead: Poorly defined dermal tumor that is paler than surroundings Inset: Tapering, undulating nuclei (arrow) and wavy collagen fibers (arrowhead)
68
Capillary hemangioma Note collection of discrete, well-formed and dilated capillaries
69
Kaposi's sarcoma Arrowheads: Slit-like vascular spaces with bland endothelium Arrow: Accentuation of spaces around existing vasculature ("promontory sign")

Book - Molavi (29 decks)

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