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Multisystems > CM- Cutaneous Neoplasia > Flashcards

CM- Cutaneous Neoplasia Flashcards

1
Q

What are the four types of cells that make up the epidermis?

A
  1. keratinocytes
  2. melanocytes
  3. Langerhans cells
  4. Merkel cells
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2
Q

What is the structure of a keratinocyte?

Describe the cytoplasm, nuclei, and relationship to other cells.

A
  • Eosinophilic cytoplasm
  • vesicular nuclei
  • closely opposed cells with intercellular bridges between cells
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3
Q

What is the function of keratinocytes?

A

epidermal barrier [provide protective covering]

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4
Q

What are the 4 layers of keratinocytes from most superficial to deepest?
Describe the histology of each layer.

A
  1. Stratum corneum [“cornified layer”]
    - flat, anucleate, eosinophilic cells
  2. Stratum granulosum [“granular layer”]
    - basophilic granules with proteins to make epidermal barrier
  3. Stratum spinosum [“spinous layer”]
    - prominent intercellular bridges
    - several layers thick
  4. Stratum basale [“basal layer”]
    - single layer, cuboidal to columnar cells
    - more basophilic than keratinocytes in upper layers
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5
Q

You are looking at histology of the epidermis and see cuboidal cells with clear cytoplasm and eccentric nuclei.
These cells are basally located.
What cell is this? What is the ratio of this cell to basal keratinocytes?

A

Melanocyte

Ratio is 1:4 to 1:9

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6
Q

How does the number of melanocytes vary by race?

What is the function of these cells?

A

All races have the same # of melanocytes, but the races vary on how much pigment is made in melanosomes.

Function of melanocytes = produce protective pigment

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7
Q

You are looking at histology and see cuboidal cells with clear cytoplasm and eccentric nuclei in the middle of the spinous layer of epidermis.
What cell is this and what is the function?

A

Langerhan’s cells - macrophage like cell derived from the bone marrow.

Function: present antigens, be involved in cutaneous immunity

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8
Q

What is the structure of a Merkel cell?

What is the function?

A

Merkel cells are hard to identify on H&E but they are similar to neuroendocrine cells.

Function: sensory perception

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9
Q

What is the function of the epidermal-dermal junction?

What are the ultrastructural and biochemical components from superficial to deep?

A

It is important for providing structural integrity to the skin.

  1. basal keratinocytes with hemidesmosomes to anchor to the BM
  2. BM
    - lamina lucida with anchoring filaments
    - lamina densa with type 4 collagen
  3. Sublamina densa with anchoring fibrils [type 7 collagen]
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10
Q

What is the difference between papillary and reticular dermis?

A

Papillary dermis- eosinophilic, tightly packed collagen bundles that extend up between epidermal rete ridges

Reticular dermis- loosely packed larger collagen bundles

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11
Q

What are the 3 ECM components of the dermis?

A
  1. collagen bundles
  2. elastic fibers
  3. glycosaminoglycans [GAGs] aka ground substance aka dermal mucin
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12
Q

What are the 3 cellular components of the dermis?

A
  1. fibroblasts
    - synthesize collagen, elastin, proteoglycans
    - spindle-shaped with dark small nuclei
  2. dermal dendrocytes
    - APCs
    - difficult to see on H&E
  3. Inflammatory cells
    - low in number for healthy skin
    - macrophages, mast cells [histamine], lymphocytes [80T,20B]
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13
Q

What 2 inflammatory cells are only seen in abnormal skin?

A
  1. eosinophils

2. neutrophils

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14
Q

Describe the blood supply located in the dermis.

A
  1. Arteries are in the transverse septum of subcutaneous fat and form DEEP PLEXUS in reticular dermis
  2. Arterioles pass into the papillary dermis and form SUPERFICIAL PLEXUS
  3. capillary-venules form superficial vascular loops which ascend and descend the papillary dermis
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15
Q

Describe the histology of the following structures in the dermis:

  1. vessels
  2. lymphatics
A
  1. basophilic, flat endothelial cells and pericytes surrounding lumen containing RBCs
  2. basophilic flat endothelial cells with FEWER pericytes and NO RBCs in the lumen
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16
Q

What is the glomus?
where is it located?
What is the function?

A

It is a vascular structure in the reticular dermis of:

  1. pads of digits
  2. nailbeds
  3. face
  4. ears

That regulates temperature via AV shunt

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17
Q

Where in the skin are the following located and what do they look like?

  1. schwann cell
  2. Meissner cell
  3. Vater-Pacini cell
A
  1. dermis; S shape, with wavy nuclei and pale cytoplasm
  2. dermal papillae; hard to see on H&E
  3. subcutaneous fat; onion-like shape
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18
Q

How histologically can you identify non-vascular smooth muscle in skin?
what are the 2 locations where this smooth muscle is found?

A

Absence of striation and centrally-located nucleus

  1. arrector pili muscles - erect hair shaft
  2. nipples and scrotum - extra smooth muscle bundles`
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19
Q

What are the 4 “epidermal appendages” found in the dermis?

A
  1. folliculosebaceous unit
  2. eccrine glands
  3. apocrine glands
  4. nail unit [matrix, bed, plate]
20
Q

Where are folliculosebaceous units found?

What are the 2 components?

A

All cutaneous sites except glabrous [hairless] skin like the palms and soles.

  1. follicle = cylidrical downgrowth of surface epithelium surrounded by connective tissue
  2. sebaceous gland = one to several lobules that lead to a common excretory docut composed of stratified squamous epithelium
21
Q

Describe the 3 parts of a hair follicle.

A
  1. infundibulum = opens to the surface
  2. isthmus = small portion from insertion of arrector pili to entrance of sebaceous duct
  3. inferior portion = hair bulb and germinating epithelium
22
Q

Describe the structure of the sebaceous gland.

A

one to several lobules leading to a common excretory duct.

  1. Lobule:
    - peripheral cuboidal, basophilic cells
    - central lipid-containing, clear cytoplasm, delicate pink strands
  2. excretory duct
    - stratified squamous epithelium
23
Q

What are eccrine glands?
where are they located?
What is the histology?

A

True sweat glands located everywhere except:

  • external auditory canal
  • lips
  • labia minora, clitoris

Composed of:

  1. Cuboidal cells with clear, glycogen containing cytoplasm
  2. darkly staining myoepithelial cells
24
Q

What is the acrosyringium?

A

The part of the eccrine gland duct that courses through the epidermis.

25
Q

Where are apocrine glands located?

A

eyelids
external ear
axillae
anogenital region

26
Q

What are the 2 major components of subcutaneous tissue [panniculus adiposus]?

A
  1. lobules of mature adipose tissue
    - adipocytes with clear cells with displaced nucleus
  2. fibrous septa-think fibrovascular tissue surrounding individual fat lobules
    - fibroblasts, collagen
    - vessels
    - nerves
27
Q

Describe variations in epidermal thickness by body region.

A
  1. Thin [few cell layers thick] = eyelids, genitalia
  2. Medium = trunk, extremities
  3. Thick = palms and soles [with compact cornified layer]
28
Q

Describe variation in hair follicles by body region.

A
  1. Scalp = long follicles that extend into fat
  2. Face = shorter follicles with larger sebaceous glands
  3. palms, soles = no hair follicles
29
Q

What areas of the body lack stratum corneum?

A

mucousal surfaces

30
Q

A lesion of the skin:

  1. remains small or grows slowly
  2. symmetric, well circumscribed, can be “shelled out”
  3. VERTICALLY oriented
  4. peripheral fibrous tissue is dense
  5. clefts between lesion’s stroma and normal dermis
  6. localized [either superficial OR deep]
  7. does not ulcerate unless traumatized
  8. uniform size/shape nests of cells with smooth borders
  9. neoplastic cells in discrete arrangements
  10. epithelial cells are NOT in single file line between collagen bundles
  11. well-differentiated cells
  12. adnexal structures are preserved.
  13. necrosis of single cells, but NONE en masse
  14. no neoplastic cells in nerves or vasculature.

Benign or malignant?

A

Benign

31
Q

How does the melanocyte differ from a benign nevus to a melanoma?

A

Benign nevus:
Melanocyte nuclei at the base of nevus is much smaller than those near the surface [maturation]

Melanoma:
Maturation is not seen

32
Q

How do clefts differ between benign and malignant skin neoplasms?

A

Benign:
cleft between lesion’s stroma and normal dermis

Malignant:
cleft between neoplastic cells and lesions stroma

33
Q

How does vertical/horizontal orientation differ between malignant and benign skin neoplasms?

A

Benign - vertically oriented and can be shelled out

Malignant - horizontally oriented

34
Q

After you use a constellation of criteria to determine benign v. malignant, what is the next step in identifying the neoplasm?

A

Pin down the specific cellular differentiation:

  1. epithelial cell:
    - squamous, follicular, sebaceous, apocrine, eccrine, melanocytic
    - ALL are + for cytokeratin except melanocytic
  2. non-epithelial
    - lymphocytes, mast cells, histiocytes
    - neural, muscular, vascular, fibrous, adipose differentiation
35
Q

What is the cellular differentiation that causes actinic keratosis, Bowen’s disease and squamous cell carcinoma?

A

Epithelium - spinous cell layer

36
Q

Histology shows thickened epidermis with downward proliferation of keratinocytes that are disordered near the bottom layers [some are anaplastic with large irregular nuclei].
Overlying hyperkeratosis and parakaratosis.
What is this called?
What is it a precursor for?

A

Actinic keratosis which is a precursor for SCC.

37
Q

Histology shows thickened epidermis with the ENTIRE epidermis consisting of disordered, anaplastic keratinocytes. What is this called?

A

Bowen’s disease [SCC in situ]

38
Q

Histology shows nests of irregular, anaplastic keratinocytes proliferating downward into the dermis.
Horn pearls [centers of compact keratin with retained nuclei] are present.
there is overlying hyperkeratosis and parakeratosis.
What is the diagnosis?

A

SCC

39
Q

Histology shows basaloid neoplastic cells extending from under surface of the epidermis. The cells are growing horizontally/radially and involve the lower epidermis/upper dermis. What is the diagnosis?

A

Superficial Basal cell carcinoma

40
Q

Histology shows infiltrative nests of basal keratinocytes [cuboidal, columnar with oval nuclei and less pink cytoplasm].
there are peripheral palisading basal cells at the edge of the nest.
There is clefts between the tumor nests and myxoid stroma.
What is the diagnosis?

A

Nodular basal cell carcinoma

41
Q

How do melanocytic nevi cells differe from melanocytes?

A

They are basically identical except nevi cells are arranged atleast partially in nests and clusters.

42
Q

How do melanocytes change in appearance the deeper into the dermis they get?

A

Melanocytes are usually cuboidal cells with pink cytoplasm and vesicular nuclei.

Deeper into the dermis = less cytoplasm, darker nuclei

43
Q

What are the 3 types of nevus?

A
  1. junctional = melanocytes confined to epidermal-dermal junction
  2. intradermal = melanocytes confined to dermis
  3. compound= junction and dermis
44
Q

Histology shows single melanocytes and nests of varying size at the epidermal-dermal junction.
Melanocytes also ascend to higher layers of the epidermis.
Nests coalesce to form sheets in the dermis.
There is exuberant inflammatory infiltrate and mitotic figures.
the lesion is asymmetric and not well-circumscribed.
What is the diagnosis?

A

Melanoma

45
Q

Describe melanoma in situ.

A

Normally melanocytes reside at the epidermal-dermal junction.
In situ melanoma:
- broad, asymmetric, poorly circumscribed lesion
-neoplasm in every layer of the epidermis

46
Q

What is Brewslow depth?

A

vertical distance in mm from granular layer to deepest melanoma cell in the subepidermal tissue.
Melanoma less than 0.76mm has not yet metastasized.

Multisystems (29 decks)

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