Derm Path III

Question 1

What are the two types of subcutaneous neoplasms?

Answer 1

Panniculitis- inflammation of fat or vessles

Tumors- Lipomas or leiomyomas

Question 2

Polyarteritis nodosum is what type of subcutaneous neoplasm?

Answer 2

Panniculitis

Question 3

What is polyarteritis nodosum?

Answer 3

Inflammatory disease of small/medium sized muscular arteries

Question 4

How does polyarteritis nodosum present?

Answer 4

Palpable purpura in the skin +/- ulceration, often in the lower limbs

Question 5

What do we see on histology of polyarteritis nodosum?

Answer 5

Inflammation of the arteries in the subcortis with fibrin deposition

Question 6

Where on the body is erythema nodosum found?

Answer 6

Most commonly on the front of the legs

Question 7

What conditions are thought to cause erythema nodosum

Answer 7

May be associated with drugs- sulfa, NSAIDs or OCP, infections, or idiopathic

Question 8

Inflammatory dermatosis is a fancy name for what?

Answer 8

Rash

Question 9

What is lichenoid dermatitis?

Answer 9

Band-like infiltrate of inflammatory cells attacking the dermal/epidermal junction

Question 10

List the 6 P’s of lichen planus?

Answer 10

Pruritic, purple, polygonal, papule, plaques

all of lichen Planus

Question 11

What changes occur in the rete ridges in lichen planus?

Answer 11

Sawtoothing

Question 12

Apoptotic cells stay where in lichen planus? Why is this important?

Answer 12

The basal layer- it differentiates lichen planus from erythema multiforme

Question 13

Where are colloid bodies seen in lichen planus?

Answer 13

In the basal layer- they are the apoptotic keratinocytes

Question 14

What causes erythema multiforme and what is the disease course?

Answer 14

EM is cause by infections, most commonly HSV

It is self-resolving

Question 15

At what % surface involvement is TENS designated?

Answer 15

SJS –> TENS at 30% surface involvement

Question 16

What is the characteristic appearance of erythema multiforme?

Answer 16

Targetoid- looks like little bullseyes

Question 17

In contrast to lichen planus, apoptotic bodies (Civatte bodies) of erythema multiforme are found where?

Answer 17

Throughout the entire thickness of the epidermis

Question 18

What are the corneal changes seen in erythema multiforme?

Answer 18

None- this is a very acute process

Question 19

What is the major difference between erythema multiforme and SJS/TENS?

Answer 19

By SJS/TENS, all of the keratinocytes have been killed off

Once the entire epidermis is necrosed, it’s going to fall off –> skin sloughing

Question 20

Lupus is what type of dermatitis?

Answer 20

Lichenoid dermatitis

Question 21

Dermal mucin is a buzzword for which dermatitis?

Answer 21

Lupus erythematosis

Question 22

On direct immunofluorescence of lupus, which proteins are positive?

Answer 22

Positive lupus band test = IgG, IgA, IgM and C3 all along the basement membrane

Question 23

How does dermatomyositis appear histologically?

Answer 23

Similar to lupus but with less mucin and epidermal atrophy….requires clinical picture to differentiate

Question 24

What is lichen sclerosis et atrophicus?

Answer 24

Seen with chronic itching/irritation –> seen in the genital area

Hyalinization of the collagen

Question 25

Atypical lymphocytes along the dermal/epidermal junction are suggestive of what disease?

Answer 25

Cutaneous T-cell lymphoma

Question 26

What is a Pautrier's microabscess?

Answer 26

Group of atypical lymphocyte seen in cutaneous t-cell lymphoma

Question 27

What makes an atypical lymphocyte from T-cell lymphoma "atypical"?

Answer 27

Cerebriform nuclei "lump of coal on a pillow"

Question 28

What is the "Lichenoid pattern" seen in Lichen planus, erythema multiform, SJS/TENS, Lupus, Lichen sclorosis and CTCL?

Answer 28

Lymphocytes coming up and attacking the dermal/epidermal junction

Question 29

List the 3 histologic features that differentiate lichen planus from the other lichenoid dermatoses

Answer 29

wedge shaped hypergranulosis, hyperkeratosis, and apoptotic stay on the basal layer.

Question 30

What is the major histologic distinguishing feature of erythema multiform?

Answer 30

Full thickness apoptotic bodies

Question 31

What is the major histologic distinguishing feature of SJS/TENS?

Answer 31

Full thickness epidermal necrosis-> sloughing

Question 32

What is the major histologic distinguishing feature of lupus?

Answer 32

follicular plugging, mucin deposition, increased basement membrane

Question 33

What is the major histologic distinguishing feature of lichen sclerosis?

Answer 33

Sclerotic collagen

Question 34

What is the major histologic distinguishing feature of cutaneous t cell lymphoma?

Answer 34

Atypical lymphocytes + Pautrier microabscesses

Question 35

What defines psoriasiform dermatitis?

Answer 35

Regular elongation of the rete ridges

Question 36

What is the clinical appearance of psoriasis?

Answer 36

Well demarcated plaques with adherent silver/white scale

Question 37

What is important about the thinning of the suprapapillary plates?

Answer 37

Thinning --> auspitz sign. When you peel off the scale, it bleeds because the dilated blood vessels in the --> pinpoint bleeding

Question 38

What causes spongiotic dermatitis?

Answer 38

Edema within the epidermis caused by inflammatory factors --> vesicle formation in the epidermis

Question 39

What is a common example of spongiotic dermatitis?

Answer 39

allergic contact dermatitis

Question 40

What causes a bullous dermatitis?

Answer 40

Split in the epidermis

Question 41

Give three examples of a bullous dermatitis

Answer 41

Bullous pemphigoid Pemphigus vulgaris Dermatitis herpetiformis

Question 42

Are the bullae of bullous pemphigoid tense or flaccid?

Answer 42

Tense

Question 43

WHere does the "split" occur in a bullous pemphigoid?

Answer 43

Subepidermal Associated with eosinophils

Question 44

What causes blistering in bullous pemphigoid?

Answer 44

IgG antibodies against hemidesmosomes (BPAG1 and BPAG2)

Question 45

Which is the most common type of pemphigus?

Answer 45

Pemphigus vulgaris

Question 46

How does pemphigus vulgaris appear clinically?

Answer 46

Superficial vesicles and bullae that rupture easily leaving shallow, crusted erosions

Question 47

IgG against which protein structure are attacked in pemphigus vulgaris?

Answer 47

Desmosomes --> intraepidermal bullae that are flaccid and more easily rupture IgG is against desmoglein, most specifically

Question 48

Dermatitis herpetiformis is associated with which disease?

Answer 48

Celiac disease Both the herpetiformis and enteropathy respond to a gluten-free disease (due to antibodies

Question 49

What is the poster child disease for granulomatous dermatitis?

Answer 49

sarcoidosis

Question 50

Name a leukocytoclastic vasculitis

Answer 50

Henoch schonlein purpura

Question 51

Verrucas are driven by what infection?

Answer 51

HPV

Question 52

What are the histologic features of verrucas?

Answer 52

Hyperkeratosis, hypergranulosis and papillomatosis (bart simpson sign) + Koilocytes- (vacuolated keratinocytes with raisin like nuclei)

Question 53

Who gets molluscom contagiousum?

Answer 53

Kids

Question 54

What causes molluscom contagiosum?

Answer 54

viral infection--> mollsucum bodies (HENDERSON PATTERSON BODIES) : intracytoplasmic virus pushes cellular structures to the outside --> glassy cellular appearance of cells

Question 55

What are the 3 M's of HSV1 and HSV2?

Answer 55

Molding ("spooning"), multinucleated and marginated chromatin

Question 56

HSV: What is hutchinson's sign? Why is it important?

Answer 56

HZV involvement of the nose: important because it could result in vision impairment if there is ocular involvement

Question 57

Where do we see the fungus on KOH prep of a cutaneous fungal infection?

Answer 57

In the corneum Can also see fungi with PAS stain

Question 58

Which fungal infection looks like "spaghetti and meatballs" on H and E?

Answer 58

Tinea versicolor

Question 59

What does a tinea versicolor infection look like?

Answer 59

Macules and patches of hypo/hyperpigmentation on the trunk

Question 60

How does the size of blasto compare to surrounding inflammatory cells?

Answer 60

Slightly larger- basically the same size, and consistent in size

Question 61

How does the size of coccidiomycosis compare to surrounding lymphocytes?

Answer 61

WAY BIGGER

Question 62

How does the size of histo compare to surrounding lymphocytes?

Answer 62

Histo is intracellular- much smaller

Question 63

How does the size of cryptococcus compare to surrounding inflammatory cells?

Answer 63

About the same size, although the sizes varies a little bit (differentiate from blastomycosis)