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MHD > Derm Pathology > Flashcards

Derm Pathology Flashcards

1
Q

What are the 5 layers of the epidermis (superficial –> deep)?

A 
Corneum
Lucindum (thick skin only)
Graulosum
Spinosum
Basale
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2
Q

Define Acanthosis

A

Thickening of the epidermis, often due to thickening of stratum spinosum

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3
Q

What is desquamatization? How long does it take?

A

Maturation of keratinocytes from undiff basal cells to diff cornified cells

Takes about 25 days normally

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4
Q

Ichthyosis

What is seen grossly?

A

Fish-like scales

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5
Q

Ichthyosis

Cause

A

Defective desquamatization leads to a buildup of a compacted scale

Mostly hereditary that appear at birth

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6
Q

Ichthyosis Vulgaris

Histology

A

Hyperkeratosis

Fish-like scales

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7
Q

What is hyperkeratosis?

A

Thickening of the cornified layer

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8
Q

Seborrheic Keratosis

Gross appearance

A

Generally well circumscribed with a “stuck on” appearance

Mostly in ppl above age 30

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9
Q

Seborrheic Keratosis

What is it? Describe the histology

A

Benign epithelial neoplasm

Hyperkeratosis
Undulations = papillomatosis
Horn cysts- small cysts filled with keratin

String sign – flat bases

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10
Q

Acanthosis Nigricans

Gross appearance

A

Velvety appearance on neck or axilla

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11
Q

Acanthosis Nigricans

Histology

A 
Lots of papillomatosis
Increased pigmentation (increased melanin)
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12
Q

Acanthosis Nigricans

Benign or Malignant?

A

Benign type in childhood (may be related to obesity or endocrine disorder)

May be a sign of malignancy in adulthood

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13
Q

Seborrheic Keratosis

Lesar Trelat Sign

A

Paraneoplastic Syndrome

Many seborrheic keratoses coming up at once – may be a sign of malignancy

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14
Q

What is a Fibroepithelial Polyp?

A

Skin tag

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15
Q

Actinic Keratosis

Gross appearance and Cause

A

Scaly erythematous patch on sun-damaged skin

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16
Q

Actinic Keratosis

Histology

A

Atypia of the lower levels of epidermis

Solar elastosis in dermis – grey-blue color

Flag sign (alternating pink/blue)

Inflammation with lots of T lymphocytes

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17
Q

Actinic Keratosis

Precursor to…

A

SCC

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18
Q

SCC

What mutations are most common?

A

P53

Could also have mutations in HRAS or Notch

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19
Q

SCC

Risk of Metastasis

A

Low (Less than 5%)

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20
Q

SCC

Risk factors

A 
Sun-exposed sites
Older age
M > F
Immunosuppression (HPV 5 and 8)
Industrial exposures
Chronic wounds
Arsenic
Burn scars
Ionizing radiation
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21
Q

SCC

Gross appearance

A

Hyperkeratotic
Ulcerated

Papules and nodules

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22
Q

SCC

Histology

A

Invasion of malignant cells into sun-damaged dermis

Keratin pearls

Atypia in squamous keratinocytes

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23
Q

SCC In Situ (Bowen’s Disease)

Describe the histology

A

Full thickness atypia of the epithelium (dark cells, mitotic figures, apoptosis)
Often see acanthosis

Basal layer is unaffected/uninvaded

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24
Q

SCC In Situ (Bowen’s Disease)

Gross Appearance and Treatment

A

Plaque-like lesion that needs to be cut out

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25
Q

Bowenoid Papulosis

Cause, Location, Appearance, Prognosis

A

HPV induced, often on genitals

Multiple papules

May spontaneously regress or progress

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26
Q

Basal Cell Carcinoma

Gross appearance

A

Pearly pink papule with overlying telangiectasia

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27
Q

Basal Cell Carcinoma

Histology

A

Blue tumor
Peripheral pallisading of nuclei

Islands of basaloid cells in the dermis (nodular type)

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28
Q

Basal Cell Carcinoma

Mutations in…

A

PTCH (regulates Hedgehog pathway signaling)

P53

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29
Q

Basal Cell Carcinoma

Two genetic diseases associated with this disease….

A

Xeroderma Pigmentosum (aut recessive, DNA mismatch repair syndrome)

Nevoid Basal Cell Caricnoma Syndrome = Gorlin Syndrome
(Aut dom, mutation in PTCH)

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30
Q

Melanocytes

Where are they located? What is their appearance and function?

A

Located on basal layer in epidermis

Dark and small nuclei

Release melanin and pass the pigment off to neighbors
Also have a small “cap” of pigment to protect themselves from DNA damage

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31
Q

What is a freckle?

A

Small, tan-red macules on sun exposed areas

Increased melanin pigment with basal keratinocytes

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32
Q

What is a Melanocytic Nevi?

A

Tan-brown macules and papules

May be common or dysplastic

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33
Q

Difference between Common and Dysplastic Melanocytic Nevi

A

Common: Junctional, compound and intradermal: nests of melanocytes

Dysplastic: single and cytologically atypical melanocytes; nests with architectural atypia

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34
Q

What are Dysplastic Nevi?

A

Architecturally atypical with melanocytic nests that may be alrger and fused
Single melanocytes along DEJ
Cytologic atypia

35
Q

Dysplastic Nevi

Prognosis

A

Vast majority are clinically stable, but some consider it to be a risk factor for melanoma

36
Q

Dysplastic Nevus Syndrome

What is it? What is the common mutation?

A

Tendency to develop many dysplastic nevi and melanomas

Mutation in CDKN2A and CDK4 mutations

37
Q

Melanoma

What are the ABCDEs?

A 
Asymmetry
Borders (irregular)
Color 
Diameter
Elevation/Evolving
38
Q

Melanoma

Prognostic Factors

A

Depth of tumor

Ulceration of tumor

of mitotic figures

39
Q

What is the major mutation in sporadic melanomas?

A

BRAF mutations (60% of melanomas)

40
Q

How are melanomas with BRAF mutations treated?

A

Vemurfenib (a monoclonal Ab against BRAF)

41
Q

What are the two major predisposing factors to melanoma?

A

Sun exposure and family history

42
Q

When do melanomas acquire metastatic potential?

A

When they develop a vertical growth phase, so it is important to cut them out before that

43
Q

Describe the 4 Stages of Melanoma

A

0: Melanoma in situ
I/II: Confined to skin (any depth)

III: nodal involvement

IV: distant skin or viscera

44
Q

Trichelemmoma

  • Mutation
  • Syndrome
  • Risks
A

PTEN mutations

Cowden’s syndrome

Increased risk for breast, endometrial, thyroid cancer

45
Q

What is a dermatofibroma and how is it identified?

A

Pink/brown papule or nodule most common on lower extremities

Dimpling sign

46
Q

Dermatofibrosarcoma Protuberans

What is it? What does nit look like?

A

Large nodule with several protuberances

Dense proliferation of spindle cells within the dermis

47
Q

Cylindroma

  • Location
  • Appearance on histology
A

Common on scalp (turban tumor)

basaloid islands in puzzle pieces

48
Q

What is a sebaceous adenoma? How is it addressed?

A

Papule or small nodule that looks like BCC

Work them up for Lynch Syndrome (HNPCC) – look for MLH1, MSH2, MSH6 mutations

49
Q

Leiomyoma
What is it?
Appearance on Histology?

A

Tumor of the smooth muscle of dermis

Histology: Bubbles and cigar shaped cells

50
Q

Polyarteritis Nodosum/Erythema Induratum

What is it? What is the rash appearance?

A

Vasculitis of small and medium sized arteries

Purpura on skin, often with ulceration and on lower limbs

51
Q

Erythema Nodosum

  • Location
  • Appearance
  • Workup
A

Front of legs

Macular appearance

Work them up for TB

52
Q

P’s of Lichen Planus

A 
Purple
Papules
Plaques
Pruritic
Polygonal
53
Q

Lichen Planus

Common location and appearance

A

Oral mucosa is common

Wickham striae – white lines across the lesion

54
Q

Erythema multiforme

  • Appearance
  • Prognosis
  • Cause
A

Annular lesion (often targetoid)

Often resolves spontaneously and is associated with viruses

55
Q

TEN and SJS

Describe the histology

A

Civatte bodies (necrotic keratinocytes)

TEN = necrotic keratinocytes at all levels of epidermis

56
Q

DLE

  • Appearance on Histology
  • Stains to use
A

Mostly cutaneous

Lichenoid infiltrate and interface change

Mucin

Get thickened basement membrane seen on PAS stain

57
Q

LS&A (Lichen Sclerosis et Atrophicus)

Appearance (histology and gross)

A

Lichenoid infiltrate gets pushed down, leaving behind pink hyaline

Often appears as a thinning white patch on vulva

58
Q

Psoriasis

Associated with…

A

HLA-C haplotype

Arthritis
Myopathy
Enteropathy
Spondylitis joint
Acquired immunodeficiency
59
Q

Psoriasis

Gross Appearance

A

Well demarcated plaques with silver/white scales

May also have yellow/brown nail discoloration with pitting

“Peeling off sign” – peel off scale, see pinpoint hemorrhage due to elongated Rete pegs

60
Q

Psoriasis

Histology

A

Elongated Rete pegs

Acanthosis is even

Wafer like scale of PMNs

61
Q

Allergic Dermatitis

Histology

A

Spongiotic dermatitis with EOSINOPHILS

62
Q

Bullous Pemphigoid

  • Gross appearance
  • Histology
  • DIF
A

Tense bullae

Subepidermal blister with eosinophils

DFA reveals IgG antibodies to HEMIDESMOSOMES (lines up along the DEJ in a linear fashion)

63
Q

Pemphigus Vulgaris

  • Gross appearance
  • Histology
  • DIF
A

Loose flaccid blister
May rupture easily

Suprabasalar clefting = tombstoning

Net-like IgG and C3 on DIF (Antibodies formed against DESMOSOMES)

64
Q

Dermatitis Herpetiformis

  • Associated with…
  • Treated with…
  • DIF
A

Assoc with celiac disease and treated with a gluten free diet

Granular IgA deposits on direct immunofluorescense

65
Q

Sarcoidosis

-Histology

A

Chronic granulomatous inflammation with few lymphocytes (naked granulomas)

66
Q

Henoch Schonlein Purpura
What it is?
-DIF

A

Leukocytoclastic vasculitis with arhtritis, abd pain, or hematuria

IgA seen around vessel walls

67
Q

Mycosis Fungoides

Gross appearance and Histology

A

Cutaneous T Cell Lymphoma

-Dark or erythematous patches and plaques, often on trunk

Histo: Lymphocytes with dark nuclei line up at the DEJ

68
Q

Verruca Vulgaris

  • Cause
  • Histology
A

Wart caused by HPV

Hyperkeratosis and hypergranulosis seen above papillomatosis

See Koilocytes: vacuolated keratinocytes with raisin like nuclei

69
Q

Molluscum Contagiosum

  • Appearance
  • Histology
A

Small papuls that often look umbilicated
Seen in kids

Histology: crater with epidermis reaching down; may see molluscum bodies

70
Q

3 Ms of HSV infection

A

Molding (nuclei)
Multinucleation
Marginalization

71
Q

Primary VZV infection is….

  • Appearance
  • Transmission
A

Chicken Pox

Vesicles on red base/papules/crusted erosions

Transmitted by resp secretions

72
Q

Reactivation of latent VZV infection is…

A

Shingles

Painful vesicles in a dermatomal distirbution

73
Q

HZV Infection

Hutchinson’s sign

A

Involvement of the nose

Should make you think of potential ocular involvement, which needs immediate attention

74
Q

Impetigo

  • Causes
  • Appearance
  • Histology
A

Staph aureus or Strep pyogenes

Loose blisters with honey colored crusts, often on face

Histo: Subcorneal blister filled with PMNs and debris

75
Q

Tinia infections

  • Where may they be located?
  • Appearance
A

Pedis- foot
Corporis- body
Cruris- genitals
Capitus- head

Annular (ring-like) lesion

76
Q

What is onchomycosis?

A

Fungi seen in the nail

77
Q

How to identify Tinia infections

A

Do a biopsy (scrape) in the office and look at it under a KOH prep or PAS stain

78
Q

Tinea versicolor

  • Appearance
  • Histology
A

Macules or patches of hypopigmentation/hyperpigmentation on the trunk

Hyphae and yeasts form in the CORNEUM (spaghetti and meatballs pattern)

79
Q

Scabies

  • What is it?
  • Histology
A

Mite infection that is highly contagious

Forms a blister in the corneum

80
Q

Blastomycosis

-Histology

A

Epidermal acanthosis
Broad based budding yeast

Can mimic SCC

81
Q

Coccidiomycosis

Appearance

A

Mariner’s wheel = single larger form filled with tinier yeasts

82
Q

Cryptococcus

Appearance

A

Encapsulated yeast seen with mucicarmine

83
Q

Histoplasma

Appearance

A

Small intracytoplasmic organisms with surrounding clear halo

PAS and GAS +

MHD (57 decks)

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