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Pathology > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Describe the histology of atopic eczema

A
  • Flexures of elbows and knees -Associated with asthma and hay fever
  • Histologically- spongiosis formation- accumulation of fluid in the epidermis
    - Perivascular inflammation in superficial dermis
    - Usually lymphocytes and mast cells are inflammatory cells
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2
Q

Describe the histology of chronic plaque psoriasis

A
  • Well demarcated, red scaly and thickened areas of skin with silvery scale
  • Extensors of knees and elbows
  • Scalp and nails involved

Histology- Chronic inflammation dermis and thickening of dermis

  • No eosinophils involved in psoriasis*
  • Hyperkeratosis , epithelial hyperplasia (acanthosis), chronic inflammation
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3
Q

What is erythema multiforme

A
  • A hypersensitivity reaction triggered by infections like herpes simplex
  • Acute skin eruption with characteristic targeted lesion
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4
Q

What are the main type of inflammatory cells seen in drug skin reactions

A

eosinophils

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5
Q

Describe Lichen Planus

A
  • Idiopathic -Itchy purple polygon shaped flat raised skin lesions
  • Lower back wrists and ankles
  • Histology: Chronic inflammatory cell infiltrate along the dermal-epidermal junction
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6
Q

What is lichen sclerosus

A

Chronic skin condition with white patches appearing on genitals, itching and slight risk of cancer
Zones of hyalinisation or sclerosis in the superficial dermis

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7
Q

Describe erythema nodosum and it’s causes

A

-Panniculitis (inflammation of subcutaneous fat) causing tender red nodules on the shins

Caused by

  • Strep throat
  • OCP and antibiotics
  • Sarcoid
  • IBD
  • Pregnancy
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8
Q

What is pemphigus vulgarisms

A

Severe blistering of the skin and mucous membranes (mouth nose throat genital)

  • Intraepidermal blisters
  • Anti-desmosome antibodies - cells falling apart from one another - chicken wire pattern on immunoflurosecence
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9
Q

What is bullous pemphigoid

A

Blisters affecting the skin and occasionally mouth, sub epidermal blister with anti basement membrane antibodies, IgG found along the basement membrane

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10
Q

What is dermatitis herpetiformis

A

Itchy blistering skin associated with coeliac disease causing sub epidermal blisters
-IgA TTG and IgA anti-edomysial antibodies

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11
Q

Describe cutaneous sarcoidosis

A

Non-infectious non-caveating granulomatous inflammation
-Plaques and papules on body anywhere
2/3 patients will have systemic sarcoidosis

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12
Q

What is granuloma annulare

A

Zones of degenerate collagen surrounded by a rim of histiocytes/ macrophages (necrobiotic granulomatous inflam)
Localised is most common
-Round pink purple patches on bony sites- knees and elbows

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13
Q

What is necrobiosis Lipodica

A

Necrobiotic granulomatous inflam
Risk factor is T1 and T2D
Yellow brown patches on lower legs- tender
-Overlying skin prone to ulceration

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14
Q

How does herpes simplex virus affect the skin

A

-Intra-epidermalblister localised - lips, genitals and rectum- can recur
With intracellular viral inclusions

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15
Q

What is molluscum contagious

A

Cutaneous infection by Molluscum contagiosum virus with round raised lesions and a central crater, resolve without treatment

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16
Q

What are the two main bacterial infections of the skin

A

Impetigo- infection of the superficial dermis- staph aureus

Cellulitis- infection of the dermis and subcutaneous fat- staph aureus or strep pyrogenes

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17
Q

What are the 3 cateogories of pre-cancers in dermatology

A
  1. Squamous dysplasia
    - Actinic keratosis -Bowen’s disease
  2. Melanocytic
    - Dsyplastic naevus -Melanoma in situ
  3. Glandular
    - Paget’s disease of nipple -Extra-mammary pagets
18
Q

What are the 4 types of invasive cancer in dermatology

A
  1. Epithelial cancers- basal carcinoma -squamous cell carcinoma
  2. Malignant melanoma
  3. Cutaneous T-cell lymphoma
  4. Kaposi sarcoma
19
Q

Explain the term dysplasia

A

Normal cells transforming into cancer cells gradually due to accumulation of genetic mutation in tumour suppressor and oncogenes- dysplasia is cells in the transitional period

20
Q

What are some of the risk factors for dysplasia

A

For Acitinic keratosis and Bowen’s disease-chronic sunlight exposure, immunosuppression (renal transplant patients), previous irradiation and chemical carcinogens

Groin and perineum- anal-vulval intraepithelial neoplasm
-HPV

21
Q

Describe the steps in squamous dysplasia

A
  1. Normal dermis undergoes mild dysplasia with abnormal hyper chromatic nuclei and increased number of mitotic figures on the lower 1/3 of the epidermis
  2. Moderate dysplasia is when these nuclei and mitotic figures extend to include the lower 2/3 of the epidermis
  3. Severe dysplasia is when the full thickness of the dermis is involved
  4. Invasive squamous cell carcinoma is when there is invasion of the basement membrane
22
Q

What is dysplastic naveus

A

A pre-malignant melanocytic lesion that has acquired atypical histology with no invasion
can be sporadic or familial (dysplastic naves syndrome- 2 hit hypothesis)

23
Q

Describe a melanoma in situ

A

Severe dysplasia of melanocytes in the epidermis
Risk factors - UV light exposure/ sun beds, fair skinned

Lentigo maligna: slow growing pigmented lesion on face

24
Q

Describe Paget’s disease of the nipple

A

Abnormal glandular or mutinous cells in the epidermis (adenocarcinoma in situ) can resemble eczema

  • Abnormal cells migrate along lactiferous duct system to reach the surface epidermis
  • Underlying ductal carcinoma in situ with or without invasive component

Extramammary pages disease happens in fairly parts of the body

25
Q

Describe a basal cell carcinoma

A
  • Originates from undifferentiated stem cells in the basal layers of the epidermis
  • Common and rarely mets - found in H zone of face- high risk areas less likely for successful excision
  • Cells at the periphery of tumour are columnar and parallel to each other like a fence
26
Q

Describe a squamous cell carcinoma

A

An invasive tumour that shows squamous differentiation

-Is more agressive and has potential to metastasise

27
Q

Describe a malignant melanoma

A

Malignant tumour of melanocytes where abnormal cells have invaded the dermis
Upward spread of cells = pagetoid spread
Horizontal spread of cells= radial spread

-Measures Breslow thickness and depth- distance between granular cell layer of epidermis and deepest malignant cell

Risk factors- sunlight, sunbeams, dysplastic naevus syndrome
-Much more aggressive

28
Q

What treatment can you give if a patient’s skin cancer has the BRAF mutation

A

Vemurafenib

29
Q

What is mycosis fungoides

A
  • Cutaneous t-cell lymphoma (non- hodgkins lymphoma)
  • Involves the epidermis and dermis - low grade and can resemble eczema, is slow growing - disease caused by infection with a fungus

Sezary syndrome = more aggressive

30
Q

What is a Kaposi Sarcoma

A

Malignant vascular proliferation within the dermis (or internal organs)
Can be HIV related or transplant related, endemic related
-Human herpes virus 8 spreads it but most people don’t develop it unless immunosuppressed or genetically susceptible

31
Q

Describe a cutaneous cyst

A

Spherical epithelial lined structure in the dermis with cheesy keratinous material
most common= epidermal inclusion cyst

32
Q

What is seborrhoea keratosis

A

Seen in elderly - barnacles

  • Can be confused for melanoma but their base is flat with makes it benign
  • Dark warty greasy lesion associated with aging
  • Often more than 1
33
Q

What is a fibrous-epithelial poly/ skin tag

A

A round structure of mostly connective tissue with a thin epithelial cover - soft benign polypoid lesion most common in skin fold areas - axilla

34
Q

What is a papilloma

A

A benign epithelial tumour arising from usually squamous epithelium with complex branching and fibrovascular core - breast, nasal cavity and larynx
-Can be single or multiple and some are caused by HPV infection

35
Q

What is a dermatofibroma

A

A benign fibroblastic proliferation in the dermis typically on the lower legs can represent an inflammatory response to trauma (insect bite)

36
Q

Describe a skin ulcer

A

Full thickness loss of epidermis so granulation tissue is in a bed of ulcer ( a mix of new blood vessels and inflam cells - neutrophils and lymphocytes)

Causes: Arterial/ venous insufficiency, diabetes, trauma, surgery, immobility (pressure ulcer)

Squamous cell carcinomas can sometimes ulcerate

37
Q

What is a pyogenic granuloma

A

A benign fast growing vascular tumour involving polypoid proliferation of small blood vessels that can ulcerate and bleed
-raspberry or mince
Causes: Trauma, infection, pregnancy, medication

38
Q

What is a pilonidal sinus

A

fragmented hair shaft material in a sinus tract in the dermis surrounded by inflam cells and fibrous scar tissue
-Sacrum/ buttocks of hairy men

39
Q

Describe what a freckle is and what is solar lentigo

A

Increase in basal pigmentation but no increase in melanocytes

Solar lentigo: Increase in basal pigmentation and a small increase in basal melanocytes but no nuclear atypia - elderly- can be a differential for lentigo malignant

40
Q

What is lentigo malignant

A

Melanoma in situ on a persons face
-Greater number of melanocytes with nuclear enlargement, atypia and increase no of mitotic figures with upward (pagetoid) spread

41
Q

What is the difference between junctional naevus, intradermal naevus and compound naevus

A
  1. Junctional naevus - proliferation of benign melanocytes confined to the epidermis
  2. Proliferation of benign melanocytes within the dermis
  3. Combined features of both of the above and an intradermal naevus
42
Q

What is halo naevus

A

“Halo around the naevus”

-Prominent lymphocytic infiltrate and melocytic lesion due to immune mediated regression of the lesion

Pathology (12 decks)

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