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Derm Surg questions > Dermatopathology > Flashcards

Dermatopathology Flashcards

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Dermatology Board Prep flashcards
1
Q

Four things that spindle cell tumors could be

A

SCC Melanoma Tumors of nerve derivation Tumors of muscle derivation

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2
Q

What is this tumor and three pearls.

A

nevus sebaceous

palliomatosis with acanthosis

Sebacesous glands attaching to epidermis

may be underlying apocrine glands

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3
Q

Name this tumor and 4 pearls

A

Merkel Cell carcinoma

dense blue dermal infiltrate

usually no epidermal connection

Nuclear molding

CD 20+ paranuclear dots Synaptophysin +

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4
Q

What are the three most common mets to the skin

A

Breast Prostate Lung

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5
Q

What is this tumor and 4 pearls

A

sebaceous carcinoma

  1. malignant epithelial cells with sebaceous differentitation.
  2. EMA stain +
  3. Usually around eyelids
  4. Cytoplasmic vacuoles indenting nuclei
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6
Q

What is this tumor and three pearls.

A

nevus sebaceous

palliomatosis with acanthosis

Sebacesous glands attaching to epidermis

may be underlying apocrine glands

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7
Q

Name this tumor and 3 pearls

A

MF 1. CD4+ 2. Pautrier Microabscesses in epidermis 3. Epidermotropism of lymphocytes without spongiosis

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8
Q

Name this tumor and 4 pearls

A

Merkel Cell carcinoma

dense blue dermal infiltrate

usually no epidermal connection

Nuclear molding

CD 20+ paranuclear dots Synaptophysin +

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9
Q

What is this tumor and 4 pearls

A

sebaceous carcinoma

  1. malignant epithelial cells with sebaceous differentitation.
  2. EMA stain +
  3. Usually around eyelids
  4. Cytoplasmic vacuoles indenting nuclei
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10
Q

Name this tumor and 4 pearls

A

Trichoepithelioma

Dermal proliferation of basaloid cells with no epi connection

stromal stromal clefting

Papillary mesechymal bodies

may have calcified cysts

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11
Q

Name this tumor and 3 pearls

A

Poroma

Tumor arises from epidermis

Plate like squamous cells

May have many cyst like stuctures

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12
Q

Three things small blue cell tumors could be.

A

Merkel cell Lymphoma/Leukemia Mets such as lung cancer

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13
Q

What are the five Clark’s levels

A
  1. in situ 2. in papillary dermis 3. in papillary reticular dermal interface 4. Reticular Dermis 5. SubQ fat
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14
Q

What is this tumor with two pearls?

A

Solar lentigo

Even pigmentation without atypical cells

Delicate rete ridge projections that look like puppy feet.

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15
Q

What is this tumor with three pearls

A

Poroma

Tumor arises from epidermis

Plate like squamous cells

May have many cyst like stuctures

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16
Q

Name this tumor and 3 pearls

A

MF 1. CD4+ 2. Pautrier Microabscesses in epidermis 3. Epidermotropism of lymphocytes without spongiosis

Bonus lymphocytes intercalulated with basal cells

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17
Q

What is this tumor and 4 pearls

A

sebaceous carcinoma

  1. malignant squamous cells with sebaceous differentitation.
  2. EMA stain +
  3. Usually around eyelids
  4. Cytoplasmic vacuoles indenting nuclei
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18
Q

Name this tumor and 4 pearls

A

Trichoepithelioma

Dermal proliferation of basaloid cells with no epi connection

stromal stromal clefting

Papillary mesechymal bodies

may have calcified cysts

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19
Q

Name this tumor and 2 pearls

A

Fibroepithelioma of Pinkus

  1. anastomosing basaloid cells
  2. Loose Myxoid Stroma
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20
Q

Name this tumor and 4 pearls

A

Cylindroma

Puzzle like pattern

Hylinized stroma

well circuscribed

Ductal differentiation

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21
Q

Name this tumor and 3 pearls

A

MF 1. CD4+ 2. Pautrier Microabscesses in epidermis 3. Epidermotropism of lymphocytes without spongiosis

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22
Q

What does this stain show?

A

CK20 + paranuclear dotting for merkel cell carcinoma

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23
Q

What is this tumor and 4 pearls

A

sebaceous carcinoma

  1. malignant epithelial cells with sebaceous differentitation.
  2. EMA stain +
  3. Usually around eyelids
  4. Cytoplasmic vacuoles indenting nuclei
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24
Q

What is this and three other things in differential

A

Pagets disease of nipple EMA +

R/O melanoma in situ

Bowen’s disease

Sebaceous carcinoma

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25
Q

When breadloafing a specimen what percent of the margin is checked?

A

<1%

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26
Q

What are the two times you see stratum lucidum.

A

acral skin rubbed skin - also warts

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27
Q

Name this tumor and 4 pearls

A

Merkel Cell carcinoma

dense blue dermal infiltrate

usually no epidermal connection

Nuclear molding

CD 20+ paranuclear dots Synaptophysin +

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28
Q

Two finding histologically in MF.

A

-pautrier Microabscesses -abnormal T lymphocytes tagging along the basal layer in the epidermis without spongiosis, becoming more atypical higher in the epidermis. bonus CD4 +

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29
Q

Name this tumor and 4 pearls

A

Dermatofibroma

look for dell

cellular blue nodule in dermis

roots of spindle cells going in dermis

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30
Q

Name this tumor and 3 pearls

A

Dermatofibroma

look for dell

cellular blue nodule in dermis

roots of spindle cells going in dermis

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31
Q

Name this tumor and 4 pearls

A

Cellular Dermatofibroma

look for dell

cellular blue nodule in dermis

roots of spindle cells going in dermis

Look for Giant Touton cells

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32
Q

Name this tumor and 4 pearls

A

DFSP

sieve like infiltration of the fat or honeycombing

Storiform pattern

CD 34 +

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33
Q

Name this tumor and 2 pearls

A

Desmoplastic Melanoma

  1. spindle cells without pigment
  2. Cellular pleomorphism
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34
Q

Name this tumor and 2 pearls

A

Desmoplastic Melanoma

  1. spindle cells without pigment
  2. Cellular pleomorphism
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35
Q

Name this tumor and two pearls

A

Intradermal nevus

1, nests of bland melanocytes

  1. no deep mitotic figures
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36
Q

What are Kamino bodies

A

eosinophilic globules found in spitz nevi usually just beyond the tips of the dermal papilla.

They are made from basement mebrane components so are PAS positive.

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37
Q

What is this tumor and four pearls

A

Spitz Nevus

Nevus cells are spindle shaped and seem to enlongate out stream up in the papillary dermis

They are sharply circumscribed

Maturation of cells in the deeper dermis becoming smaller

Kamino bodies may be present

38
Q

What is this and 4 pearls

A

Spitz Nevus

Nevus cells are spindle shaped and seem to enlongate out stream up in the papillary dermis

They are sharply circumscribed

Maturation of cells in the deeper dermis becoming smaller

Kamino bodies may be present

39
Q
A
40
Q
A
41
Q

What varient of DFSP is positive for melanin

A

Bednar varient

+Fontana-Masson stain (Melanin) and + CD34 stain

42
Q

what are these pallisaded spindle cells with this pattern calls and what tumor are they associated?

A

Verocay Bodies (Schwannoma) S100+

43
Q

What is going on in the basal layer here of this tumor?

A

Basaloid follicular induction over a dermatofibroma

44
Q

What does induction refer to in regards to dermatopathology

A

hyperplasia in nearby non-tumoral epithelial structures like basaloid follciular induction with underlying dermatofibroma

45
Q

What type of glands are these in the eyelid.

A

Meibomian glands

these are free (not associated with follicles) modified sebaceous glands.

found on the inner aspect of the eyelid

46
Q

In the eyelid what gland is this?

A

Glands of Zies

modified sebaceous glands associated with follicles of the eyelashes

47
Q

What is this gland in the eyelid

A

modified lacrimal gland

48
Q

What gland in the eyelid is this?

A

Moll’s gland

a modified apocrine gland

49
Q

what is this bluesh substance in this basal cell carcinoma?

A

Mucin

50
Q

what is this tumor

A

chondroid syringoma

ductal structures

Dhondroid looking stroma

51
Q

This is going on in the lower leg what is happening?

A

Chronic venous insufficency

look for vertically oriented vessels and scar like changes

52
Q

What two features might make you think desmoplastic trichoepithelioma over a morpheaform bcc

A

calcification

horn cysts

53
Q

What is this in the eyelid

A

lacrimal duct

54
Q

what is this tumor

A

basaloid follicular hamartoma

55
Q

What is this?

A

trichostasis spinulosa

retained hair follicles (inside a follicle)

56
Q

what is this stuff

A

monsels solution

57
Q

What tumor is this

A

Atypical Fibroxanthoma (AFX) if dermal only, Pleimorphic Dermal scarcoma if SubQ

dermal tumor abutting the epidermis

fast growing

very pleiomorphic spindle cells

giant multinuclated cells

58
Q

What is this tumor

A

Syringocystadenoma papilliferum

epidermal attachments of endophytic ductal structures lined with cuboidal cells.

59
Q

What is this tumor

A

sebaceous carcinoma

60
Q

What is this tumor

A

sebaceous carcinoma

61
Q

Name three lesions that can show the Borst-Jadassohn effect

A

well defined nests of cells in acantholyic epidermis

SCC Bowen’s disease

Clonal Seb Ker

Hidroacanthoma (an epidermal poroma)

62
Q
A
63
Q

what is this effect known as

A

Borst-Jadassohn effect

Nests of cells in a clonal seb Ker

can also be in SCC bowens and hidroacanthoma (an epidermal varient of Poroma)

64
Q
A
65
Q

what is this called and what condition is it associated with?

A

Chornoid lamella

Porokeratosis

There is a column of parakeratois with focal loss of granular layer

66
Q

what is this tumor

A

syringoma

67
Q

What is this tumor

A

mucinous carcinoma

nests of basal cells floating in mucin separated by thin trabeculae

68
Q

What is this tumor

A

mucinous carcinoma

nests of basaloid cells floating in mucin separated by trabeculae

69
Q

what tumor is this

A

MAC Microcystic Adenexal Carcinoma

Cysts and calcifications

DEEP (unlike syrigoma)

Tadpole like ducts deep

70
Q

what tumor is this

A

Adenoid cystic carcinoma

Looks like a sponge with mucin in the holes (ducts)

normal parotoid gland cells to left (usually arises out of a salivary gland , lacrimal, breast)

71
Q

What is this tumor and the key features

A

sebaceous carcinoma

atypical basaloid cells

scattered sebocytes withmitoses necrosis and squamous metaplasia

72
Q

What is this tumor and what is it associated with?

A

sclerotic fibroma

Cowdens disease

tricholemmomas

acral keratoses

oral papilomatosis

73
Q

what is this tumor

A

mucinous carcinoma

nests of Basloid cells floating in pools of mucin

pools are separated by thin trabeculae

eyelid most common location (scalp neck axillae trunk)

74
Q

what is this tumor

A

Microcystic Adenexal carcinoma

paisly tie pattern with cysts

deep

hard to tell from desmoplatic trichoepitheloma without deep bx

75
Q

What is the average depth of perineural involvement across all body sites ?

A

2.7 mm

76
Q

What is the average perineural depth of involvement on the head depth wise.

A

2.2 mm

77
Q

What is the depth average for perineural involvement on the back?

A

4.3

Mesusured from the granular layer to the middle of the most superior nerve involved.

78
Q

What is this tumor

A

merkel cell carcinoma

small blue cells groupsed in sheets or trabecular pattern

79
Q

What is this tumor

A

trichoadenoma

multiple dermal cysts that have a granular layer (as opposed to seb kers which have more keratinocytes and less cysts)

cystic spaces may look like infundibular portions of hair follicles

Solid epithelial islands may be interspersed among the cyst like structures

80
Q

when staining for melanoma with MART 1 what are three features used to determine + margins

A

Melanocytes above the Dermoepidermal Junction

Confluence of nine or more adjacent melanocytes

Nests of 3 or more atypical melanocytes

81
Q
A
82
Q

What is this condition?

A

Spiny keratoderma (inherited AD no problem)

(aquired over age 50) check for internal malignancy

These are not arsenical keratoses as seen below

83
Q

Why is breslow thickness not useful in oral melanoma for prognosis.

A

There is an absense of a granular layer.

84
Q

What is this tumor

A

blue nevus

spindled melanocyts with melanophages

look for sclerotic collagen

GNAQ & GNA11 mutations (like uveal melanoma)

85
Q

What is this tumor

A

blue nevus

spindled melanocyts with melanophages

look for sclerotic collagen

GNAQ & GNA11 mutations (like uveal melanoma)

86
Q
A
87
Q

in melanoma what are the three most important prognostic factors on histopathologic exam

A
  1. Breslow thickness
  2. Mitotic rate (corolates strongly with breslow thickness)
  3. Ulceration
88
Q

What is this tumor and what two features may it share with melanoma

A

Spitz nevus

Look for large junctional nests raining down

well circumscribed

May share with melanona the below

Pagetoid spread

Mitoses (usually upper dermis not lower)

89
Q

What is this tumor

A

Bapoma (BAP1 inactivated Spitzoid nevus)

Dermal neoplasms

Melanocytes have pink glassy cytoplasm with sharp borders.

associated with multiple other cancers

90
Q

What is this lesion called.

found mostly in young adult females

A

Reed nevus (benign) Pigmented spindle cell nevus

structureless central area with radical streaming

starburst pattern

91
Q

What does aluminum choride do to collagen bundles?

A

turns them a magenta color

92
Q

When cells are frozen what disappears first?

A

nuclei

Derm Surg questions (26 decks)

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