Dermatopathology Flashcards

1
Q

traumatic lesion breaking the epidermis and causing a raw linear area (i.e., deep scratch); often self-induced

A

excoriation

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2
Q

thickened, rough skin (similar to a lichen on a rock); usually the result of repeated rubbing

A

lichenification

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3
Q

circumscribed, flat lesion distinguished from surrounding skin by color
macules = 5mm or less
patches = greater than 5mm

A

macule, patch

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4
Q

separation of nail plate from nail bed

A

onycholysis

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5
Q

elevated dome-shaped or flat-topped lesion
papules = 5mm or less
nodules = greater than 5mm

A

papule, nodule

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6
Q

elevated flat-topped lesion, usually greater than 5mm across

A

plaque

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7
Q

discrete, pus-filled, raised lesion

A

pustule

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8
Q

dry, horny, platelike excrescence
usually the result of imperfect cornification

A

scale

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9
Q

fluid-filled raised lesion
vesicle = 5mm or less
bulla = greater than 5mm
blister = common term for either

A

vesicle, bulla, blister

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10
Q

itchy, transient, elevated lesion with variable blanching and erythema formed as the result of dermal edema

A

wheal

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11
Q

diffuse epidermal hyperplasia

A

acanthosis

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12
Q

abnormal, premature keratinization within cells below the stratum granulosum

A

dyskeratosis

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13
Q

discontinuity of the skin showing incomplete loss of the epidermis

A

erosion

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14
Q

infiltration of the epidermis by inflammatory cells

A

exocytosis

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15
Q

intracellular edema of keratinocytes, often seen in viral infections

A

hydropic swelling

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16
Q

hyperplasia of the stratum granulosum, often due to intense rubbing

A

hypergranulosis

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17
Q

thickening of the stratum corneum, often associated with a qualitative abnormality of the keratin

A

hyperkeratosis

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18
Q

linear pattern of melanocyte proliferation within the epidermal basal cell layer

A

lentiginous

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19
Q

surface elevation caused by hyperplasia and enlargement of contiguous dermal papillae

A

papillomatosis

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20
Q

keratinization with retained nuclei in the stratum corneum
on mucous membranes = normal

A

parakeratosis

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21
Q

intercellular edema of the epidermis

A

spongiosis

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22
Q

discontinuity of the skin showing complete loss of the epidermis revealing dermis or subcutis

A

ulceration

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23
Q

formation of vacuoles within or adjacent to cells
often refers to basal cell-basement membrane zone area

A

vacuolization

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24
Q

appear AFTER sun exposure
fade and darken cyclically with season changes

A

freckle (ephelis)

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25
Q

increase melanin pigment in basal keratinocytes

A

hyperpigmentation

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26
Q

in neurofibromatosis: similar histology to freckle
larger, arise independently of sun exposure
contain aggregated melanosomes (macromelanosomes) in cytoplasm of melanocytes

A

café au lait spots

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27
Q

benign localized hyperplasia of melanocytes

initiated in infancy/childhood

do NOT darken when exposed to sunlight

linear melanocytic hyperplasia

restricted to cell layer immediately above basement membrane

lentiginous

A

lentigo

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28
Q

mutations in RAS or BRAF

p16/INK4a permanent growth arrest

uniformly pigmented

well defined rounded borders

A

melanocytic nevus (mole)

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29
Q

nests at dermoepidermal junction

A

junctional nevus

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30
Q

nest in epidermis & dermis

A

compound nevi

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31
Q

no epidermal nests

usually older lesions

A

intradermal nevi

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32
Q

superficial: nests, large-rounded cells, increased melanin
deeper: cords or single cells, smaller, decreased pigment
deepest: fusiform, fascicles resembling neural tissue

A

melanocytic nevus benign histo

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33
Q

AD, >50% chance developing melanoma by age 60

CDKN2A or CDK4 gene

A

dysplastic nevus syndrome

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34
Q

mutations in NRAS & BRAF

larger than acquired nevi, >5mm, can be hundreds

variegated pigmentation, irregular borders

lentiginous hyperplasia: single nevus cells replace basal cells along E-D junction

atypia: large nuclei, irregular angulated nuclear contour, hyperchromasia

lymphocytic infiltrates, melanin incontinence

linear fibrosis

shouldering: junctional component > 2 rete ridges beyond dermal component

A

dysplastic nevi

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35
Q

most deadly of all skin cancers

mutations caused by UV radiation in sunlight

A

melanoma

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36
Q

Light complexion, hair, eyes

History of blistering sunburn(s)

Proximity to the equator

Indoor occupation; outdoor hobbies

Family history of melanoma or dysplastic nevi

Precursor lesions (congenital or dysplastic nevi)

Xeroderma pigmentosum

A

melanoma risk factors

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37
Q

blacks and Asians

palms, soles, mucous membranes, nail beds

A

acral melanoma (acral lentiginous melanoma)

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38
Q

Asymmetry

Irregular Borders

Variegated Color

Increasing Diameter

Evolution/changeover time (esp rapid)

Any pigmented lesion with diameter >6mm, any change, itching or pain

A

ABCDEs of melanoma

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39
Q

disrupt cell cycle control genes: CDKN2A in 40% familial, 10% sporadic → encodes p15, p16, ARF

activate pro-growth signaling: increase RAS & P13K/AKT signaling; BRAF 40-50% of melanomas, 15-20% RAS

activate telomerase: TERT in 70%

A

mutations in melanoma

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40
Q

horizontal spread

lack capacity to metastasize

lentigo maligna: indolent lesion on face of older men

superficial spreading: most common type, sun-exposed skin

acral/mucosal lentiginous: unrelated to sun exsposure

A

radial growth melanoma

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41
Q

vertical downward growth into deeper dermis

appearance of nodule correlates with emergence of tumor subclone with metastatic potential

probability of metastasis correlates with depth

A

vertical growth melanoma

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42
Q

distance from superficial epidermal granular cell layer to deepest intradermal tumor cells

A

Breslow thickness

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43
Q

thinner tumor depth

NO mitosis

brisk tumor infiltrating lymphocyte response

NO regression

lack of ulceration

A

favorable melanoma prognosis

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44
Q

metastases

and degree of LN involvement correlates with overall survival

A

poor melanoma prognosis

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45
Q

middle age or older

arise spontaneously, mainly trunk

dermatosis papulosa nigra: POC, mult small lesions on face

round, flat, coin-like, waxy papules; tan-dark brown

velvety or granular surface

pore-like ostia impacted with keratin

horn cysts

mutations in FGFR-3

A

seborrheic keratoses

46
Q

paraneoplastic syndrome

sudden appearance of large # of seborrheic keratoses

associated with carcinomas of GI tract

A

Leser-Trélat sign

47
Q

cutaneous sign of several underlying benign & malignant conditions

thickened, hyperpigmented skin with velvet-like texture in flexural areas; intertriginous areas

80% assoc with benign condition (obesity & diabetes)

mutation in FGFR3 or increase stimulation IGFR1

A

acanthosis nigricans

48
Q

head, neck, trunk, face & intertriginous areas; middle age –elderly

assoc diabetes, obesity, & intestinal polyposis

soft, flesh-colored, slender stalk

A

fibroepithelial polyp (acrochordon, skin tag)

49
Q

invagination & cystic expansion of epidermis or hair follicle

subject to traumatic rupture, spill keratin into the dermis → extensive & painful granulomatous inflammatory response

A

epithelial or follicular inclusion cyst (Wen)

50
Q

multiple trichilemmomas, loss of function in PTEN

↑ risk for endometrial cancer, breast cancer, etc

A

Cowden syndrome

51
Q

ductal differentiation, forehead or scalp; “jigsaw puzzle”

tumors coalesce, multiple confluent nodules, hat-like growth, multiple potato-like tumors, CYLD (tumor suppressor gene)

CYLD assoc genetic syndromes: Familial Trichoepithelioma & Brooke-Spiegler Syndrome (CYLD cutaneous syndrome)

A

cylindroma

52
Q

Muir-Torre syndrome (internal malignancies)

hereditary nonpolyposis colorectal carcinoma syndrome (Lynch syndrome)

DNA mismatch repair proteins

A

sebaceous adenoma

53
Q

gene PTCH

A

nevoid basal cell carcinoma syndrome

54
Q

CDKN2

A

familial melanoma syndrome

55
Q

internal malignancy (colon)

A

Muir-Torre syndrome

56
Q

sun damaged skin, hyperkeratosis

progressively worsen → squamous cell carcinoma (SCC)

<1cm, tan-brown, red or skin colored, rough sandpaper-like consistency

cutaneous horn: excessive keratin production

dyskeratosis (pink cytoplasm), intracellular bridges, blue-gray elastosis (sun damage), parakeratosis

actinic cheilitis: similar lesions on the lips

A

actinic keratosis

57
Q

2nd most common tumor arising in sun exposed areas

<5% metastasize to regional LN

DNA damage induced by UV light

immunosuppression, chemotx, organ transplant (infection-HPV 5 & 8)

epidermodysplasia verruciformis: AR, HPV implicated, increase cutaneous SCC

A

squamous cell carcinoma

58
Q

TP53 mutations high in Caucasians (p53 dysfunction)

mutations in RAS signaling & decrease Notch signaling

A

squamous cell carcinoma mutations

59
Q

AR, XPA gene, mutation in nucleotide excision repair pathway, accurate repair of pyrimidine dimers, ↑SCC risk

A

xeroderma pigmentosum

60
Q

sharply defined, red, scaling plaques

atypical (enlarged & hyperchromatic) nuclei involve all levels of epidermis

A

in situ squamous cell carcinoma lesions

61
Q

nodular, keratin production (hyperkeratotic scale), may ulcerate

anaplastic cells, dyskeratosis (single-cell keratinization)

A

invasive squamous cell carcinoma lesions

62
Q

most common invasive cancer

slow growing, rarely metastasize

sun exposed sites, immunosuppression, xeroderma pigmentosum

A

basal cell carcinoma

63
Q

unbridled Hedgehog** signaling, **PTCH gene

A

basal cell carcinoma gene

64
Q

aka Gorlin syndrome = basal cell nevus syndrome

AD, mult BCC <20yo, plus medulloblastoma, ovarian fibromas, odontogenic keratocysts, pits of palms & soles

A

nevoid basal cell carcinoma syndrome

65
Q

pearly papules, telangiectasias, rodent ulcers

basophilic/basaloid cells, hyperchromatic nuclei, peripheral palisading (arranged radially with their long axes in parallel alignment)

artificial clefts separate stroma from tumor

A

basal cell carcinoma characteristics

66
Q

benign dermal neoplasm of uncertain origin

adults, legs of young-middle age women

asymp/tender, +/-size over time, indolent

dimple sign: lateral pressure on the skin produces a depression

firm, tan-brown papules, <1cm, become flattened with time

benign spindle-shaped cells, well defined, non-encapsulated mass in mid dermis

overlying epidermal hyperplasia, downward elongation of hyperpigmented rete ridges = pseudoepitheliomatous hyperplasia

A

benign fibrous histiocytoma (dermatofibroma)

67
Q

well differentiated primary fibrosarcoma of the skin

slow growing, locally aggressive, can recur, rarely metz

translocation COL1A1 & PDGFB

“protuberant” nodule, usually trunk, firm indurated plaque +/-ulcerate

closely packed fibroblasts arranged radially, ie blades of a pinwheel= storiform (school of fish)

honeycomb pattern = deep extension from the dermis into the subQ fat

A

dermatofibrosarcoma protuberans (DFSP)

68
Q

CD4+ T helper cells in skin

remains localized for many years, may eventually evolve into systemic lymphoma

>40yo, truncal lesions, scaly, red-brown patches (can be confused with psoriasis), fungating nodules

prognosis: % of body surface involved, & progression from patch →plaque →nodule

eczema-like lesions = early stages; multiple tumor nodules = systemic spread

A

mycosis fungiodes (cutanteous T-cell lymphoma)

69
Q

topical steroids or UV light

A

treatment for mycosis fungiodes, Sézary syndrome

70
Q

erythroderma, diffuse erythema & scaling of entire body surface

Sézary cells: markedly folded nuclear membrane, hyperconvoluted or cerebriform contour

Band-like aggregates within the superficial dermis

Pautrier microabscesses: small clusters of cells in the epidermis

A

Sézary syndrome

71
Q

cutaneous form, children, >50% of mastocytosis cases

multiple, widely distributed lesions, round-oval, red-brown, nonscaling papule & small plaques

A

urticaria pigmentosa

72
Q

young kids, pink-tan brown nodule, +/- pruritic or blister formation

A

solitary mastocytoma

73
Q

released when mast cells degranulate

A

histamine, heparin

74
Q

localized area of dermal edema & erythema (wheal) when skin is rubbed

A

darier sign

75
Q

area of dermal edema resembling hive

result of local stroking skin with pointed instrument

A

dermatographism

76
Q

pruritus & flushing; triggered by certain foods, temperature changes, alcohol, rugs (morphine, codeine, aspirin); rhinorrhea; rarely GI or nasal bleeding; bone pain

osteoporosis in premenopausal women & men due to excessive histamine release in BM

A

mastocytosis systemic symptoms

77
Q

impaired epidermal maturation, chronic excessive keratin buildup (hyperkeratosis) that results in clinically fish-like scales

defective desquamation → retain abnormally formed scale

buildup of compacted stratum corneum

ichthyosis vulgaris (AD or acquired) - may be associated with lymphoid & visceral malignancies

A

ichthyosis

78
Q

acute lesions characterized by inflammatory infiltrates (lymphocytes & macrophages)

chronic lesions assoc with changes in epidermal growth or dermal fibrosis

A

inflammatory dermatoses

79
Q

localized mast cell degranulation → dermal microvascular hyperpermeability

antigen-induced release of vasoactive mediators from mast cells

wheals: pruritic edematous plaques

angioedema: (closely related to urticaria) edema of the deeper dermis & subQ fat

macro: small, pruritic papules to large edematous plaques
micro: sparse superficial perivenular infiltrate of mononuclear cells

A

urticaria

80
Q

follows exposure to different antigens

type I hypersensitivity reaction

A

mast cell-dependent, IgE-dependent urticaria

81
Q

results from substances that directly incite the degranulation of mast cells (opiates, certain antibiotics, radiographic contrast media)

A

mast cell-dependent, IgE-independent urticaria

82
Q

triggered by local factors that increase vascular permeability

exposure to chemicals/drugs: aspirin (inhibit cyclooxygenase & arachidonic acid production)

hereditary angioneurotic edema: def of C1 inhibitor → excessive activation of early components of complement system

A

mast cell-independent, IgE-independent urticaria

83
Q

external application of Ag (poison ivy) or internal circulating Ag (ingested food or drug)

urushiol in poison ivy/oak (Rhus toxicodendron)

T-cell mediated inflammatory rxn - type IV hypersensitivity

TX: palliative; topical steroids

red, papulovesicular, oozing & crusted (impetiginization) lesions (if persists, dev acanthosis & hyperkeratosis→ raised scaling plaques)

A

acute eczematous dermatitis

84
Q

acute eczematous dermatitis, edema in intracellular spaces, splaying them apart, particularly in stratum spinosum → intraepidermal vesicles

A

spongiosis

85
Q

self-limited hypersensitivity rxn to certain infections & drugs

infections: herpes simplex, mycoplasma, histoplasmosis, coccidiodomycosis, typhoid, leprosy

drugs: sulfonamides, PCN, barbiturates, salicylates, hydantoins, antimalarials

cancer: carcinomas & lymphomas

collagen vascular dz: SLE, dermatomyositis, polyarteritis nodosa

CD8+ cytotoxic T lymphocyte mediated

targetoid lesions

interface dermatitis, Stevens-Johnson, toxic epidermal necrolysis

A

erythema multiforme

86
Q

children, extensive skin involvement plus oral mucosa, conjunctiva, urethra, genital & perianal areas

secondary infections can lead to life-threatening sepsis

A

Steven-Johnson

87
Q

autoimmune basis

Koebner phenomenon: induce psoriatic lesions in susceptible pts by local trauma, starts a self-perpetuating local inflammatory response

pink to salmon colored plaque covered by silver scale

30% with nail changes: pitting, yellow-brown discoloration, oncolysis

elongation of rete ridges “test tubes in a rack”

extensive parakeratotic scale

munro microabscesses: small PMN aggregates in parakeratotic stratum corneum

Auspitz sign: mult, minute, bleeding points when scale lifted from plaque

A

psoriasis

88
Q

mulitple, minute, bleeding points when scale lifted from plaque

A

Auspitz sign

89
Q

TNF & IL-17 inhibitors

A

psoriasis treatment

90
Q

in areas with increase sebaceous glands

inflammation of epidermis (NOT disease of sebaceous glands)

increase sebum production

Parkinson’s disease: increase sebum production secondary to dopamine def (tx levadopa)

follicular lipping: mounds of parakeratosis containing neutrophils and serum at ostia of hair follicles

A

seborrheic dermatitis

91
Q

Pruritic

Purple

Polygonal

Planar

Papules

Plaques

A

6 P’s of Lichen Planus

92
Q

Pruritic, Purple, Polygonal, Planar, Papules, Plaques

self limited resolves spontaneously

SCC can rarely occur in chronic cases

Koebner phenomenon (also seen in psoriasis)

itchy violet, flat-topped papules, that may coalesce

Wickham striae: papules highlighted with white dots, areas of hypergranulosis

sawtoothing: angulated zigzag contour of dermoepidermal surface

Civatte bodies: anucleate, necrotic basal cells in dermis

A

lichen planus

93
Q

produce dramatic lesions which can be fatal if untreated

blisters occur at different levels of skin

histologic assessment essential for accurate diagnosis

A

bullous diseases

94
Q

autoantibodies dissolution of intracellular attachments

may be fatal without tx

IgG autoantibodies disrupt intracellular adhesions → blisters

Net-like pattern of intercellular IgG deposits; vulgaris = all levels, foliaceus = superficial

Tx: immunosuppressives

acantholysis: dissolution of intercellular bridges connecting squamous epith cells (acantholytic cells dissociate from one another, become rounded)

A

pemphigus

95
Q

most common

mucosa & skin of scalp, face, axilla, groin, trunk, & points of pressure

histo: “tombstones”; immunofluor: fishnet-like pattern

superficial vesicles rupture easily → shallow erosions with dried serum & crust

A

pemphigus vulgaris

96
Q

rare

large moist verrucous (wart-like) vegetating plaques with pustules

groin, axilla, & flexural surfaces

A

pemphigus vegetans

97
Q

elderly; flexor surfaces

BPAGs: bullous pemphigoid antigens, components of hemidesmosomes

do NOT rupture easily; subepidermal, nonacantholytic blisters

A

bullous pemphigoid

98
Q

urticarial & grouped vesicles; men

B/L, symmetric, grouped lesions on extensor surfaces of elbows, knees, upper back, butt

assoc with celiac disease: dev IgA Abs to gluten, Abs cross react with reticulinsubepidermal blister

A

dermatitis herpetiformis

99
Q

inherited defects in structural proteins

blisters at sites of pressure, rubbing, trauma at birth

electron microscopy to differentiate types

A

epidermolysis bullosa

100
Q

group of inborn/acquired disturbances in porphyrin metabolism

porphyrins: pigments normally present in Hgb, myoglobin, & cytochromes

urticaria & vesicles assoc with scarring, exacerbated by sunlight

A

porphyria

101
Q

middle age/older; females

4 stages: 1. flushing, 2. persistent erythema & telangiectasia, 3. pustules/papules, 4. rhinophyma (permanent thickening of nasal skin)

assoc with high cutaneous levels of antimicrobial peptide cathelicidin

A

rosacea

102
Q

open comedones: central black keratin plug

closed comedones: keratin plug trapped under epidermal surface

multifactorial: 1. keratin blocks sebum outflow, 2. sebaceous gland hypertrophy, 3. propionibacterium acnes colonize hair follicles, 4. secondary inflamm of follicles

acne congloblate: severe variant, sinus tract formation & dermal scarring

A

acne vulgaris

103
Q

antibiotics for propionibacterium acnes, 13-cis-retinoic acid (isoretinoin) → antisebaceous action

A

acne vulgaris tx

104
Q

inflammatory rxn in subQ adipose tissue

erythema nodosum (most common)

erythema induratum

A

panniculitis

105
Q

poorly defined, exquisitely tender erythematous plaques & nodules, more readily palpated (ropy) than seen

delayed hypersensitivity rxn to microbial or drug related antigens

infectious β-hemolytic streptococcal infection, tuberculosis, or less commonly coccidiodomycosis, histoplasmosis, & leprosy

drugs: sulfonamides, oral contraceptives

sarcoidosis, IBD, & certain malignant neoplasms

A

erythema nodosum

106
Q

uncommon; adolescents, menopausal females

NOT assoc with any disease

primary vasculitis of deep vessels supplying fat lobules of the subQ → fat necrosis & inflammation

erythematous, slightly tender nodule that usually ulcerates

early lesions: necrotizing vasculitis of sm-med arteries & veins in deep dermis & subQ

granulomatous inflammation & zones of caseous necrosis involving fat lobule

A

erythema induratum

107
Q

warts

squamoproliferative DOs caused by HPV

anogenital warts: HPV types 6 & 11

HPV type 16 assoc with in situ SCC of the genitalia and bowenoid papulosis (genital lesions of young adults with the histo appearance of carcinoma in situ, usually regress spontaneously)

HPV subtypes 5 & 8 related to SCC, esp indv with epidermodysplasia verruciformis - dev mult flat warts, some progress to carcinoma

keratohyaline granules, verrucous or papillomatous epidermal hyperplasia, koliocytosis (cytoplasmic vacuolization)

A

verrucae

108
Q

common, self limited poxvirus infection

virus is brick shaped, dumbbell shaped DNA core

trunk & anogenital regions

firm, pruritic, pink-skin colored umbilicated papules; curd-like material can be expressed from umbilication

Giemsa or H&E: molluscum bodies= ellipsoid, homogeneous, cytoplasmic inclusion

A

molloscum contagiosum

109
Q

common superficial bacterial infection of skin; highly contagious

Staphylococcus aureus → toxin causing epidermal injury

toxin cleaves desmoglein 1

erythematous macule initially, then mult small pustules which break → shallow erosions

Honey colored crust: drying serum, if crust not removed, new lesions form around periphery & extensive epidermal damage may occur

A

impetigo

110
Q

confined to stratum corneum

Tinea capitis: scalp

Tinea barbae: beard

Tinea corporis: common; on body surface

Tinea cruris: inguinal areas of obese men during warm weather

Tinea pedis: bacterial superinfection

Tinea versicolor: upper trunk; Malassezia furfur (yeast)

A

superficial fungal infections