Dermatopathology Flashcards
1
Q
what layers of the epidermis are not nucleated?
A
stratum corneum and lucidum
2
Q
what are the layers of the epidermis
A
stratum corneum, stratum lucidum, stratum granulosum, stratum spinosum, stratum basale
3
Q
a traumatic lesion that breaks the epidermis causing tissue damage, often self induced
A
excoriation
4
Q
thickened, rough skin that is usually the result of constant scratching and rubbing
A
lichenification
5
Q
circumscribed, flat lesion with different color, 1cm in diameter or less
A
macule
6
Q
circumscribed, flat lesion with different color, greater than 1cm in diameter
A
patch
7
Q
separation of nail plate from the nail bed
A
onycholysis
8
Q
elevated dome shaped or flat topped lesion that is 5mm or less in size
A
papule
9
Q
elevated dome shaped or flat topped lesion that is greater than 5mm in size
A
nodule
10
Q
elevated flat topped lesion that is usually more than 5mm across, circumscribed
A
plaque
11
Q
discrete, pus filled and elevated lesion containing neutrophils
A
pustule
12
Q
dry, poorly organized lesion with plate like excrescence, improper cornification
A
scale
13
Q
fluid filled raised lesion 1cm in size or less
A
vesicle
14
Q
fluid filled raised lesion greater than 1 cm
A
bulla
15
Q
common name for vesicle and bulla
A
blister
16
Q
elevated, itchy, and transient lesion with varied blanching and erythema from dermal edema
A
wheal
17
Q
another term for scar
A
cicatrix
18
Q
loss of superficial epidermis, part of all of the epidermis is lost
A
erosion
19
Q
diffuse epidermal hyperplasia
A
acanthosis
20
Q
thickening of the stratum corneum, often associated with a qualitative abnormality of the keratin
A
hyperkeratosis
21
Q
keratinization with retained nuclei in the stratum corneum (normal on mucous membranes)
A
parakeratosis
22
Q
pearly papule may be indicative of what disease
A
basal cell carcinoma
23
Q
a moist and friable papule may be indicative of what disease
A
pyogenic granuloma
24
Q
5 characteristics of malignant skin cancer
A
asymmetry, borders, color, diameter, and evolving
25
freckles that appear after sun exposure and fade between seasons due to pigmentation, most common in white people
ephelis
26
common benign localized hyperplasia of melanocytes, darker than a freckle and does not fade; melanocyte overgrowth
lentigo/lentigines
27
common benign neoplasm usually caused by acquired activating mutations in the RAS signaling pathway
pigmented nevus/mole
28
melanocytic nevus with fascicular growth
Spitz nevus
29
melanocytic nevus with lymphocytic infiltrate surrounding the nevus cells
Halo nevus
30
melanocytic nevus with non-nested dermal infiltrate with associated fibrosis
Blue nevus
31
melanocytic nevus with deep dermal and some subcutaneous growth around the adnexa, neurovascular bundles and blood vessel walls
congenital nevus
32
melanocytic nevus with coalesced intraepidermal nests, larger than most acquired nevi (>5mm)
dysplastic nevi
33
most deadly skin cancer and strongly linked to acquired mutations caused by exposure to UV radiation
melanoma
34
other than skin, where can melanoma occur (4)
oral and anogenital mucosal surfaces, esophagus, meninges, eye
35
where does melanoma commonly occur in men
upper back
36
where does melanoma commonly occur in women
back and legs
37
most important risk factor for melanoma
periodic severe sunburns early in life
38
gene mutated in autosomal dominant familial melanoma
CDKN2A
39
most common type of melanoma involving sun exposed skin
superficial spreading
40
during what stage of melanoma do tumor cells lack the capacity to metastasize
radial growth phase
41
horizontal spread of melanoma within the epidermis and superficial dermis
radial growth phase
42
tumor cells invade downward into the deeper dermal layers as expansive melanoma mass
vertical growth phase
43
the distance from the superficial epidermis (granular layer) to the deepest intradermal tumor cells
Breslow thickness
44
2nd most common subtype of melanoma
nodular
45
this indicates development of deep dermal invasion
one or more elevated firm blue-black nodules on the surface
46
nuclei are large with irregular contours, chromatin clumped at nuclear membrane periphery, eosinophilic nucleoli
melanoma nuclei
47
these are derived from the keratinizing stratified squamous epithelium of the epidermis and hair follicles and the ductular epithelium of cutaneous glands
benign epithelial tumors
48
spontaneous pigmented small lesions numerous on the trunk, extremities, head or neck
seborrheic keratosis
49
seborrheic keratosis on the face in people of color
dermatosis papulosa nigra
50
gross appearance of seborrheic keratosis
stuck on appearance / sharply demarcated from the adjacent epidermis
51
micro appearance of seborrheic keratosis
hyperkeratosis at surface, horn cysts filled with keratin, and invagination cysts into the main mass
52
20% of acanthosis nigricans can arise with what cancer
gastrointestinal adenocarcinomas
53
80% of acanthosis nigricans is associated with what conditions
obesity and diabetes
54
thickened, hyperpigmented skin with a velvet like texture that commonly appears in flexural areas
acanthosis nigricans
55
3 names for fibroepithelial polyp
acrochordon, squamous papilloma, skin tag
56
microscopic characteristic of fibroepithelial polyps
fibrovascular core covered with benign squamous epithelium
57
formed by the invagination and cystic expansion of the epidermis or a hair follicle
epithelial/follicular inclusion cyst
58
another name for epithelial/follicular inclusion cyst
wen
59
if an epithelial/follicular inclusion cyst reoccurs and ruptures spilling keratin into the dermis, what can occur?
granulomatous inflammatory response
60
nondescript, flesh colored, solitary or multiple papules and nodules
adnexal/appendage tumors
61
originating in acrosyringium, occuring predominantly on the palms and soles of feet where sweat glands are
eccrine poroma
62
intradermal spiral ducts in eccrine glands
acrosyringium
63
micro appearance of eccrine poromas
interconnecting bands of epithelial cells growing down into the dermis
64
tumor with ductal (apocrine/eccrine) differentiation usually occurring on the forehead and scalp
cylindroma
65
multiple cylindromas are seen in the autosomal dominant disease:
brooke-spiegler syndrome
66
micro of cylindroma
jigsaw puzzle/giraffe spots pattern of basaloid nests of ductal sweat glands
67
lesions with eccrine differentiation, usually occurring as multiple, small, tan papules in the vicinity of the lower eyelids, confined to the upper dermis
syringoma
68
this material may be present in syringomas
intraluminal eosinophilic material
69
adnexal tumor associated with Lynch syndrome
sebaceous adenoma
70
clinical variant of Lynch syndrome that have sebaceous adenomas as hallmark feature
Muir-Torre syndrome
71
hair follicle tumor derived from hair matrix cells
pilomatricoma/pilomatrixoma
72
these type of cells indicate necrosis
ghost cells
73
what occurs in pilomatricomas
basaloid cells undergo hair follicle keratinization, giant cells and calcification
74
arises from the meibomian glands of the eyelid, aggressive and may have systemic metastases
sebaceous carcinoma
75
sun damaged skin exhibiting hyperkeratosis with potential for malignant transformation
actinic keratosis
76
these may develop in actinic keratosis (2)
cutaneous horn and actinic cheilitis
77
SCC in situ skin name
Bowen's disease
78
epidermis changes in Bowen's disease (3)
acanthosis, hyperkeratosis, parakeratosis
79
20% of SCC in situ progresses to what?
malignant SCC
80
most important cause of skin SCC
DNA damage from UV light
81
second common association w skin SCC
chronic immunosuppression from chemotherapy or organ transplant or oncogenic virus
82
there is higher incidence of skin SCC in this gender
men, more than women (except lower legs)
83
stains to distinguish in situ SCC from invasive SCC (3)
cytokeratins, p63, p40
84
most common invasive cancer in humans
basal cell carcinoma
85
mutation in basal cell carcinoma
mutation that activates the Hedgehog (SHH) signaling pathway
86
slow growing tumors that rarely metastasize are a characteristic of what type of skin cancer
basal cell carcinoma
87
majority of these skin cancers are recognized at an early stage and cured by local excision
basal cell carcinoma
88
pearly papules containing prominent dilated supepidermal blood vessels (teleangiectasias)
seen in basal cell carcinoma
89
ulcerations in BCC used to be called
rodent ulcers
90
another name for benign fibrous histiocytoma
dermatofibroma
91
where are dermatofibromas usually seen in women
on the legs
92
what may cause the formation of dermatofibromas
history of trauma
93
micro of dermatofibromas
dense area of spindled fibroblasts and histiocytes
94
primary fibrosarcoma of the skin that is well differentiated
dermatofibrosarcoma protuberans
95
presents as a protuberant nodule within a firm plaque that may ulcerate
dermatofibrosarcoma protuberans
96
micro of dermatofibrosarcoma protuberans
packed fibroblasts arranged radially like a pinwheel, called Storiform
97
dermatofibrosarcoma protuberans has these 4 characteristics
slow growing, locally aggressive, potential to recur, rare metastasis
98
highly aggressive primary neuroendocrine cancer that primarily affects the elderly and immunosupressed
Merkel cell carcinoma
99
slow adapting mechanoreceptors of neural crest origin involved in touch sensation
Merkel cells
100
growth pattern of Merkel cell carcinoma
sheet-like growth
101
gross appearance of Merkel cell carcinoma
glistening pink cut surface and multinodular growth
102
two stains for Merkel cell carcinoma
synaptophysin and chromogranin
103
cutaneous T-cell lymphoma
Mycosis fungoides
104
CD4 helper T cells accumulate in the dermis, clustering around Langerhan cells forming these in mycosis fungoides
Pautrier microabscesses
105
mycosis fungoides most commonly affects this age group
people older than 40
106
scaly, red-brown patches with raised, scaly plaques and fungating nodules
gross appearance of mycosis fungoides
107
histologic hallmark of mycosis fungoides, propensity of lymphocytes to colonize the epidermis
epidermotropism
108
cutaneous t cell lymphoma that does not involve vasculature
mycosis fungoides
109
involves vasculature
Sezary syndrome
110
malignant T cells in the blood cause diffuse erythema and scaling of the body surface
Sezary syndrome
111
histology of Sezary syndrome
atypical lymphocytes with hyperconvoluted nuclei called Sezary or Lutzner cells
112
spectrum of disorders characterized by increased numbers of mast cells in the skin and possible organ involvement
mastocytosis
113
cutaneous lesion of mastocytosis
urticaria pigmentosa
114
wheal sign in mastocytosis
Darier sign
115
edema resembling hives caused by stroking skin
dermatographism
116
cutaneous mastocytosis
localized
117
systemic mastocytosis
poor prognosis with systemic involvement
118
mast cell degranulated substances (2)
histamine and heparin
119
cytoplasm of mast cells in mastocytosis has what type of granules (appearance)
purple metachromatic granules
120
presents as pruritus and flushing
Systemic mastocytosis
121
4 triggers of mastocytosis
certain foods, temperature change, alcohol, and drugs (morphine, codeine, aspirin)
122
3 presentations of systemic mastocytosis
rhinorrhea, GI/Nasal bleeding, bone pain
123
inherited disorder associated with chronic, excessive keratin buildup, resulting in fishlike scales
ichthyosis
124
the defective desquamation process in ichthyosis causes what
buildup of compacted stratum corneum
125
autosomal dominant/acquired form of ichthyosis associated with lymphoid or visceral malignancies
ichthyosis vulgaris
126
autosomal recessive form of ichthyosis
congenital ichthyosiform erythroderma
127
autosomal recessive form and X-linked ichthyosis
lamellar ichthyosis
128
characterized by localized mast cell degranulation and resultant dermal microvascular hyperpermeability
urticaria
129
results from T cell mediated inflammatory reactions (type iv)
acute eczematous dermatitis
130
edema that seeps into the intercellular spaces of the epidermis in eczema
spongiotic dermatitis
131
4 conditions associated with erythema multiforme
infections, exposure to drugs, cancer, collagen vascular disease
132
febrile form of erythema multiforme involving the lips, oral mucoa, conjunctiva, urethra, genital and perianal areas
Stevens-Johnson syndrome
133
characterized by keratinocyte injury mediated by skin-homing CD8 cytotoxic t lymphocytes
erythema multiforme
134
chronic inflammatory dermatosis with autoimmune basis
psoriasis
135
gross appearance of psoriasis
well demarcated plaque covered by loosely adhered silver-white scales
136
nail changes in 30% of psoriasis
onycholysis, discoloration, thickening
137
is seborrheic dermatitis more common that psoriasis
yes
138
six P's of lichen planus
planar, purple/violaceous, polygonal, pruritic, papules, plaques
139
oral lesions of lichen planus appearance
white, reticulated, or netlike
140
lichen planus often leaves this after recovery
post-inflammatory hyperpigmentation
141
gross appearance of lichen planus
itchy, violaceous, flat topped papules that may coalesce to plaques
142
effects on nails in lichen planus
thinning and longitudinal ridging
143
caused by autoantibodies (IgG) that result in the dissolution of intercellular attachments within the epidermis and mucosal epithelium, creating blisters
pemphigus
144
most common form of pemphigus
pemphigus vulgaris
145
subcorneal blisters
pemphigus foliaceus
146
suprabasilar blisters
pemphigus vulgaris
147
subepidermal blister
bullous pemphigoid
148
most common histologic feature of pemphigus
intraepidermal acantholysis
149
blistering disorder associated with celiac disease
dermatitis herpetiformis
150
caused by autoantibodies (IgA) that bind to proteins that are required for the adherence of basal keratinocytes to the basement membrane
dermatitis herpetiformis
151
sites of involvement of dermatitis herpetiformis (5)
inner thighs and flexor surfaces of arms, armpits, groin, lower abs
152
inherited defect in proteins that cause layers of skin to bind
epidermolysis bullosa
153
epidermolysis bullosa in the lower epidermis, mutation in the keratin14/keratin5 gene
simplex type
154
epidermolysis bullosa in between the epidermis and dermis, laminin subunit defect
junctional type
155
epidermolysis bullosa in the dermis, mutation in COL7A1 gene
dystrophic type
156
disturbances of porphyrin metabolism
porphyria
157
pigments that are normally present in hemoglobin, myoglobin, cytochromes
porphyrins
158
caused by overproduction of photosynthesizing porphyrins
cutaneous porphyria
159
vesicles in porphyria are located
subepidermal/between dermis and epidermis
160
pathogenesis of acne vulgaris (4)
1. keratin plug blocking outflow of sebum
2. hypertrophy of sebaceous glands
3. lipase-synthesizing bacteria
4. secondary inflammation of the follicle
161
large patulous orifices
open comedones
162
most severe form of rosacea characterized by permanent thickening of the nasal skin
rhinophyma
163
people with rosacea have high cutaneous levels of this antimicrobial peptide
cathelicidin
164
four stages of rosacea
1. flushing
2. persistent erythema and telangiectasia
3. pustules and papules
4. rhinophyma
165
inflammatory reaction in the subcutaneous fat
panniculitis
166
two forms of panniculitis
erythema nodosum and erythema induratum
167
panniculitis often affects what region of the body
lower legs
168
most common form of panniculitis that has a subacute presentation
erythema nodosum
169
panniculitis caused by delayed hypersensitivity reaction to microbial or drug related antigens
erythema nodosum
170
when does erythema nodosum typically occur
after an infection
171
uncommon type of panniculitis that affects primarily adolescents and menopausal women
erythema induratum
172
erythema induratum is associated with what disease
tuberculosis
173
does erythema induratum involve the vasculature
yes, it causes primary vasculitis of deep vessels
174
gross appearance of erythema nodosum
poorly defined, tender, erythematous plaques and nodules that is more palpated than seen
175
rare form of lobular, nonvasculitic panniculitis seen in children or adults
Weber-Christian disease
176
form of secondary panniculitis caused by self inflicted trauma or injection of foreign or toxic substances
factitial panniculitis
177
what two other forms of panniculitis can occur?
rare types of t cell lymphoma, lupus erythematous
178
squamoproliferative disorders caused by HPV
verrucae /warts
179
caused by HPV types 6 and 11
anogenital warts (benign)
180
caused by HPV type 16
genital warts (precancerous)
181
caused by HPV subtype 5 and 8
epidermodysplasia verruciformis (asso. with SCC)
182
most common type of wart
verruca vulgaris
183
another name for venereal wart
condyloma acuminatum
184
common on the face of the dorsal surfaces of the hands (wart)
verruca plana
185
self limited viral disease of the skin caused by pox virus
molloscum contagiosum
186
warts on the soles and palms
verruca plantaris and verruca palmaris
187
common superficial bacterial infection of the skin that is highly contagious and in children
impetigo
188
gross appearance of impetigo
honey colored crust around the lips
189
both forms of impetigo- contagiosa and bullosa- are now caused by what bacteria
staph aureus
190
fungal infection of the scalp
tinea capitis
191
fungal infection of the beard
tinea barbae
192
fungal infection of the body surfaces affecting children in particular but also people of all ages
tinea corporis
193
fungal infection in the inguinal areas of obese men during warm weather
tinea cruris
194
athlete's foot fungal infection
tinea pedis
195
yeast infection occurring on the upper trunk and multicolored, caused by Malassezia furfur
tinea versicolor
196
gross appearance of tinea versicolor
groups of macules of varying size and color
197
most common type of porphyria
porphyria cutanea tarda
198
cutaneous manifestations of urticaria and vesicles associated with scarring that are exacerbated by exposure to sunlight
porphyria
199
vesicles in porphyria are located
subepidermal
200
the dermis in porphyria
vessel walls are thickened by glassy deposits of serum proteins
