Dermatopathology 2 Flashcards
Dermatofibroma is also known as
benign fibrous histiocytoma
Dermatofibroma usually occurs where on the body
lower legs
how fast does Dermatofibroma grow
slow
clinical signs for Dermatofibroma
Flesh-colored to pigmented papule
- “dimple-sign” depresses when squeezed
what proliferates in Dermatofirbroma
fibroblasts with collagen
histo pic for dermatofibroma
whirling (pinwheel or storiform) fibroblasts with collagen bundles
Does Dermatofibroma metastasize
no
what happens to overlying epidermis in Dermatofibroma
thins
Dermatofibroma extends where in the skin and how
dermis to subcutaneous fat
“honeycomb” pattern
What happens in Mycosis Fungoides
T cell lymphoma presents in skin and may evolve into generalized lymphoma
where does Mycosis Fungiodes occur
trunk
what are the 3 stages of Mycosis Fungoides
Patch: scaly, red, brown
plaque: raised
nodule ( tumor)
the three stages of Mycosis Fungoides is similar to what other disease
Kaposi Sarcoma
Explain histo process of Mycosis Fungoides
- T-helper cells form bands in superficial dermis
- single cells or small clusters invade epidermis
what are two types of Mastocytosis
Urticaria pigmentosa
Systemic mastocytosis
Urticaria pigmentosa usually presents in who
children
Systemic Mastocytosis usually occurs in who
adults
what are two signs and symptoms for Mastocytosis
Darier sign
Dermatographism
Darier sign
Wheal ( dermal edema and erythema) when skin lesion is rubbed
Dermatographism
hive occurs when normal skin is stroked with pointed instrument
Why do these signs and symptoms occur in mastocytosis
release of histamines, heparin, and other mast cell content
In systemic disease of Mastocytosis, foods, drugs, alcohol can trigger what
Pruritus and flushing
what do the dendritic mast cells look like in mastocytoma
metachromatic granules within dendritic mast cells
- Fried egg cells : central nuclei with rigid rim of peripheral cytoplasm
what stain is good for Mastocytoma
Giemsa
define Ichthyosis
disorders which impair epidermal maturation
what are two types of Ichthyosis
congenital
acquired
histo for Ichthyosis: stratum corneum
build up of compacted stratum corneum with loss of basket-weave pattern
which types of Ichthyoses has stratum granulosum normal to slightly thickened
- lammellar
- X-linked
- congenital ichthyosiform erythroderma
which types of Ichthyosiss has stratum granulosum thin or absent
ichthyosis vulgaris
what is a common name for urticaria
hives
how does urticaria form
from mast cell degranulation through sensitization with specific IgE
and microvascular hyper-permeability
histo for Urticaria
pervenular infiltrate
dermal edema
no epidermal changes
another name for Acute Eczematous Dermatitis
Spongiotic Dermatitis
what are 2 forms of contact dermatitis
irritant and allergic
Allergic contact dermatitis creates what type of reaction
cell-mediated, delayed-type hypersensitivity reaction type 4
Allergic contact dermatitis, explain process form skin contact
- Antigen on skin taken up by langerhans cell
- dermal lymphatics to lymph nodes
- CD 4 helper T cells
what are common allergic contact dermatitis
Nickel, poison ivy/oak
for allergic contact dermatitis characterize the vescicles
fluid in vesicles do not contain allergen and cannot induce disease in others.
for allergic contact dermitis when does sensitization occur for first time exposure? reexposure?
1st: 1-2 weeks
2nd: hours to days
Mechanism of actin for irritant and allergic
irritant: direct effect
allergic: type IV
onset for irritant and allergic
Irritant: few hours
allergic: 12-72 hours
incidence for irritant and allergic
I: anyone
A: only sensitized person
lesionfor irritant and allergic
I: erythema, vesicles, crust
A: erythema, papules, vesicles, scale
common name for atopic dermatitis
eczema
clinical feature for atopic dermatits? when does it start?
chronic waxing and waning
dry skin
extremely pruritic, papules, vesicles, oozing, crusting
beginning first yr of life
where do babies usually get atopic dermatitis
face, diaper area
where do children and adults get atopic dermatitis
neck, face, axillae
chronic atopic dermatitis can lead to what
Lichenification: epidermal thickening, visible and palpable skin thickening with accentuated skin lines
Nummular dermatits is what shape? clinical presentation
coin-shaped
- itchy red plaques with vesicles and distinct borders
asteatotic dermatitis is known as what? clinical presentation
winter itch
- dry cracked skin
histo what does acute eczyematous dermatitis ( spongiotic dermatitis) look like
Spongiosis: intracellular edema
exocytosis: infiltration of epidermis by inflammatory cells
what happens in erythema multiforme
CD8 T cells, hypersensitivity reaction resulting in epidermal cell injury
what is a clinical diagnostic factor for erythema multiforme? other clinical features
- target lesions
- macules, papules, vesicles, bullae, puritic
what can trigger Erythema multiforme
HSV
mycoplasma pneumonia
histo for Erythema multiforme
early: dermal edema
degenerating and necrotic keratinocytes
later: lymphocytes migrate into epidermis
which is more severe Stevens-Johnson syndrome or erythema multiforme
Steves-Johnson syndrome
who usually gets Stevens-Johnson Syndrome
children
what involves Stevens-Johnson Syndrome
mucous membranes ( mouth and conjuctivae) fever, difficulty eating, renal failure
how is a Stevens-Johnsone syndrome patient treated
burn patient
what my cause Steven-Johnson syndrome
sulfa drugs and anticonvulsants
toxic Epidermal Necrolysis what happens
detachment of large areas of epidermis
body surface involvement for EM, Steven johnson, TEN
EM: less than 30%
SJ: 10-30%
TEN: more than 30
Pityriasis Rosea is possibly related to what virus
herpes virus 7
What time of year does Pityriasis occur
winter
Clinically what does PItyriasis Roasea look like
- Initial “herald patch” resembles ringworm
- pink, scaling near border
- “Christmas tree pattern”
what does the histo for pityriasis rosea
spongiosis with erthrocyte extravasation
where is Pityriasis Rosea commonlyfound
trunk, upper arms, thighs
not face
what is venous insufficiency
venous incompetence causes increased hydrostatic pressure and capillary damage
- extravasation of RBCs and serum
clinically what does venous insufficiency look like
edema and hyperpigmentation
- pruritic erthema and stasis dermatitis
- ulceration above medial malleoulus
what is the histo features for stasis dermatitis of venous incompetence
subacute spongiotic dermatitis
- intracellular epidermal edema
how is venous insufficiency treated
compression stocking
what is Psoriasis
accelerated proliferation of skin cells resulting in scaling
clinically what does Psoriasis look like
well-demarcated, erythematous plaques and plaques with SILVER SCALING
- symmetrical
what is Auspitz’ sign
pinpoint bleeding on removal
- Psoriasis
what is the koebner phenomenon
trauma to the skin and stress can cause exacerbations
- Psoriasis
histo for Psoriasis
- Downward elongation of rete ridges
- thining on stratum granulosum
- parakertosis above granulosum layer
capillaries in dermal papillae brought close to the surface
Erythrodermic psoriasis
entire skin, very serious
Guttate psoriaisis
scattered, drop-like, pink, scaly plaques
may follow Strep
Pustular psoriasis
pustules on erythematous skin,
Psoriasis effects on nails
oil spotting: focal brown discoloration of nail plate
onycholysis: distal separation of plate from bed
subungural hyperkeratosis
pitting
Psoriasis can cause what other health problem? what does it look like
arthritis
“pencil-in-cup”
what should you not give a psoriasis patient
oral steroids
what are common names for Seborrheic dermatitis
“cradle cap”
dandruff
what causes seborrheic dermatitis
Malassezia furfur
what areas on the skin does seborrheic dermatitis impact
sebaceous gland rich areas
Seborrheic dermatitis is usually found in patients who have what conditions
Parkinson and HIV
what does Seborrheic dermatitis look like
yellow, greasy, scaly patches with surrounding erythema
what is the histo for Seborrheic dermatitis
features of both spongiotic dermatitis and psoriasis
- mounds of parakeratosis with neutrophils
- serum at ostia of hair follicle
what is Lichen Planus
idiopathic Inflammatory disorder
what are the 5 P’s for Lichen Panus
Pruritic Purple Polygonal Planar Papules Plaques
where is Lichen Panus common
wrists and ankle
clinical presentation of Lichen Panus
Wickham’s striae: fine, reticulated, white lines
mucous involvement
Koebner phenomenon
severe ithcing
Lichen Planus can be associated with what disease
Hep. C
Histo for Lichen Planus
- many lymphocytes along dermo-epidermal junction
- Civatte bodies
- saw-tooth pattern
Civatte bodies
incorporation of necrotic basal keratinocytes into inflammaed papillary dermis
Systemic Lupus Erythematosus involves what organs
autoimmune disease involving connective tissue and blood vessel
Who is more likely to have Systemic Lupus Erythematosus
African Americans
Which gender is more likely to get Systemic Lupus Erythematosus
females
what are some clinical symptoms of Systemic Lupus Erythematosus
skin lesions fatigue fever weight loss CNS symptoms
what are classic symptoms of Systemic Lupus Erythematosus
Malar rash- butterfly rash ( spares nasolabial folds)
histo for lupus
epidermal atrophy
thickening of basal membrane
