Dermatopathology Flashcards
What are the normal layers of the skin?
What are the 6 different inflammatory reaction patterns in skin?
- Vesiculobullous
- Spongiotic
- Psoriasiform
- Lichenoid
- Vasculitic
- Granulomatous
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Pemphigoid
- What does this image show?
- What is it?
- Where do they originate from?
- Bullous Pemphigoid
- Bullous pemphigoid is the result of an attack on the basement membrane of the epidermis by IgG +/- IgE immunoglobulins (antibodies) and activated T lymphocytes (white blood cells). The target is the protein BP180 (also called Type XVII collagen), or less frequently BP230 (a plakin). These proteins are within the NC16A domain of collagenXVII. They are associated with the hemidesmosomes, structures that ensure the epidermal keratinocyte cells stick to the dermis to make a waterproof seal. Hermidesomosomes in the activation of complement are destroyed leading to blistering
- Pemphigoid - forms in the subepidermal (while pemphigus are superficial)
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Pemphigus vulgaris
A superficial blistering disorder
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Pemphigus vulgaris
The blistering forming is very superficial, in the top layer of the skin, hence why they so easily burst
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- Pemphigus foliaceus
- Pemphigus foliaceus is a relatively benign form of pemphigus and there is formation of blisters on what looks like healthy looking skin. They tend to form on skin that has been ‘rubbed’ or Nikolsky sign
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Discoid eczema
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Contact dermatitis
- What does this image show?
- What causes it?
- Contact dermatitis - dermis of the skin is full of inflammatory cells in response to an allergen
- Contact dermatitis can cause blistering, urticaria and reddening and itching of the skin. this reaction can be to any allergen
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- Plaque psoriasis
- What does this image show?
- What is the underlying pathophysiology?
- Psorasis
- Psorasis is caused by a hyper-proliferation of keratinocytes, that causes thick plaques to form on the surface of the skin
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Lichen planus
- What does the image show?
- What is the underlying pathophysiology?
- Lichen planus
- Lichen planus is a T cell-mediated autoimmune disease, in which inflammatory cells attack an unknown protein within skin and mucosal keratinocytes. It is a chronic inflammatory skin disease
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Pyoderma gangrenosum
- What does this image show?
- What is the underlying pathophysiology?
- Pyoderma gangrenosum
- Pyoderma gangrenosum is an autoinflammatory disease (excessive response to an internal antigen) due to some form of neutrophil dysfunction. T lymphocytes and cytokines are involved. There may be a genetic predisoposition. Drugs are occasionally implicated as triggers of pyoderma gangrenosum, especially cocaine, isotretinoin, propylthiouracil and sunitinib.
Rapidly enlarging , very painful ulcers. One of the group of theautoinflammatory disorders known as neutrophilic dermatoses.
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- What is it?
- Seborrhoeic keratosis
- A seborrhoeic keratosis is a harmless warty spot that appears during adult life as a common sign of skin ageing
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Sebaceous cyst
- What does the image show?
- What is the underlying pathophysiology?
- Sebaceous cyst
- Fluid filled bump that forms on the skin
Epidermal cyst - forms in the epidermis
Pilar cyst - forms on the scalp most commonly
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Basal cell carcinoma
Pearly, rolled edges, ulcerated center. Is benign but can invade surrounding structures
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BCC
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Bowen’s disease
Bowen’s disease is a very early form of skin cancer that’s easily treatable. The main sign is a red, scaly patch on the skin. It affects the squamous cells – which are in the outermost layer of skin – and is sometimes referred to as squamous cell carcinoma in situ.
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Squamous cell carcinoma
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SCC
Typical SCC has nests of squamous epithelial cells arising from the epidermis and extending into the dermis. The malignant cells are often large with abundant eosinophilic cytoplasm and a large, often vesicular, nucleus. Variable keratinisation (keratin pearls etc) is present
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Benign junctional naevus
A common benign concentration of melanocytes that form, completely harmless
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Compound naevus
A compound nevus is a type of mole formed by groups of nevus cells found in the epidermis and dermis (the two main layers of tissue that make up the skin
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Compond naevus
Nests ofnevus cells within the epidermis as well as nevuscells within the dermis. The junctional component does not typically extend peripherally beyond the dermal component, in contrast to atypical nevi and melanomas.
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Pigmented spindle cell naevus of Reed
Pigmented Spindle Cell Nevus of Reed. Pigmented spindle cell nevus is a benign melanocytic lesion that was initially described in 1975 by Reed et al. It is generally found on the trunk or lower extremities of young women. Most authors consider it to be a variant of Spitz nevus.
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Multiple melanoma
Melanoma, also known as malignant melanoma, is a type of cancer that develops from the pigment-containing cells known as melanocytes. Melanomas typically occur in the skin, but may rarely occur in the mouth, intestines, or eye.
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Multiple melanoma
Histologically, melanomas are asymmetrical and poorly circumscribed lesions with architectural disturbance and usually marked cytological atypia. Specific features include consumption of the epidermis, pagetoid spread of melanocytes, nests of melanocytes with variable size and shape (which may be confluent and lack maturation), melanocytes within lymphovascular spaces, deep and atypical mitoses and increased apoptosis. Ulceration, if present, is a poor prognostic factor. Mitotic figures are common.
What are the two types of malignant melanoma?
epithelioid and spindle cells. Epithelioid cells are large and round with abundant eosinophilic cytoplasm, prominent vesicular nuclei and large nucleoli. They most commonly arise in superficial spreading and nodular melanomas.
