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BASIC Exam Study Guide > Dermatopathology > Flashcards

Dermatopathology Flashcards

1
Q

Name the anatomic location.

  • Look for hair follicles
  • What glands are present?
A

Scalp

  • Numerous follicles that extend down into fat
  • Sebaceous glands, arrector pili muscles
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2
Q

Name the anatomic location.

  • What is present in upper dermis?
  • What special cells are present?
  • What is absent?
A

Eyelid

  • Skeletal muscle bodies are present in upper dermis
  • Stratum corneum and hair follicles are absent on the conjunctival surface of the eyelid, but goblet cells are present
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3
Q

Name the anatomic location.

  • What tissue is present?
  • What kind of hair follicles are present?
A

Ear

  • Look for cartilage
  • Many vellus hair follicles
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4
Q

Name the anatomic location.

  • What occurs in the epidermis?
  • What is present in the mid to deep dermis?
  • What glands are present in the deep dermis?
A

Areolar skin

  • Acanthosis with basilar hyperpigmentation
  • Smooth muscle bundles in the mid to deep dermis
  • Apocrine glands in reticular dermis
  • Sometimes there is a central invagination of the epidermis leading to a follicle and sebaceous gland
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5
Q

Name the anatomic location.

  • What is present in abundance in the dermis?
  • What other special incidental finding may occur?
A

Facial skin

  • Thin epidermis
  • A lot of hair follicles and sebaceous glands in dermis (not in fat like scalp)
  • Demodex mites common
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6
Q

Name the anatomic location.

  • What occurs in the corneum?
  • What gland is there an abundance of?
  • What is absent? (2)
A

Volar skin (palms and soles)

  • Compact eosinophilic hyperkeratotic stratum corneum
  • Stratum lucidum present
  • No hair follicles or sebaceous glands
  • A lot of eccrine glands (the major sweat glands of the body)
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7
Q

Name the anatomic location.

  • What epidermal layer is absent?
  • Why are keratinocytes large and pale?
  • What may be present in the submucosa? (2)
A

Mucosa

  • Absent granular layer
  • Keratinocytes are large and pale because they are filled with glycogen
  • Dilated vessels in submucosa
  • Smooth muscle bundles may be present in submucosa (see photo)
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8
Q

Name the anatomic location.

  • What is present in the superficial dermis?
  • What special cells are present?
  • What is absent? (2)
A

Eyelid

  • Skeletal muscle bodies are present in upper dermis
  • Stratum corneum and hair follicles are absent on the conjunctival surface of the eyelid, but goblet cells are present
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9
Q

Name the anatomic location.

  • What occurs in the corneum?
  • What gland is there an abundance of?
  • What is absent? (2)
A

Volar skin (palms and soles)

  • Compact eosinophilic hyperkeratotic stratum corneum
  • Stratum lucidum present
  • No hair follicles or sebaceous glands
  • A lot of eccrine glands
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10
Q

Name the cell type.

  • What is unique about the nucleus (i.e., how many lobes usually) and cytoplasm?
A

Eosinophil

  • Bilobed nucleus
  • Granular cytoplasm
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11
Q

Name the layers in this transverse section of a hair follicle.

A
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12
Q

Name the layers in this vertical section of a hair follicle

A
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13
Q

Name the prominent cell.

  • Look at the nucleus
A

Neutrophil

  • Multilobulated nucleus (segemented nucleus resembles “ants”)
  • Predominant cell in acute infection
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14
Q

Name the cell type.

  • What is the dermpath buzzword?
  • How would you describe the nucleus and cytoplasm?
  • Name three histologic stains for this.
A

Mast cell

  • “Fried egg” appearance
  • Central round nucleus and surrounding oval blue cytoplasm
  • Contains granules composed of heparin, histamine, tryptase, carboxypeptidase, leukotrienes
  • Stains with toluidine blue, CD117 (c-kit) and CD203c
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15
Q

Name the cell type.

  • What is special about the nucleus and its placement?
  • What is the area adjacent to to the nucleus called?
A

Plasma cell

  • Eccentric nucleus with “clock face”
  • Perinuclear Hopf (clearing), corresponding to Golgi apparatus
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16
Q

Name the cell type.

  • How does the nucleus and cytoplasm compare with a lymphocyte?
  • What is the cell of origin?
A

Histiocyte

  • ​Epithelioid cell with central, round/oval nucleus (that is less dense than a lymphocyte) surrounded by pale pink cytoplasm (i.e., relatively lower N:C ratio)
  • Derived from monocytes
  • Functions: phagocytosis and antigen presentation
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17
Q

Name the predominant inflammatory cell.

  • What is notable about the nucleus and cytoplasm?
A

Lymphocyte

  • Round dark nucleus
  • Generally no visible cytoplasm (i.e., very high N:C ratio)
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18
Q

Name the cell type.

  • What is notable about the nucleus?
  • What markers are positive? (4)
  • What are they derived from?
A

Langerhans cell

  • Dendritic cells in epidermis and dermis that present antigens to T-cells
  • Eccentric, reniform (kidney-shaped) nucleus
  • CD1a+, S100+, peanut agglutinin+, langerin+
  • Birbeck granules (tennis racket-shaped) seen on electron microscopy
  • Derived from monocytes
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19
Q

Name the cell at the arrow.

  • What lesions can this be found in? (3)
A

Touton giant cell

  • Found in juvenile xanthogranuloma, xanthoma and sometimes dermatofibroma (such as “ankle-type”)
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20
Q

Name the type of secretory gland.

A

Sebaceous glands

(In sebaceous gland hyperplasia)

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21
Q

Name the type of secretory gland.

A

Eccrine glands

  • The major sweat glands in the body
  • Two layers of cells
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22
Q

Name the type of secretory gland.

A

Apocrine glands

(Think about apocrine hidradenoma and cystadenoma.)

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23
Q

What does S100 stain?

  • What cell origin?
A

S100

  • Stains neural crest-derived cells and some mesenchymal lines
  • Stains: melanocytes, Langerhans cells, sweat glands, nerves, Schwann cells, myoepithelial cells, fat, muscle, and chondrocytes
  • Photo is of a granular cell tumor.
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24
Q

What does Sox-10 stain? (2)

A

Sox-10

  • Nuclear marker of Schwann cells and melanocytes
  • Sensitive marker of melanoma
  • Photo is of desmoplastic melanoma
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25
Q

What does CK polyclonal keratin (pankeratin) stain?

  • What tumors would stain positive?
  • What tumors would NOT stain positive?
A

CK polyclonal keratin (pankeratin)

  • All epithelial tumors (SCC, adnexal tumors)
  • Does NOT stain mesenchymal, melanocytic and hematopoietic tumors
  • More sensitive than AE1/AE3 (monoclonal cytokeratin antibodies)
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26
Q

What does PAS stain?

  • It stains 3 things red.
  • What can it be useful in diagnosing?
A

PAS (periodic acid-Schiff)

  • Stains glycogen, neutral mucopolysaccharides (such as the basement membrane) and fungi red
  • Useful in tinea corporis, tinea versicolor, candida, basement membrane thickening of lupus erythematosis
  • Photo is of PAS-positive fungi in stratum corneum (tinea versicolor) with light green counter-stain
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27
Q

What type of stain was used on this slide with Nocardia?

  • For what organisms is this stain helpful?
A

Fite acid-fast stain

  • Mycobacteria appear bright red
  • Fite is preferred for “partially acid-fast” organisms like lepra bacilli, atypical mycobacteria and Nocardia
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28
Q

What stain was used on this slide of focal mucinosis?

  • What does it stain?
A

Colloidal iron

  • A carbohydrate stain
  • Blue color indicates acid mucopolysaccharides
  • Can be combined with hyaluronidase digestion to differentiate between hyaluronic acid and other mucosubstances
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29
Q

What is this stain and what is it used for?

  • What is helpful for distinguishing between?
A

Iron stain, a.k.a. Prussian blue, a.k.a. Perls stain

  • Ferric ions react to form deep blue color
  • Useful to distinguish melanin from hemosiderin
  • Example: hemosiderin in pigmented purpuric dermatosis
  • Will not stain iron in intact RBCs
  • Photograph is blue iron deposition from Monsel’s use
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30
Q

What stain was used in this slide of vitiligo, and what does it stain?

A

Fontana-Masson

  • Stains melanin with a black precipitate
  • A silver stain
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31
Q

Interface dermatitis is split into what two basic patterns?

A
  1. Lichenoid
  2. Vacuolar
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32
Q

Identify the reaction pattern.

A

Spongiosis

  • Intracellular edema in epidermis with stretching of cell-cell junctions
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33
Q

Identify the reaction pattern.

A

Spongiosis

  • Intracellular edema in epidermis with stretching of cell-cell junctions
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34
Q

What are the three components of lichenoid interface dermatitis?

A
  1. Sawtooth rete ridge pattern with destruction of the basal layer
  2. Bandlike lymphoid infiltrate
  3. Presence of Civatte bodies (debris left behind after keratinocyte apoptosis)
  • Things can be further divided based on whether parakeratosis and eosinophils are present
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35
Q

What are the three basic components of vacuolar interface dermatitis (according to Elston)?

A
  • Intact basal layer
  • Vacuoles within the basal layer
  • Rounded rete pattern
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36
Q

What inflammatory reaction pattern is seen here?

A

Vacuolar interface dermatitis

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37
Q

What inflammatory reaction pattern is seen here?

A

Vacuolar interface dermatitis

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38
Q

What are common causes of spongiotic dermatitis? (5)

A
  1. Allergic contact dermatitis
  2. Dyshidrotic dermatitis
  3. Nummular dermatitis
  4. Stasis dermatitis
  5. Id reaction
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39
Q

Granulomas are made of which immune cell type?

A

Histiocytes

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40
Q

What are the four categories of granulomas?

  • Which have surrounding inflammation?
  • Which have central necrosis?
  • Which features neutrophils?
A
  1. Sarcoidal: composed of epithelioid histiocytes in “naked granulomas” with little surrounding inflammation
  2. Tuberculoid: peripheral mononuclear infiltrate and central caseous necrosis
  3. Palisading: histiocytes surround devitalized collagen (necrobiosis), mucin or foreign material
  4. Suppurative: central collection of neutrophils (i.e., stellate abscess)
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41
Q

Identify the reaction pattern.

A

Psoriasiform

  • Look for regular, club-shaped acanthosis
  • In this photo, alternating neutrophils and parakeratosis (sandwich sign) leads you towards plaque psoriasis
42
Q

Identify the reaction patterns. (2)

A

Psoriasiform and spongiosis

  • Psoriasiform because of the regular acanthosis that is somewhat club-shaped
  • Spongiosis due to the edema in the epidermis
  • This photo is showing subacute spongiotic dermatitis (dDx: ACD vs. dyshidrotic vs. nummular vs. stasis vs. ID reaction).
43
Q

Identify the reaction pattern.

A

Vesiculobullous

  • Photo shows pemphigus vulgaris
  • Villi are in a “tombstone row”
44
Q

What inflammatory reaction pattern is present in this slide?

  • What is the diagnosis?
A

Granulomatous

(Necrobiosis lipoidica; “layered cake”)

45
Q

What inflammatory reaction pattern is present in this slide?

  • What is the diagnosis?
A

Granulomatous

(Sarcoidosis, a naked granuloma)

46
Q

What inflammatory reaction pattern is present in this slide?

  • What is the diagnosis?
A

Granulomatous

(Necrobiosis lipoidica; “layered cake”)

47
Q

What inflammatory reaction pattern is present in this slide?

A

Granulomatous

(Palisading granuloma annulare)

48
Q

What inflammatory reaction pattern is present in this slide?

A

Vasculopathic

(Leukocytoclastic vasculitis)

49
Q

What inflammatory reaction pattern is present in this slide?

A

Vasculopathic

(Septic vasculitis)

50
Q

Identify the reaction pattern.

A

Vesiculobullous

  • Specifically, PCT due to the festooning and subepidermal vesicle that is pauci-immune
51
Q

Name the diagnosis.

  • In what other lesions can Touton giant cells be found?
A

Xanthogranuloma

  • ​Touton giant cells can be found in JXG, xanthomas and sometimes in dermatofibromas
52
Q

Septal or lobular panniculitis?

A

Septal

53
Q

Septal or lobular panniculitis?

A

Septal

54
Q

What blistering dermatosis does this DIF represent?

  • Note the primary involvement of the upper epidermis.
A

Pemphigus foliaceus

55
Q

What disease is the most common form of septal panniculitis?

A

Erythema nodosum

56
Q

What blistering dermatosis does this DIF represent?

  • Note the primary involvement of the lower epidermis.
A

Pemphigus vulgaris

57
Q

Septal or lobular panniculitis?

A

Lobular

(Erythema induratum)

58
Q

Septal or lobular panniculitis?

A

Lobular

(Lipodermatosclerosis)

59
Q

Septal or lobular panniculitis?

A

Lobular

(Eosinophilic panniculitis)

60
Q

What is seen on DIF of dermatitis herpetiformis?

A

Granular deposition of IgA in dermal papillae

61
Q

What is seen on DIF of linear IgA bullous dermatosis?

A

Linear deposition of IgA along DEJ

62
Q

Describe this dermpath finding of the epidermis.

A

Acanthosis

  • Increase in thickness of the epidermis
  • Can be regular (all rete pegs to the same level) or irregular (rete pegs descend to different levels in dermis)
63
Q

Describe what apoptosis looks like histologically.

A
  • Programmed cell death
  • “Dead red” keratinocytes with pyknotic (condensed chromatin) nuclei
64
Q

Describe what epidermolysis looks like.

A

Splitting of the epidermis from the dermis

65
Q

Describe what epidermotropism looks like histologically.

A
  • Lymphocytes in epidermis with relative absence of spongiosis
  • Term usually reserved for mycosis fungoides (as in photo)
66
Q

Name the diagnosis.

A

Basal cell carcinoma (BCC)

  • Blue islands
  • Peripheral palisading
  • High nuclear-to-cytoplasmic ratio (very blue)
  • Retraction artifact
  • Fibromyxoid stroma
67
Q

Name the diagnosis.

A

Inflamed acanthotic seborrheic keratosis

  • Broad sheets of keratinocytes with intervening “horn cysts”
  • Loose lamellar “shredded-wheat” or “onion-skin”
68
Q

Name the diagnosis.

A

Basal cell carcinoma (BCC)

  • Blue islands
  • Peripheral palisading
  • High nuclear-to-cytoplasmic ratio (very blue)
  • Retraction artifact
  • Fibromyxoid stroma
  • Solar elastosis
69
Q

Name the diagnosis.

A

Nodular BCC

  • Nodular blue islands
  • Peripheral palisading
  • Retraction artifact
  • Distinctive fibromyxoid stroma
  • Hyperchromatic “monster cells” may be present but do not affect prognosis
70
Q

Name the diagnosis.

A

Clonal seborrheic keratosis

  • Look for clonal islands of small keratinocytes within the epidermis
71
Q

Name the diagnosis.

A

Seborrheic keratosis

72
Q

Name the diagnosis.

A

Reticulated seborrheic keratosis

73
Q

Name the diagnosis.

A

Epidermal inclusion (epidermoid) cyst

  • Cyst wall resembles surface epidermis
  • Loose lamellar “onion-skin” keratin within cyst
  • Connection to surface punctum may be visible histologically
  • Ruptured cysts may have neutrophils, histiocytes and foreign-body giant cells
74
Q

Name the diagnosis.

A

Proliferating pilar cyst

  • “Rolls and scrolls”
  • May form small new cysts within the mother cyst
75
Q

Name the diagnosis.

A

Pilar cyst

  • Abrupt keratinization without a granular layer
  • Deeply eosinophilic dense keratin
  • Can see focal calcifications
76
Q

Name the diagnosis.

A

Pilar cyst

  • Abrupt keratinization without a granular layer
  • Deeply eosinophilic dense keratin
  • Can see focal calcifications
77
Q

Name the diagnosis.

A

Epidermal inclusion (epidermoid) cyst

  • Cyst wall resembles surface epidermis
  • Loose lamellar “onion-skin” keratin within cyst
  • Connection to surface punctum may be visible histologically
  • Ruptured cysts may have neutrophils, histiocytes and foreign-body giant cells
78
Q

Name the diagnosis.

  • What is abundant in the dermis?
  • What occurs in the overlying epidermis?
A

Dermatofibroma

  • Spindle cell proliferation
  • Collagen trapping
  • Overlying platelike acanthosis
79
Q

Name the diagnosis.

  • What is abundant in the dermis?
  • What occurs in the overlying epidermis?
A

Dermatofibroma

  • Spindle cell proliferation
  • Collagen trapping
  • Overlying platelike acanthosis
80
Q

Name the diagnosis.

  • What is abundant in the dermis?
  • What occurs in the overlying epidermis?
A

Dermatofibroma

  • Spindle cell proliferation
  • Collagen trapping
  • Overlying platelike acanthosis
81
Q

Name the diagnosis.

A

Actinic keratosis

  • Crowding, disorder and atypia of epidermal keratinocytes
  • Arises from the basal layer
  • Solar elastosis typically present
  • May have alternating zones of eosinophilic (pink) parakeratosis and more normal basophilic (blue) lamellar keratin, called the “flag sign”
82
Q

Name the diagnosis.

A

Actinic keratosis

  • Crowding, disorder and atypia of epidermal keratinocytes
  • Arises from the basal layer
  • Solar elastosis typically present
  • May have alternating zones of eosinophilic (pink) parakeratosis and more normal basophilic (blue) lamellar keratin, called the “flag sign”
83
Q

Name the diagnosis.

A

Actinic keratosis

  • Crowding, disorder and atypia of epidermal keratinocytes
  • Arises from the basal layer
  • Solar elastosis typically present
  • May have alternating zones of eosinophilic (pink) parakeratosis and more normal basophilic (blue) lamellar keratin, called the “flag sign”
84
Q

Name the diagnosis.

A

Benign melanocytic nevus

  • Sharply defined
  • Well-nested at the DEJ
  • Round to oval nests at the tips and sides of rete ridges
  • Matures
  • No deep mitoses, no deep pigment in nests
85
Q

Name the diagnosis.

A

Benign melanocytic nevus (specifically, a combined nevus)

Characteristics of benign melanocytic nevi are:

  • Sharply defined
  • Well-nested at the DEJ
  • Round to oval nests at the tips and sides of rete ridges
  • Matures
  • No deep mitoses, no deep pigment in nests
86
Q

Name the diagnosis.

A

Spitz nevus

  • Hyperkeratosis, hypergranulosis
  • Nests oriented vertically (“bananas on a tree”)
  • Kamino bodies (eosinophilic globules that represent trapped BM material)
  • Clefts around nests
87
Q

Name the diagnosis.

  • What is the special name for these “bodies”?
A

Molluscum contagiosum

  • Cup-shaped lesion with scalloped border
  • Henderson-Paterson bodies (molluscum bodies): large cells with abundant granular eosinophilic cytoplasm (virions) and small peripheral nucleus
88
Q

Name the diagnosis.

  • What is the special name for these “bodies”?
A

Molluscum contagiosum

  • Cup-shaped lesion with scalloped border
  • Henderson-Paterson bodies (molluscum bodies): large cells with abundant granular eosinophilic cytoplasm (virions) and small peripheral nucleus
89
Q

Name the diagnosis.

  • What is the special name for these “bodies”?
A

Molluscum contagiosum

  • Cup-shaped lesion with scalloped border
  • Henderson-Paterson bodies (molluscum bodies): large cells with abundant granular eosinophilic cytoplasm (virions) and small peripheral nucleus
90
Q

Name the diagnosis.

A

Malignant melanoma

  • Broad, asymmetrical
  • Poorly nested
  • Irregularly spaced and shaped nests not just at tips and sides of rete
  • Lack of maturation and dispersion
  • Deep mitoses and deep pigment in nest
91
Q

Name the diagnosis.

A

Malignant melanoma (specifically, superficial spreading)

  • Broad, asymmetrical
  • Poorly nested
  • Irregularly spaced and shaped nests not just at tips and sides of rete
  • Lack of maturation and dispersion
  • Deep mitoses and deep pigment in nest
92
Q

Name the diagnosis.

A

Malignant melanoma (specifically superficial spreading)

  • Broad, asymmetrical
  • Poorly nested
  • Irregularly spaced and shaped nests not just at tips and sides of rete
  • Lack of maturation and dispersion
  • Deep mitoses and deep pigment in nest
93
Q

Name the diagnosis.

A

Malignant melanoma

  • Broad, asymmetrical
  • Poorly nested
  • Irregularly spaced and shaped nests not just at tips and sides of rete
  • Lack of maturation and dispersion
  • Deep mitoses and deep pigment in nest
94
Q

Name the diagnosis.

  • What two patterns may this lesion have?
  • Mucin in this lesion may be made more apparent with what stain?
A

Granuloma annulare

  • May occur in an interstitial or palisading pattern
  • Interstitial pattern: patchy lymphohistiocytic infiltrate and mucin comprise a “busy dermis”
  • Palisading pattern: histiocytes surround altered dermal collagen and mucin
  • Mucin more apparent with colloidal iron
95
Q

Name the diagnosis.

  • What two patterns may this lesion have?
  • Mucin in this lesion may be made more apparent with what stain?
A

Granuloma annulare

  • May occur in an interstitial or palisading pattern
  • Interstitial pattern: patchy lymphohistiocytic infiltrate and mucin comprise a “busy dermis”
  • Palisading pattern: histiocytes surround altered dermal collagen and mucin
  • Mucin more apparent with colloidal iron
96
Q

What would you expect on a Tzanck smear with HSV?

  • How do you obtain an adequate smear?
  • What is special about the keratinocytes? What is inside of them? What can keratinocytes form?
A
  • Scrape the base/edges of a freshly unroofed vesicle
  • Swollen, pale, degenerating keratinocytes form multinucleated giant cells
  • Eosinophilic (pink/red) intranuclear bodies surrounded by an artifactual cleft (Cowdry type A inclusions)
97
Q

Where do you biopsy a suspected blistering dermatosis for H&E and DIF?

A
  • H&E: Intact bulla or edge of bulla
  • DIF: Perilesional skin < 1 cm from bulla
98
Q

Where do you biopsy for suspected vasculitis for H&E and DIF?

A
  • H&E: Lesion < 72 hours old
  • DIF: Acute lesion < 24 hours old
99
Q

Name the diagnosis.

A

Scabies

  • Patchy to diffuse infiltrate with prominent eosinophils
  • Entire mites, scybala (feces) and eggs may be visible
100
Q

Name the parts of a microscope.

A
101
Q

Name the parts of the microscope.

A
  1. Eyepiece
  2. Coarse focus knob
  3. Fine focus knob
  4. Power switch
  5. Stage adjustment controls
  6. Condenser focus knob
  7. Field diaphragm
  8. Centration screws
  9. Aperture diaphragm
  10. Condenser
  11. Stage
  12. Objective lens

BASIC Exam Study Guide (11 decks)

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