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Skin & MSK > Dermatopathology: Non-pigmented lesions > Flashcards

Dermatopathology: Non-pigmented lesions Flashcards

1
Q

Most common benign skin tumor of keratinocytes

A

Seborrheic Keratosis

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2
Q

What is the age of the typical patient with Seborrheic Keratosis?

A

Middle age or older

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3
Q

Where does Seborrheic Keratosis develop on the body?

A

Anywhere except palms/soles

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4
Q

What is the skin color of the typical patient with Seborrheic Keratosis?

A

Tan-black

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5
Q

Condition where lesions have waxy, “stuck-on” appearance, and keratotic plugs are seen on close exam

A

Seborrheic Keratosis

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6
Q

Keratotic plugs are seen in this condition

A

Seborrheic Keratosis

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7
Q

Condition with this morphology:
Well-demarcated papule/plaque
Small/immature appearing keratinocytes
Pseudo-horn cysts
Flat bottom
Hyperkeratosis

A

Seborrheic Keratosis

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8
Q

What causes Seborrheic Keratosis?

A

FGFR-3 activating mutations and TGF-alpha

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9
Q

FGFR-3 activating mutations and TGF-alpha drive this condition

A

Seborrheic Keratosis

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10
Q

Term for when paraneoplastic syndrome may produce abrupt increase in size/number of Seborrheic Keratoses

A

Leser-Trelat sign

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11
Q

What is the Leser-Trelat Sign?

A

Paraneoplastic syndrome may produce abrupt increase in size/number of Seborrheic Keratoses

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12
Q

The Leser-Trelat sign is involved in what condition?

A

Seborrheic Keratosis

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13
Q

Condition involving velvety hyperpigmentation of intertriginous and extensor surfaces

A

Acanthosis Nigricans

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14
Q

Acanthosis Nigricans is most common on these 2 regions of the body

A

Neck and Axilla

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15
Q

Acanthosis Nigricans is associated with these 2 conditions

A

Insulin resistance (type 2 DM)
Internal malignancy

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16
Q

In Acanthosis Nigricans, signaling through this causes dermal expansion, keratinocyte hyperplasia, and melanocyte pigment production

A

FGFR3 (Fibroblast growth factor receptor)

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17
Q

2 molecules produced in some neoplasms or endocrine disorders that are involved in Acanthosis Nigricans

A

TGF-alpha and IGF

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18
Q

Condition where papillary dermis expands and pushes into epidermis producing papillomatosis

A

Acanthosis Nigricans

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19
Q

Benign Acanthosis Nigricans is associated with these 3 factors

A

Obesity
Insulin resistance
Drugs (hormonal contraceptives)

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20
Q

Malignancy-associated Acanthosis Nigricans is most commonly related to this cancer

A

GI carcinoma

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21
Q

Malignancy-associated Acanthosis Nigricans in pediatric patients is associated with this cancer

A

Osteosarcoma

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22
Q

Rare inherited forms of Acanthosis Nigricans involve mutations of this

A

FGFR (fibroblast growth factor receptor)

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23
Q

Acrochordon and Fibroepithelial polyp are other names for this

A

Skin tag

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24
Q

Polypoid skin surrounded by normal appearing skin

A

Skin tag (Acrochordon, Fibroepithelial polyp)

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25
Q

Skin tags are frequently in these 3 locations

A

Neck, Axilla, Trunk of older people

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26
Q

Skin tags (acrochordon, fibroepithelial polyp) are associated with these 2 conditions

A

Obesity and Type II diabetes

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27
Q

Presence of skin tags (acrochordon, fibroepithelial polyp) may increase during this

A

Pregnancy

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28
Q

Cutaneous cyst involving a plugged hair follicle, often seen as punctum

A

Epidermal inclusion cyst

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29
Q

Cutaneous cyst that is lined by stratified squamous epithelium with granular layer

A

Epidermal inclusion cyst

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30
Q

Cutaneous cyst where some form by implantation of epithelium into dermis

A

Epidermal inclusion cyst

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31
Q

Cutaneous cyst that is mostly found on scalp/head

A

Pilar (trichilemmal) cyst

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32
Q

Cutaneous cyst that is lined by stratified squamous epithelium with abrupt keratinization

A

Pilar (trichilemmal) cyst

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33
Q

Cutaneous cyst with no punctum

A

Pilar (trichilemmal) cyst

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34
Q

Does Pilar (trichilemmal) cyst have a punctum?

A

No

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35
Q

Does Epidermal inclusion cyst have a punctum?

A

Often yes

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36
Q

Cutaneous cysts are filled with what type of material?

A

Keratinaceous

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37
Q

Hyperkeratotic dysplastic lesion on sun-damaged skin

A

Actinic Keratosis

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38
Q

Condition involving white, scaly, papules or macules
Variable size but usually less than 1cm

A

Actinic Keratosis

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39
Q

What is the typical patient with Actinic Keratosis?

A

Usually elderly, fair skinned

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40
Q

Does Actinic Keratosis involve sun damaged skin?

A

Yes

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41
Q

Basal layer squamous atypia and dermis with Solar Elastosis are seen in this condition

A

Actinic Keratosis

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42
Q

Condition of Actinic Keratosis of lower lip
Scaly, thin skin
Erythema, Leukoplakia

A

Actinic Cheilitis

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43
Q

Condition that is similar to Actinic Keratosis but involves full thickness keratinocyte atypia

A

Squamous cell carcinoma in situ (Bowen Disease)

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44
Q

Is Squamous cell carcinoma in situ (Bowen Disease) related to sun damaged skin?

A

Mostly but not exclusively

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45
Q

Squamous cell carcinoma in situ (Bowen Disease) may arise de novo or from this condition

A

Actinic Keratosis

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46
Q

Squamous cell carcinoma in situ (Bowen Disease) is increased in this type of patient

A

Immunocompromised

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47
Q

Condition involving erythematous, scaly macule/papule, often hyperkeratotic

A

Squamous cell carcinoma in situ (Bowen Disease)

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48
Q

Full thickness keratinocyte atypia is morphologically seen in this condition

A

Squamous cell carcinoma in situ (Bowen Disease)

49
Q

Is there dermal invasion in Squamous cell carcinoma in situ (Bowen Disease)?

A

No

50
Q

What is the main difference between Actinic Keratosis and Squamous cell carcinoma in situ (Bowen Disease)?

A

Squamous cell carcinoma in situ (Bowen Disease) involves full thickness keratinocyte atypia

51
Q

Invasive tumor of keratinocytes into dermis

A

Invasive squamous cell carcinoma

52
Q

Is there dermal involvement in Invasive squamous cell carcinoma?

A

Yes, it is an invasive tumor of keratinocytes into dermis

53
Q

Keratin pearls are seen in this condition

A

Invasive squamous cell carcinoma

54
Q

Desmoplasia is seen in this non-pigmented lesion

A

Invasive squamous cell carcinoma

55
Q

Is Invasive squamous cell carcinoma related to sun damaged skin?

A

Sun exposed skin is most common

56
Q

Condition that is very similar to Actinic Keratosis and Squamous cell carcinoma in situ but may ulcerate and may have mass or nodularity

A

Invasive squamous cell carcinoma

57
Q

Non-pigmented lesion that occurs often with Squamous cell carcinoma in situ, and also involves ulceration and hyperkeratosis

A

Invasive squamous cell carcinoma

58
Q

Solar Elastosis of the dermis is seen in this condition

A

Actinic keratosis

59
Q

Non-pigmented lesion that is increased in immunocompromised patients and also seen with chronic ulcer, scar, burn sites

A

Invasive squamous cell carcinoma

60
Q

Scaly, red, macule/papule that may ulcerate and have mass or nodularity is seen in this non-pigmented lesion

A

Invasive squamous cell carcinoma

61
Q

Non-pigmented lesion involving detached nests of atypical keratinocytes, desmoplastic stroma, and keratin pearls if well-differentiated

A

Invasive squamous cell carcinoma

62
Q

Invasive squamous cell carcinoma has a poor prognosis in these 2 situations

A

Deeply invasive or on lip

63
Q

Do Invasive squamous cell carcinoma metastasize?

A

Rarely

64
Q

Malignant neoplasm of basal keratinocytes

A

Basal cell carcinoma

65
Q

Do Basal cell carcinomas metastasize?

A

Almost never

66
Q

Non-pigmented lesion that is a pearly papule with rolled borders, often with telangiectatic vessels, often ulcerate, and slow progressive locally destructive invasion

A

Basal cell carcinoma

67
Q

Dark, basophilic basal layer that descends into the dermis and outer nuclei showing peripheral palisading are seen in this non-pigmented lesion

A

Basal cell carcinoma

68
Q

Small, firm dermal nodule often with overlying hyperpigmentation that may occur anywhere on adults

A

Benign fibrous histiocytoma (Dermatofibroma)

69
Q

Where does Benign fibrous histiocytoma (Dermatofibroma) occur on the body?

A

Anywhere on adults; commonly on legs of young to middle age women

70
Q

Pinch sign is seen in this dermal tumor

A

Benign fibrous histiocytoma (Dermatofibroma)

71
Q

Dermal tumor that is well-defined, unencapsulated, may touch subcutaneous fat but not invade, made of spindled cells with “entrapped” collagen, and may have epidermal hyperplasia with pigmentation

A

Benign fibrous histiocytoma (Dermatofibroma)

72
Q

Dermal tumor that may touch subcutaneous fat but not invade

A

Benign fibrous histiocytoma (Dermatofibroma)

73
Q

Well-differentiated fibrosarcoma of skin that begins as dermal plaque

A

Dermatofibrosarcoma Protuberans (DFSP)

74
Q

Dermatofibrosarcoma Protuberans (DFSP) most often occur in this part of the body

A

On trunk of adults

75
Q

IHC marker for Dermatofibrosarcoma Protuberans (DFSP)

A

CD34+

76
Q

CD34+ by IHC indicates this dermal tumor

A

Dermatofibrosarcoma Protuberans (DFSP)

77
Q

Dermal tumor that involves cellular proliferation of fibroblasts, similar to dermatofibroma, and extends into deep subcutis

A

Dermatofibrosarcoma Protuberans (DFSP)

78
Q

How far does Dermatofibrosarcoma Protuberans (DFSP) extend in the skin?

A

Into deep subcutis

79
Q

How far does Benign fibrous histiocytoma (Dermatofibroma) extend into the skin?

A

May touch subcutaneous fat but does not invade

80
Q

This type of growth in Dermatofibrosarcoma Protuberans (DFSP) gives multi-nodularity

A

Downward growth

81
Q

Histological pinwheel pattern is seen in this dermal tumor

A

Dermatofibrosarcoma Protuberans (DFSP)

82
Q

Marker present on all lymphocytes

A

CD45

83
Q

CD45 is a marker on these cells

A

All lymphocytes

84
Q

Tryptase and CD117 are markers for this type of cell

A

Mast cell

85
Q

2 makers for Langerhans cells

A

S100 and CD1a

86
Q

Condition where malignant epidermotropic CD4+ T cells infiltrate skin

A

Mycosis fungoides

87
Q

Peak age of Mycosis fungoides patient

A

40’s

88
Q

Is Mycosis fungoides associated with sun exposed areas?

A

No, involves non-sun exposed areas

89
Q

Pautrier microabscess is seen in this lesion

A

Mycosis fungoides

90
Q

Aggregates of atypical CD4+ T cells within the epidermis that are indicative of mycosis fungoides

A

Pautrier microabscess

91
Q

What does a Mycosis fungoides lesion in the patch stage look like?

A

Red and scaly

92
Q

What does a Mycosis fungoides lesion in the plaque stage look like?

A

Red, brown scaling plaques

93
Q

Condition associated with the leukemic phase of Mycosis fungoides
Invovles generalized erythroderma, lymphadenopathy

A

Sezary syndrome

94
Q

Circulating lymphocytes with cerebriform nuclei are seen in this condition

A

Sezary syndrome associated with Mycosis fungoides

95
Q

Epidermotropic CD4+ T cells are seen in this lesion

A

Mycosis fungoides

96
Q

What type of T cells are seen in Mycosis fungoides?

A

CD4

97
Q

Accumulation of mast cells in dermis

A

Cutaneous mastocytosis

98
Q

In Cutaneous mastocytosis, there is an accumulation of mast cells in this skin layer

A

Dermis

99
Q

Term that describes an isolated Cutaneous mastocytosis lesion

A

Mastocytoma

100
Q

What age does Cutaneous mastocytosis present?

A

Birth to middle age
>50% are early childhood; may be congenital, usually present by 2 eyars

101
Q

Genetic driver mutation in Cutaneous mastocytosis

A

c-kit

102
Q

Common generalized form of Cutaneous mastocytosis

A

Urticaria pigmentosa

103
Q

What is the difference between childhood and adult onset Cutaneous mastocytosis?

A

Mostly limited to skin in children, often with spontaneous resolution by adulthood
Adult onset tends to persist as chronic disease with dissemination

104
Q

Darier’s sign is seen in this condition

A

Cutaneous mastocytosis

105
Q

Levels of serum tryptase in Cutaneous mastocytosis

A

Elevated

106
Q

2 IHC markers for Cutaneous mastocytosis

A

Tryptase and CD117 (c-kit)

107
Q

Tryptase is elevated in this non-pigmented lesion

A

Cutaneous mastocytosis

108
Q

Urticaria pigmentosa is the more common generalized form of this non-pigmented lesion

A

Cutaneous mastocytosis

109
Q

What is Darier’s sign?

A

When a lesion welts up after rubbing it due to histamine release
Seen in Cutaneous mastocytosis

110
Q

Type of xanthoma:
Crops of yellow papules
Extensor surfaces and buttocks
Associated with Hypertriglyceridemia

A

Eruptive

111
Q

Type of xanthoma:
Deposits over elbows/knees
Associated with Hypercholesterolemia > Hypertriglyceridemia

A

Tuberous

112
Q

Type of xanthoma:
Usually Achilles tendon or hands, knees, elbows
Associated with Familial Hypercholesterolemia

A

Tendinous

113
Q

Type of xanthoma:
Flat deposits on palms and flexural folds
Dysbetalipoproteinemia
Familial Hypercholesterolemia

A

Planar

114
Q

Type of xanthoma:
Eyelids
>50% have normal lipids, more predictive if young

A

Xanthelasma

115
Q

Xanthoma on the eyelids

A

Xanthelasma

116
Q

Dermal infiltration with foamy macrophages is the morphological finding of this non-pigmented lesion

A

Xanthomas

117
Q

What layer of skin is infiltrated in a xanthoma?

A

Dermis

118
Q

Dermal infiltration of this type of cell is seen in Xanthomas

A

Foamy macrophages

Skin & MSK (8 decks)

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