Dermopathology CIS - Nicolina Flashcards
Older man who works as a farmer presents with an erythematous macule smaller than 1cm. Biopsy reveals marked parakeratosis, orthokeratosis, cell atypia seen with mild lymphocytic infiltration. What is this and what malignant skin cancer could it progress to?
Actinic Keratosis if atypia seen in epidermis –COT–> SCCa if atypia seen in epidermis and dermis
keratin pearl is characteristic for…
SCCa
risk factors for SCCa
UV-B, albinism, IMMUNOSUPPRESSIVE THERAPY, arsenic…….
10 month old female presents with terrible blisters after playing in sun. Erythematous tender skin all over face and dorsum of hands. ……. AR disease dx. What DNA repair mechanism missing in this patient?
NUCLEOTIDE EXCISION REPAIR is missing
baby has AR xeroderma pigmentosum
19 year old male presents with a bumpy mark on his nose. Mom has hx of BCCa
PMH: @3yo dx with medulloblastoma and successfully tx
PE: elevated nodule with central ulceration and telangectasia found on nose. palms had 1cm sharply marginated, depressed regions.
-This is _____ syndrome.
-Protein mutated in this dz is ____ and activated by ____ ligand?
Syndrome: nevoid basal cell carcinoma syndrome
Mutated Protein: Sonic hedgehog
Ligand that activates the mutated PTCH.
HA, unsteady gait, vomiting, dizziness in 4yo - What cancer that can lead to BCCa?
medulloblastoma
PTCH allele mutated in __.
nevoid basal cell carcinoma syndrome
The following are risk factors for ____: basal cell carcinoma, family hx of BCCa, or hx of medullary blastoma, ovarian fibroma, or odontogenic keratocysts (epithelium-producing cyst in mandible)
nevoid basal cell carcinoma syndrome
#1 type of skin cancer Prognosis \_\_\_\_
BCCa
Good prognosis
**Peripheral Palisading cells are characteristic for…
Basal Cell Carcinoma
79 year old male with numerous “waxy looking dark spots”. Round, flat, coin like. Raised lesion common on trunk, head, neck.
**Pathology report: Pseudocysts filled with keratin (aka horn cells) and proliferation of squamous cells.
This is ____.
Prognosis is ____.
Seborrheic Keratoses
They are normal in elderly population. If sudden onset in a younger person, worry about possibly malignancy.
Mutated FGFR3 mutation.
Seborrheic Keratoses, achondroplasia, acanthosis nigricans
Characteristic: *hyperplasia with hyperkeratosis, repeating peaks and valleys
acanthosis nigricans
14 year old male with acne vulgaris. Has many comedones, pustules, and nodules.
What is the stain and morphology of the microbe (____) that causes acne pustules?
Gram (+) rod - Propionibacterium acens can infect hair shaft and use sebum as fuel.
32 year old IV drug user with itchy wrists with purple spots. Hep C dx month ago.
PE shows many planar, polygonal purple papules.
What pathology is top of DDx?
lichen planus
“the P’s” pruritic, planar, polygonal purple papules.
white lines on surface of wrists, elbows, and oral mucosa - this is called ___ and assoc with ___
Wickham striae, associated with lichen planus.
- Saw-tooth rete ridges
- Lymphocytes lining dermoepidermal junction.
- destroyed BM
Lichen planus
5 year old with erythematous, pruritic, red, oozing rash on face. Recently dx with asthma and allergic rhinitis.
What hypersensitivity reaction is this and what ytokine is elevated in this patient?
Type 1 HSR: IL-4
**Bullous Pemphigoid and Guilliane Barre Disease are Type__ HSR
2
Sensitized ab to an area (i.e. blood type, skin, etc) and either compliment destroys the area or phagocytosis occurs.
Multiple Sclerosis and poision ivy are Type__ HSR
4
Lupus is Type__ HSR
3
1st sensitization: hapten binds to carrying molecuel –>DC picks up and places on MHC2 cell –> Th1
2nd sensitization - IFN-2 secretion and MQ and IL2 secretion=CD8
type 4
IL-4, causing B-cell proliferation and IgE.
type 1 (dt cigarette smoke, etc)
25 year old with hard scaly pin k spots on elbow and scalp, peel and scale turn red.
PE: circumscribed salmon.
Gene linked to pathology?
Psoriasis
HLA-C (homozygous)
HLA-B27 =
psoriatic arthritis = Joint pain + Psorias
excessive proliferation of keratinocytes, hyperkaratosis, elongated dermal papillae, **Monroe microabscesses
psoriasis
collection of neutrophils within stratum corneum
Monroe microabscesses
Autoantibodies against ___ in a pt with bullous pemphigoid.
basement membrane
IgG antibodies against desmoglein 1 and 3. Blistering ulceration and oral mucosal. +Nikolsky sign
Pemphigus Vulgaris
Sensitized ab to an area (i.e. blood type, skin, etc) and either compliment destroys the area or phagocytosis occurs.
type 2
- type 4 HSR. Caused by **infection (i.e. HSV), drugs, cancer. Self limiting.
- Target lesion with multiple rings - CD8+ cells on inside, CD4+ and largerhan cells on periphery
erythema multiforme
FEVER, high mortality rate, usually adverse drug reaction,
Stevens-Johnson Syndrome
FEVER, high mortality rate, usually adverse drug reaction, >30% of body surface area.
Toxic Epidermal Necrolysis (TEN)
bullae, necrosis, sloughing skin, some targetoid may appear, SUPER SICK
SJS/TEN
PALMAR and SOLE rash.
- Rocky mountain spotted fever - Rickettsia rickettsia
- Hand foot mouth dz - coxsackie (ssRNA)
- Secondary syphilis
20 year old started to tan and noticed areas of decreased pigmentation. Malassezia furfur that looks like spaghetti and meatballs on microscopy.
Dx is___
Tinia versicolor (yeast)
Malessezia produces acids that degrades lipids and damage melanocytes
Black mole around anus in a 30 year old female. Has external hemorrhoids.
PE: 2.5mm lesion with irregular borders and different color within lesion.
Excisional biosy: taken with CLEAR margins. Pathology report indicates many melanocytes infiltrating the epidermis. The borders were of normal findings.
What is this___ and greatest prognostic factor is___.
Melanoma. Poor prognosis.
***Breslow depth (thickness) -
Why is breslow depth so important in melanoma? Where does it met?
Once in dermis, it has access to capillaries –> MET to lung, liver, brain
Importance of clear margins in melanoma.
Non clear margins = can still met even if biopsy!
What is SCCa insitu?
actinic keratosis
