DERMPATH KODACHROMES Flashcards
Cornoid lamellae
Porokeratosis
CORPS RONDS / GRAINS / DYSKERATOSIS
Darier’s Disease
FESTOONING
-Papillary dermis retains an undulating pattern
Seen in Porphyria Cutanea Tarda
Flame Figures
- formed by degranulated eosinophils surrounding altered collagen
seen in Well’s syndrome, other eosinophil predominant dermatitis
Flame Figures
- formed by degranulated eosinophils surrounding altered collagen
seen in Well’s syndrome, other eosinophil predominant dermatitis
Flame Figures
- formed by degranulated eosinophils surrounding altered collagen
seen in Well’s syndrome, other eosinophil predominant dermatitis
Eccrine Glands
“-Donut-shaped” tubules -made of one layer of clear and dark cells and an outer thin layer of myoepithelial cells
Sebaceous Glands
-Several lobules of sebocytes (pale cells with vacuolated fenestrated cytoplasm which contains lipids and stellate central nuclei)
Apocrine Glands
Clue: Look for decapitation secretion (detachment of the apical portion of the secretory cells into the lumina) as a clue to apocrine differentiation.
Langhans Giant Cells
Foreign Body Giant cell
Touton Giant cell
Kamino Body
Seen in Spitz Nevus
identify the cells
Langerhans Cells
Smooth Muscle
OTHER NOTES:
- squamous eddies- Circular whorls composed of eosinophilic, flattened squamous cells arranged in an onion-peel fashion (irritated seb ker); irritated seborrheic keratosis (inverted follicular keratosis)
- horn/keratin pearl- Trapped keratin within cystic nests; dense/parakeratin (not loose flaky keratin) and 2. Located in dermis (not epidermis); (eosinophilic parakeratotic keratinization); well or moderately differentiated; WITH DENSE PINK KERATIN; IN THE MIDDLE OF ISLANDS OF ATYPICAL KERATINOCYTES; A LOT OF NUCLEI; IN THE DERMIS; YUNG KERATIN PARANG NATTRAP INSIDE THE NEST OF TUMOR; ENTRAPPED PARAKERATOSIS - horn cyst - foci of orthokeratosis within the substance of the lesion, loose keratin; In the EPIDERMIS; representfoci of abrupt complete keratinization(with only a very thin surrounding granular cell layer and without retained nuclei); Seb ker; NASA EPIDERMIS TAPOS LOOSE YUNG KERATIN; ORTHOKERATIN (WALANG NUCLEI) - pseudohorn cyst - Keratin-filled cystic structure that is the result of cutting through invaginations of the stratum corneum; with connection on the surface; in the epidermis; seb ker; OPEN UP TO THE SURFACE
Identify the site
SCALP
-Numerous follicles that extend down into the panniculus
-Associated sebaceous glands, arrector pili muscles
Identify the site
FACE
-Thin epidermis
-Hair follicles and sebaceous glands numerous in the dermis
-Eyelid and ear: vellus hair
-Upper dermis of eyelid: skeletal muscle
Meissner Corpuscle
Pacinian Corpuscle
SPONGIFORM PUSTULE OF KOGOJ
Neutrophils in the stratum spinosum, associated with spongiosis at periphery
SQUAMOUS EDDIES
- Circular whorls composed of eosinophilic, flattened squamous cells arranged in an onion-peel fashion
- Concentric whorls of squamous cells, with gradual keratinization towards the center
- seen in irritated seb ker, SCC, keratoacanthoma
OTHER NOTES:
- squamous eddies- Circular whorls composed of eosinophilic, flattened squamous cells arranged in an onion-peel fashion (irritated seb ker); irritated seborrheic keratosis (inverted follicular keratosis)
- horn/keratin pearl- Trapped keratin within cystic nests; dense/parakeratin (not loose flaky keratin) and 2. Located in dermis (not epidermis); (eosinophilic parakeratotic keratinization); well or moderately differentiated; WITH DENSE PINK KERATIN; IN THE MIDDLE OF ISLANDS OF ATYPICAL KERATINOCYTES; A LOT OF NUCLEI; IN THE DERMIS; YUNG KERATIN PARANG NATTRAP INSIDE THE NEST OF TUMOR; ENTRAPPED PARAKERATOSIS - horn cyst - foci of orthokeratosis within the substance of the lesion, loose keratin; In the EPIDERMIS; representfoci of abrupt complete keratinization(with only a very thin surrounding granular cell layer and without retained nuclei); Seb ker; NASA EPIDERMIS TAPOS LOOSE YUNG KERATIN; ORTHOKERATIN (WALANG NUCLEI) - pseudohorn cyst - Keratin-filled cystic structure that is the result of cutting through invaginations of the stratum corneum; with connection on the surface; in the epidermis; seb ker; OPEN UP TO THE SURFACE
Pityriasis Rubra Pilaris
- alternating ortho and parakeratosis in both vertical and horizontal directions
Pityriasis Rosea
- extravasated erythrocytes in the papillary dermis
- MOUNDS of parakeratosis
Seborrheic Dermatitis
- “shoulder parakeratosis”
- regular acanthosis and elongation of the rete ridges
- mild spongiosis sparse
- mononuclear cell infoltrate
What do you call this sign? What condition is this seen
Hair Palm Sign: folliculosebaceous units seen with a thick compact cornified layer (resembles a biopsy taken from the volar skin)
LICHEN SIMPLEX CHRONICUS
Nutritional deficiency dermatitis
SMALL PLAQUE PARAPSORIASIS
- elongated parakeratosis above a basket-weave cornified layer
- scant spongiosis, slight acanthosis
HAILEY HAILEY DISEASE
DARIER DISEASE
Dermatitis herpetiformis
- subepidermal vesiculation
- accumulation of neutrophils at the tips of dermal papillae
- slight fibrin deposition
ERYTHEMA ANNULARE CENTRIFUGUM
- FOCAL PARAKERATOSIS
- TIGHTLY CUFFED LYMPHOHISTIOCYTIC INFILTRATES INFILTRATES
Inflammatory linear verrucous epidermal nevus (ILVEN)
- HORIZONTAL
- SLIGHTLY RAISED PARAKERATOTIC AREA
- PSORIASIFORM
POROKERATOSIS
* CORNOID LAMELLA
⚬ COLUMN OF COMPACT PARAKERATOSIS ON AN AREA OF DEPRESSION OF EPIDERMIS WITH (-) GRANULAR LAYER
⚬ DYSKERATOTIC CELLS
VERRUCA
* SPIRES OF PARAKERATOSIS
- OVER THE TIPS OF THE PAPILLARY PROJECTIONS
- ALTERNATE WITH ORTHOKERATOSIS
- OVERLY HYPERGRANULOTIC VALLEYS OF THE EPIDERMIS
LICHEN PLANUS
* COMPACT ORTHOKERATOSIS
* WEDGE-SHAPED HYPERGRANULOSIS
* BAND-LIKE DERMAL LYMPHOCYTIC INFILTRATE
LICHEN PLANUS
* CIVATTE BODIES
⚬ NECROTIC KERATINOCYTES IN THE LOWER EPIDERMIS
⚬ HOMOGENOUS, EOSINOPHILIC
Pityriasis lichenoides et varioliformis acuta (PLEVA)
- CONFLUENT PARAKERATOSIS
- LICHENOID WITH SUPERFICIAL. AND DEEP PERIVASCULAR LYMPHOCYTIC INFILTRATES
VITILIGO
What do you call this sign? What condition is this seen
Dermatophytosis
* COMPACT ORTHOKERATOSIS
* SANDWICH SIGN: HYPHAE SANDWICHED BETWEEN 2 ZONES OF CORNIFIED CELLS
* NEUTROPHILS IN THE SC
PITYRIASIS VERSICOLOR
* MALASSEZIA FUNGAL FORMS LOCATED IN THE SC
* “ SPAGHETTI/ZITI AND MEATBALLS”
SCABIES
- SCALE-CRUST WITH NEUTROPHILS
- MILDLY HYPERPLASTIC EPIDERMIS
- PATCHY LYMPHOID INFILTRATE
- PIGTAILS
⚬ CURLED PINK STRUCTURES
⚬ REMNANTS OF EGGS OR CASINGS LEFT BEHIND AFTER HATCHING
SCABIES
* ADULT FEMALE MITE
TOXIC EPIDERMAL NECROLYSIS
- NORMAL STRATUM CORNEUM
- NECROTIC KERATINOCYTES AT ALL LEVELS OF THE EPIDERMIS
- BLISTER ROOF- DUE TO CONFLUENCE
- INTERFACE DERMATITIS
Diagnosis?
Pattern?
POLYARTERITIS NODOSA
SEPTAL PANNICULITIS WITH VASCULITIS
- Neutrophilic LCV involving medium arteries of the subcutaneous septa
- Neutrophils, leukocytoclastic nuclear dust, extravasated erythrocytes, and fibrin aggregate within and around the affected artery.
ERYTHEMA NODOSUM
IDENTIFY. WHAT CONDITION IS THIS SEEN?
MIESCHER RADIAL GRANULOMA: Collection of nonenlarged histiocytes forming a central radial or slitlike extracellular cleft
ERYTHEMA NODOSUM
NECROBIOSIS LIPOIDICA
RHEUMATOID NODULE
A. Pattern?
B. Diagnosis
C. Give 2 differentials
A. Lobular panniculitis
B. SC fat necrosis of the newborn
C. sclerema neonoatrum, poststeroid pannicuitis
GRANULOMA ANNULARE
* Zone of degenerated collagen and mucin is surrounded by a rim of palisading histiocytes
* Multinucleated histiocytes often present, but usually subtle
* Eosinophils in half of the cases
GRANULOMA ANNULARE
* Zone of degenerated collagen and mucin is surrounded by a rim of palisading histiocytes
- Multinucleated histiocytes often present, but usually subtle
- Eosinophils in half of the cases
NECROBIOSIS LIPOIDICA
- Entire thickness of the dermis (or lower 2/3)
- Horizontal, acellular, pale, degenerated collagen between layers of granuloma -likened to TIERED CAKE
- Rectangular punch due to sclerosis
RHEUMATOID NODULE
* Several areas of fibrinoid degeneration of collagen -> homogenously red
- Mucin is always minimal or absent
- Foreign-body giant cells - 50% of biopsies
NECROBIOTIC XANTHOGRANULOMA
- X-shaped red zones of necrosis within granulomatous nodule (X-shaped necrosis in NXG)
- Characteristic finding: lymphoid follicles or aggregates
- Cholesterol clefts are common
GOUT
* Palisaded granuloma surrounding amorphous, gray blue material with feathery appearance
- Granuloma- infiltrate with many foreign-body giant cells
ASTEROID BODY
Eosinophilic, star-burst inclusion within a giant cell
Sarcoidosis
SCHAUMANN BODY
Cytoplasmic, laminated calcifications
Sarcoidosis
JUVENILE XANTHOGRANULOMA
Identify the cells
LANGERHANS CELL
A. LOCATION?
B. DIAGNOSIS?
EYELID, PERIORBITAL AREA
XANTHELASMA
- Characterized by foamy cells (macrophages that have engulfed lipid droplets)
LICHEN PLANUS
PROTOTYPE OF LICHENOID INTERFACE DERMATITIS
COLLOID, CYTOID, OR CIVATTE BODIES
LICHEN PLANUS
MAX JOSEPH SPACE: DUE TO EXTENSIVE DAMAGE TO BASAL CELLS
LICHEN PLANUS
PAUTRIER MICROABSCESS: PROMINENT CLUSTERS OF ATYPICAL LYMPHOCYTES WITHIN THE EPIDERMIS
- EPIDERMOTROPISM OF LARGE, ATYPICAL LYMPHOCYTES WITH LITTLE SPONGIOSIS
- LYMPHOCYTES HYPERCHROMATIC AND SURROUNDED BY WHITE SPACE (LUMP OF COAL ON A PILLOW)
- LYMPHOCYTES TEND TO LINE UP ALONG THE DEJ
MYCOSIS FUNGOIDES
Identify the pointed structure. What sign is this
BARE UNDERBELLY SIGN: TENDENCY FOR THE SUPERFICIAL PERIVASCULAR LYMPHOID INFILTRATE TO PREDOMINATE ABOVE THE VESSEL
MYCOSIS FUNGOIDES
Pityriasis lichenoides et varioliformis acuta (PLEVA)
- COMPACT STRATUM CORNEUM WITH OR WITHOUT ULCERATION
- DENSE BANDLIKE LYMPHOCYTIC INFILTRATE
- EXTENDS INTO THE RETICULAR DERMIS IN A WEDGE-SHAPED PATTERN
ERYTHEMA MULTIFORME: PROTOTYPE OF VACUOLAR INTERFACE DERMATITIS
- KERATINOCYTE NECROSIS WITHIN AND ABOVE BASAL LAYER
SJS/ TEN
- FULL-THICKNESS NECROSIS
- FOLLICULAR INVOLVEMENT- BASAL LAYER DEGENERATION
FIXED DRUG ERUPTION
- HYDROPIC DEGENERATION OF THE BASAL LAYER LEADS TO PIGMENTARY INCONTINENCE
fixed drug eruption
A. PREDOMINANT CELL IN FULLY DEVELOPED LESION?
B. DIAGNOSIS?
HISTIOCYTE
LICHEN NITIDUS
DIAGNOSIS?
ETIOLOGY?
A. ERYTHEMA MULTIFORME
B.HSV, MYCOPLASMA
PLASMA CELL
WARTHIN STARRY, STEINER
SYPHILIS
WHAT TYPE OF GRANULOMA
TUBERCULOID GRANULOMA
LICHEN SCLEROSUS ET ATROPHICUS
a) hyperkeratosis
b) atrophy of the s malpighii
c) edema & homogenization of collagen in the upper dermis
d) inflammatory infiltrate in the mid-dermis
ELASTOSIS PERFORANS SERPIGINOSA
- Channel
⚬ Coarse elastic fibers
⚬ Granular basophilic debris
REACTIVE PERFORATING COLLAGENOSIS
- Channel lined by acanthotic epithelium
- Base- attenuated layer of keratinocytes
- Vertically oriented collagen
SCAR
- Vertically-aligned vessels
- East to west orientation of fibroblasts
- Parallel bundles of cellular collagen
KELOID
* Hypocellular zones of thickened glassy collagen bundles in haphazard array, in contrast to normal collagen
OCHRONOSIS
- Free pigment in the tissue, endothelial cells, basement membrane, secretory cells of the sweat glands, within macrophages
- OCHRONOTIC PIGMENT WITHIN COLLAGEN BUNDLES ⚬ fractured, pointed ends
A. Diagnosis?
B. Close differential
A. Keloid
B. Hypertrophic scar
A. Diagnosis?
B. Stain?
A. Elastosis perforans serpiginosa (EPS)
B. Verhoeff Van Gieson
A. Morphea
B. Eccrine trapping
Donovan Body
Intracytoplasmic collections of bacteria seen in granuloma inguinale
Angiolipoma
A, Narrow and dilated, thin-walled capillaries are admixed with mature adipocytic tissue.
B, The adipocytic component can predominate.
- diagnosis?
- this is a benign neoplasm of what tissue?
- common site affected
- stain that will highlight tumor cells
- Hibernoma
- Brown fat
- thigh
- S100 and uncoupling protein
- Typical hibernomas are composed of large, polygonal, brown fat cells with multivacuolation, granular cytoplasm, and a small, centrally located nucleus admixed with mature white fat cells
- Immunohistochemically, tumor cells stain positively for S-100 protein and for **uncoupling protein, **a protein unique to brown adipocyte mitochondria
congenital nevomelanocytic nevus
compound nevus
junctional nevus
intradermal nevus
- diagnosis
- mutation present
- variant with elevated risk for development of melanoma
- related lesions
- areas of predilection
- positive stains
- blue nevus
- GNAQ/GNA11
- cellular blue nevus
- nevus of Ota/Ito, Mongolian spot, dermal dendritic hamartoma
- dorsal hands and feet, scalp, and buttocks or sacral skin
- S100, Mart-1, HMB-45
- All types of blue nevus have components that include some of the following: **deeply pigmented dendritic melanocytes, spindled and less pigmented melanocytes, oval melanocytes, melanophages, and fibrotic stroma **
- Nevus cells may show perivascular or periadnexal accentuation.
- Almost all blue nevi lack a junctional component.
- diagnosis
- identify the eosinophilic globules
- age group where this is commonly seen
- associated mutation
- spitz nevus
- kamino bodies
- children
- HRAS
- Spitz nevi are characterized by melanocytic cells with large epithelioid nuclei, often with prominent nucleoli and surrounded by a rim of eosinophilic cytoplasm with “ground-glass” appearance
- Small intraepidermal eosinophilic globules (Kamino bodies), which are positive for periodic acid–Schiff and diastase resistant (resembling colloid bodies), may be seen.
Dysplastic nevus.
A, Compound dysplastic nevus with architecturally disordered junctional nests extending well beyond the dermal component (100× magnification).
B, Junctional melanocytic nests are situated along the tips and sides of rete and display random cytologic atypia. There is underlying papillary dermal fibroplasia, lymphocytic infiltrate, and pigment incontinence (200× magnification).
Dysplastic nevus
Dysplastic nevus
Lamellar fibroplasia and bridging of the melanocytic nests. Upward migration of the nevomelanocytes is present.
foam cells seen in xanthoma
etiologic agent?
Histoplasma capsulatum
etiologic agent?
Histoplasma capsulatum
The fungus can be found in KOH mounts of pus, skin scrapings, or sputum as thick-walled, rounded, refractile, spherical cells with** broad-based buds**
What is the diagnosis?
Blastomycosis
- Diagnosis
- Causative agent
- Paracoccidioidomycosis
- Paracoccidioides brasiliensis
**spore-containing spherules **can be seen in what condition?
Coccidioidomycosis
mycosis fungoides
**Patch stage of mycosis fungoides. **
A, Single atypical mononuclear cells in epidermis with sparse superficial perivascular infiltrate in the papillary dermis. (Hematoxylin and eosin-stained section.)
B, High-power view of atypical cells in epidermis of same section.
Indeterminate leprosy histopathology.
Up to 70% of the indeterminate cases may have an unspecific histopathology. In 30% it is possible to observe a perineural infiltrate with nerve delamination (A and B, arrows), as demonstrated here, and if extensively searched, sometimes it is possible to find an acid-fast bacilli (C, arrow).
Tuberculoid leprosy histopathology.
Presence of deep and superficial well-developed granuloma, that touch the epidermis (A), associated with lymphocyte infiltration surrounding or invading and destroying skin appendages, like nerves, erector pili muscle (B), or sweat gland (C).
**Borderline-tuberculoid leprosy **histopathology.
Deep and superficial tuberculoid granuloma (A) that does not touch the epidermis (B). The tuberculoid granuloma may be seen invading the nerves (C), and acid-fast bacilli can be found (D, 100×).
Borderline-borderline leprosy histopathology.
Deep and superficial tuberculoid granuloma that does not touch the epidermis, starting to form a grenz zone (A). Inflammatory cells are invading cutaneous annexes and nerves, that are degenerated (B), and acid-fast bacilli can be found more easily, some forming globi (C).
Borderline-lepromatous leprosy histopathology.
There is a mixed macrophage lymphocytic inflammatory infiltrate (macrophage granuloma) on superficial and deep dermis (A). The mixed infiltrate does not touch the epidermis and may be seen surrounding or invading nerve bundles (B). A large number of acid-fast bacilli is seen (C).
