Eyelids

Question 1

acanthosis

Answer 1

hyperplasia of the stratum malpighii (s. basale, s. spinosum, s. granulosum)

Question 2

hyperkeratosis

Answer 2

increased thickness of stratum corneum

Question 3

parakeratosis

Answer 3

retention of nuclei in stratum corneum with correspoding absence of s. granulosum

Question 4

papillomatosis

Answer 4

formation of fingerlike upward projections of epidermis lining fibrovascular cores

Question 5

dyskeratosis

Answer 5

premature individual cell keratinization within the stratum malpighii

Question 6

acantholysis

Answer 6

loss of cohesion between adjacent epithelial cells

Question 7

spongiosis

Answer 7

widening of intercellular spaces between cells in the stratum malpighii due to edema

Question 8

Normal eyelid skin histology?

Answer 8

keratinized stratified squamous epithelium, APCs (melanocytes and Langerhans cells). Dermis with cilia and associated sebaceous glands of Zeis, apocrine sweat glands of Moll, eccrine sweat glands, and pilosebaceous units

Question 9

Two types and the locations of accessory lacrimal glands?

Answer 9

Wolfring (superior tarsus) and Krause (fornices)

Question 10

layers of eyelid at level of tarsus?

Answer 10

epidermis, dermis, orbicularis, tarsus, palpebral conjunctiva

Question 11

Distichiasis

Answer 11

aberrant formation of cilia arriving from meibomian gland.

Question 12

Zimmerman’s tumor

Answer 12

phakomatous choristoma; aberrant location of lens epithelium in inferonasal eyelid

Question 13

Hordeolum

Answer 13

primary, acute, self-limited inflammation of glands of Zeis or less often meibomian glands

Question 14

Histologic characteristics of papilloma?

Answer 14

hyperkeratosis, acanthosis, papillary growth patterns, koilocytosis, mixed inflammatory infiltrate in dermis

Question 15

Dome-shaped, waxy epidermal nodule with central umbilication and follicular conjunctivitis? Histology of lesion?

Answer 15

Molluscum conatgiosum; nodular proliferation of infected epithelium with central necrosis. Large viral inclusions displace nuclei peripherally

Question 16

Histology of chalazion?

Answer 16

lipogranulomatous inflammation of meibomian gland (or less likely gland of Zeis)

Question 17

Soft yellow plaques near medial canthus? Systemic correlations?

Answer 17

xanthelasma; hyperliporpoteinemia

Question 18

Difference between epidermal and dermal inclusion cyst?

Answer 18

Both are keratin-filled cysts lined with stratified squamous epithelium. Dermal cysts include adnexal structures (hair follicles and sebaceous glands), and their lumens also contain hair and sebum

Question 19

Histology of apocrine hidrocystoma?

Answer 19

Cyst lined by double layer of cuboidal epithelium. Epithelial cells demonstrate decapitation secretion

Question 20

histology of stuck-on, brown, dome-shaped lesion?

Answer 20

(seborrheic keratosis) hyperkeratosis, acanthosis, papillomatous growth, concentric collections of surface keratin (pseudohorn cysts)

Question 21

sudden onset of multiple seborrheic keratosis?

Answer 21

Leser-Trelat sign, which is a harbinger of malignancy (usually GI adenocarcinoma)

Question 22

Diagnosis and histology of rapidly growing, dome-shaped nodule with central keratin-filled crater

Answer 22

keratoacanthoma. well-differentiated squamous cells arranged in nests and strands, with possible mitotic activity or nuclear atypia

Question 23

Diagnosis and histology of erythematous, scaly macule or papule in sun-exposed area?

Answer 23

actinic keratosis. hyperkeratosis and parakeratosis with underlying solar elastosis and chronic inflammatory infiltrate. possibly with dyskeratosis or mitotic figures

Question 24

most common malignant neoplasm of eyelid?

Answer 24

BCC (90% of all eyelid malignancies)

Question 25

Dx and histology of pearly nodule with central umbilication on lower eyelid?

Answer 25

nodulr variant of BCC. cohesive islands of abnormal basal cells with nuclear pallisading of the peripheral cell layer

Question 26

abnormal epithelial cells in nests invading into dermis and inciting a fibrotic tissue variant

Answer 26

SCC

Question 27

thin cords and strands of basaloid tumor cells in a fibrotic dermis

Answer 27

morpheaform (sclerosing) BCC

Question 28

% of regional lymph node metastasis in SCC?

Answer 28

20%

Question 29

histology of capillary hemangioma

Answer 29

unencapsulated proliferation of endothelial cells with vascular lumen formation

Question 30

Diagnosis, clinical appearance, and origin of multiple comma-shaped or round ductules lined with a double layer of epithelium with central lumen, often with secretory material

Answer 30

Syringoma. Multiple tiny papules on lower eyelid. Malformation of eccrine sweat glands

Question 31

most common location of sebaceous carcinoma

Answer 31

upper eyelid (more meibomian glands)

Question 32

Diagnosis and systemic correlation of yellow circumscribed eyelid nodule with pathology showing multiple sebaceous lobules irregularly shaped and incompletely differentiated?

Answer 32

sebaceous adenoma. Muir-Torre syndrome

Question 33

How should a clinician prepare a suspected sebaceous carcinoma biopsy for the pathologist?

Answer 33

make sure to include frozen sections so that lipid staining can be performed with Sudan black or oil red O

Question 34

chronic unilateral blepharitis with madarosis

Answer 34

sebaceous carcinoma

Question 35

most common type of melanoma occurring on the eyelids>

Answer 35

lentigo maligna