Final - Dermatopathology Flashcards
Vesicle/Bulla
- Definition
- Causes
- Pathological Processes
- Changes that can lead to Vesicle/Bulla
- Typical Locations
- Palpable elevation filled with clear fluid
– Vesicle < 1cm
– Bulla > 1cm
- Causes
– Auto-immune dermatoses
– Viral infections
– Chemical irritants
– Burns
- Degeneration/Necrosis
Inflammation & Repair
4. Changes Intracellular Edema (spongiosis/Hydropic Degeneration) Disruption of intercellular Junctions (Acantholysis)
- All layers (Subcorneal, suprabasal, subepidermal)
Pustule
- Definition
- Cause
- Pathological Processes
- Palpable elevation filled with pus
- Cause – leukocyte infiltrate
- Inflammation & Repair
Crusts
- Definition
- Causes
- Pathological Process
- Dried exudate, serum, blood, and scale that is adhered to the skin surface
- Causes
– Severe disorders of keratinization
– Severe pustular dermatitis
– Secondary to ulcers - Degeneration/Necrosis
Inflammation/Repair
Disorders of Growth
What is the MDx for Inflammation & Repair?
What are some ways to differentiate it?
______ dermatitis.
Tips for differentiating
- Look for ‘cardinal signs of inflammation’ – erythema, edema, exudate, heat, pain; + itching!
- If there are pustules/crust, there is an inflammatory component to the lesion
- Depigmentation – immune mediated inflammatory lesions
- If inflammatory infiltrate is severe enough, will see papules, plaques,nodules, but disorders of growth (neoplasia) can also result in these changes
Describe the gross features of Dermatitis.
Early
– Edema
– Erythema
– +/- pustules, crust, vesicles
Later
– Scaling
– Change in oiliness
– Ulceration
– Alopecia
– Lichenification
– Pigmentary change
– Fibrosis/scarring
What are the modifiers related to dermatitis and what do they indicate?
KNOW THIS
– Suppurative/Pustular/Exudative/Neutrophilic –bacterial, auto-immunity
– Proliferative – viral
– Vesicular – viral, auto-immunity
– Granulomatous – ‘higher’ bacteria, mycobacteria, fungal, foreign substance
– Eosinophilic – allergy, parasitic
– Interface – auto-immunity
What kind of lesion is this?
What pathological process is it?
Dog with superficial spreading pyoderma, a superficial pyoderma with bacterial folliculitis
Inflammation and repair
Pyoderma
What are the types of pyoderma?
Clinical term encompassing several diseases; “pus in the skin” – usually bacterial infection involved
Types:
-
Superficial – epidermis and hair follicles
– Disease examples
Canine superficial spreading pyoderma / Bacterial folliculitis
Impetigo (superficial pustular dermatitis)
Greasy pig disease
Dermatophilosis -
Deep – deep dermis
– Disease examples
• Bacterial furunculosis
• Abscesses
How do bacterial infections of the skin occur?
Portals for:
Pores (follicular openings)
Hematogenous spread
Direct entry through damaged skin
Predisposing factors for:
Allergy
Disorders of keratinization (seborrhea)
Immunodeficiency
Anatomic predisposition
Common in dogs:
Thin stratum corneum, lack of lipid seal of hair follicles, high skin pH
Bacterial infections often involve _____.
Staphylococcus spp.
TRUE/FALSE.
One way that bacteria cause skin infections is through the production of exfoliative toxins that cause intraepidermal splitting.
TRUE
This puppy is presented to you. Give:
- Disease Name
- MDx
- Cause
- Consequence/CS
- Impetigo
- Pustular Dermatitis, a type of superficial pyoderma.
- Bacterial infection secondary to immunosuppression/debilitation
- Nonfollicular pustules, which develop into crusts.
Prepuscent puppies are otherwise healthy
Adults - Look for underlying disease.
What’s going on with this puppy? Give:
- Disease Name
- MDx
- Pathogenesis
- What types of cells will you find?
- Intertrigo/Skin Fold pyoderma
- Neutrophilic dermatitis
- Closely apposed skin surfaces –> frictional trauma –> moisture –> opportunistic bacterial infections
- Neutrophils
What is going on with this dog? Give
- Disease Name
- MDx/Gross lesions
- Pathogenesis
- Pyotraumatic Dermatitis (“Hot Spots”) - Very common in dogs
- MDx: ulcerative/exudative dermatitis.
Gross: Moist, alopecic, slightly raised, red well-circumscribed lesions –> ulceration/crusting - Pathogenesis:
– Self trauma –> bacterial infection
– Underlying pruritis – especially flea allergy dermatitis!
What can you tell me that’s going on in this disease? Give:
- Disease Name
- MDx/Gross lesions
- Cause
- Predisposing factors/Consequences
- Greasy Pig Disease (Exudative Epidermitis)
- MDx: pustular to exudative dermatitis.
Gross: erythema –> pustules –> crusts - Caused by Staphylococcus hyicus
- Predisposing factors – other skin lesions, poor nutrition/husbandry, lacerations
- Fatal in neonatal pigs
Ew. Give:
- Disease Name
- MDx/Gross Lesions
- Cause
- Pathogenesis
- Predisposing factors
- How would you diagnose this?
- Dermatophilosis aka rain rot
- MDx: Exudative dermatitis
Lesions on back or distal extremities - Caused by Dermatophilus congolensis – gram positive filamentous bacteria which subdivide longitudinally and transversely
- Stimulate neutrophilic exocytosis: pustules–>exudate –> matting of hair/wool –> alopecia
- Predisposing factors
– Wet weather in humid climates (“rain rot”) – prolonged wetting of skin/hair/wool allows penetration of epidermis by “zoospores” - Diagnosis in the crust (characteristic appearance of bacteria - tram track)
What is this?
What does it look like and how would you differentiate it?
This is dermatophilosis
It looks similar to squamous cell carcinoma due to repeated sun exposure. You know it’s not because of the distribution of the lesions.
What is this? Give:
- Disease Name
- MDx/Gross lesions
- DDx
- Diganostics
- Canine superficial spreading pyoderma - Usually secondary condition; Bacterial infection of superficial follicles and adjacent skin
- MDx: neutrophilic/exudative dermatitis/folliculitis.
Gross: scaling, erythematous macules (often circular –> ring shaped), papules, pustules, crusts, epidermal collarettes, alopecia - DDx: (Grossly indistinguishable)
– Dermatophytosis (‘ring worm’)
– Demodicosis -
Diagnostics:
– Cytology of pustule/crust • neutrophils with cocci
– Woods lamp
– Fungal culture
– Skin scraping
What is the difference between folliculitis and furunculosis?
Furunculosis is more severe.
What two conditions resemble Canine Superficial Spreading pyoderma?
What lesions do they have in common?
Demodicosis & Dermatophytosis
Both have Folliculitis; erythematous macules –> Alopecia/Scaling
This dog presents to your clnic. You perform a skin scraping, demonstrated in the histology. Give
- Disease Name
- Cause
- MDx
- How do the lesions vary?
- What are the two forms that can affect dogs?
- Demodicosis
- Cause: Demodex spp. mite
- Neutrophilic Dermatitis/folliculitis w/ intrafollicular mites and bacteria; Gross MDx of Dog: Multifocal exudative dermatitis
- Lesion vary by host/mite species
– Distribution on body
– Neutrophilic to granulomatous (exudative vs nodular grossly) - In dogs
–Localized form (face, forelegs) – young dogs, self-limiting
– Generalized form - Familial with young dogs
Adult-onset – often associated with systemic disease such as neoplasia, endocrinopathy, or immunosuppressive therapy
This animal presents to your clinic. What can you tell me?
- Dermatophytosis
- Cause: Epidermophyton, Microsporum, and Trichophyton spp. (keratinophilic fungi)
- Contagious – acquired by contact with scales shed from infected animals
- Colonize keratin, do not need to invade tissue to cause disease
- Self-limiting in healthy animals, can become chronic/generalized in immunocompromised animals
- Predisposing factors:
– Young or immunosuppressed – Hot/humid environments - Use GMS or Groscott (silver stains)
5 yo FS dog has acutely developed some nasty skin lesions…
How do we describe these changes?
What can we do to determine the pathological process and cause?
Final Diagnosis?
- MDx: Pustular/exudative dermatitis; Lesion = pustules, crusts
- There is leukocyte infiltrate of the epidermis. Pathlogical process is likely inflammatory
- Tests:
- Skin scraping: No mites or fungus seen
- Wood’s lamp: No fluorescence
- Fungal culture: No growth
- Cytology of a pustule: Eosinophils, Some bacteria, but not within cytoplasm of leukocytes, and not many neutrophils
- Eosinophilic pustular dermatitis with tintralesional acantholytic keratinocytes. Consisten with Pemphigus foliaceous
Pemphigus foliaceous
- “Pemphigus” – group of auto-immune diseases involving type II hypersensitivity against cell adhesion proteins (desmosomes)
- PF is the most common and milder form of pemphigus (reported in horses, dogs, cats and goats) – others are rare but covered in text
- Often involves face, ears, footpads, clawbeds
- Vesicles, pustules, crusts, ulcers
- Can be spontaneous, drug-induced, or associated with allergic skin disease
What is this?
Mdx: Proliferative dermatitis with “ballooning degeneration” & intracytoplasmic inclusion bodies
Comment: Consistent with swine-pox infection
Describe the lesions that occur with Pox Viruses
- Sequence of lesions: macule → papule → vesicle → umbilicated pustule → crust → scar
- Poxviruses have a gene whose product is similar to epidermal growth factor → epidermal hyperplasia
- Many cutaneous lesions only, some systemic and fatal
- Some are foreign animal diseases
- Umbilicated center is very characteristic of pox viruses
What do you know?
Lamb with contagious ecthyma, early papular to vesicular phase
MDx: papular/vesicular dermatitis/cheilitis.
Note the epidermal hyperplasia (acanthosis), ballooning degeneration, vesicle (V), and neutrophils accumulating in the vesicle, which subsequently results in the formation of a pustule. Epidermal hyperplasia, upward movement of the pustule, and rupture of the vesicle or pustule contribute to crust formation as seen in A. H&E stain.
What’s this?
Lambs with contagious ecthyma, late crusty phase
MDx: pustular/exudative dermatitis/cheilitis.
Seeing lameness, anorexia, ptyalism in some backyard livestock…
Lesions are seen in cattle, sheep and pigs.
- Something is injuring keratinocytes… The pathological process is likely degeneration&necrosis or inflammatory
- Differential Diagnoses?? Viruses!!
- Early herpesvirus
- Early poxvirus
Vesicular diseases – FMD, VSV, SVD, VES
- The only sure way to distinguish these diseases is by laboratory testing
- Producers and private practitioners, are the first line of defense against these economically devastating diseases.
- WHENEVER YOU SEE ULCERS – LOOK FOR VESICLES!
What is this?
Cat with ulcerative facial dermatitis due to FHV-1
MDx: pustular/vesicular dermatitis/cheilitis/rhinitis.
McGavins
What is this?
Cow with pseudo-lumpy skin disease, a vesiculo-ulcerative dermatitis due to BHV-2
What is this?
Cows with herpesviral mammilitis, vesiculo-ulcerative mammillitis also due to a strain of BHV-2
Multiple lesions in 4 y/o mixed breed. All tests that were done were inconclusive.
Granulomatous Dermatitis w/o Agents (“sterile”)
Idiopathic Sterile Granuloma and Pyogranuloma Syndrome
Give the Pathogenesis
- Rare
- Esp. dogs
- Pathogenesis – cause unknown
- – Caused by fastidious unrecognized organisms?
- – Abnormal immune response to unidentified microbial antigen?
- – Variant of histiocytic neoplasia?
- Diagnosis of exclusion