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Medical Derm Revision > Histo Characteristic Patterns > Flashcards

Histo Characteristic Patterns Flashcards

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USMLE® Step 1 flashcards Dermatology Board Prep flashcards
1
Q

Follicular plugging

A

Pityriasis rubra pilaris (PRP), lichen planopilaris (LPP), lichen sclerosus, lupus erythematosus (LE), perforating folliculitis

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2
Q

Cornoid lamella

A

Porokeratosis

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3
Q

Compact parakeratosis with retained KHG

A

Axillary granular parakeratosis

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4
Q

‘Checkerboard’ and ‘shoulder’ parakeratosis

A

PRP

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5
Q

Mounds of parakeratosis

A

Psoriasis

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6
Q

Focal parakeratosis

A

Guttate psoriasis, pityriasis rosea, pityriasis lichenoides

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7
Q

Confluent parakeratosis

A

Psoriasis, Bowen’s disease, necrolytic migratory erythema (NEM) in glucagonoma syndrome

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8
Q

Columns of parakeratosis

A

Verruca vulgaris (VV), porokeratosis

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9
Q

Alternating parakeratosis

A

Actinic keratosis (AK)

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10
Q

Sandwich parakeratosis

A

Tinea

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11
Q

Confluent hyperkeratosis

A

Lichen planus (LP)

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12
Q

Massive orthokeratosis

A

Acquired digital fibrokeratoma

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13
Q

‘Church spire’ papillomatosis

A

Acrokeratosis verruciformis

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14
Q

Papillomatosis

A

Acanthosis nigricans, VV, seborrheic keratosis (SK), acrochordon

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15
Q

Neutrophils in crust

A

Candidiasis, psoriasis, impetigo, tinea, syphilis

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16
Q

Munro microabscess in cornified layer

A

Psoriasis (plate-like neutrophils in multilayered scale)

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17
Q

‘Claw’ (epidermis) clutching a ‘ball’ (dermis)

A

Lichen nitidus

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18
Q

Epidermal necrosis

A

Herpes simplex (HSV) infection, toxic epidermal necrolysis, erythema multiforme (EM), NEM, hydroa vacciniforme, graft-versus-host disease (GVHD), acute fixed drug reaction (FDE)

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19
Q

Atrophic epidermis

A

Porokeratosis, atrophic AK, radiation dermatitis, lichen sclerosus, LE, dermatomyositis, poikiloderma, necrobiosis lipoidica, GVHD

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20
Q

Upper pallor with normal- appearing lower epidermis

A

NEM, +/- acrodermatitis enteropathica

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21
Q

Windblown appearance

A

Bowen’s disease

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22
Q

Subcorneal/intragranular split with acantholytic cells (cling on)

A

Pemphigus foliaceous (sometimes can look like impetigo if neutrophils within blister cavity)

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23
Q

Eosinophilic spongiosis (hAPPIE)

A

Arthropod bite, pemphigoid, pemphigus, incontinentia pigmenti (IP), eruption (drug), contact dermatitis

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24
Q

Foam cells in epidermis

A

Balloon cell nevus

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25
Q

Dyskeratotic or necrotic keratinocytes

A

EM, pityriasis lichenoides et varioliformis acuta (PLEVA), paraneoplastic pemphigus, acrodermatitis enteropathica, acute FDE, IP, NEM, GVHD, radiation dermatitis

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26
Q

Vacuolated keratinocytes (‘empty shells’)

A

Tissue processing artifact, freezing artifact, epidermolytic hyperkeratosis

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27
Q

Elongated keratinocytes

A

Electrodessication artifact

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28
Q

Acantholytic cells

A

Darier’s disease, Hailey-Hailey disease, HSV infection, transient acantholytic dermatosis (Grover’s disease), pemphigus (acantholysis involves hair follicles), warty dyskeratoma, acantholytic SCC or AK

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29
Q

Koilocytes

A

HPV infection

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30
Q

Multinucleated keratinocytes

A

HSV (steel gray nuclei)

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31
Q

Epidermotropic lymphocytes

A

Cutaneous T-cell lymphoma (CTCL)

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32
Q

Pagetoid cells

A

Bowen’s disease, melanoma, recurrent nevus, Paget’s disease, CTCL, lymphomatoid papulomatosis (LyP), Langerhans cell histiocytosis (LCH)

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33
Q

Dilapidated brick wall

A

Hailey-Hailey disease

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34
Q

Pautrier microabscesses

A

CTCL

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35
Q

Tombstoning of basal cells

A

Pemphigus vulgaris

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36
Q

Clumped keratohyaline granules (KHG)

A

Epidermolytic hyperkeratosis, verruca (HPV infection)

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37
Q

Squamous eddies

A

Irritated seborrheic keratosis (SK), inverted follicular keratosis (IFK), SCC, trichoblastoma

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38
Q

Horn pseudocysts

A

SK, IFK, trichoepithelioma, microcystic adnexal carcinoma

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39
Q

Basilar hyperpigmentation

A

Dermatofibroma, SK, acanthosis nigricans

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40
Q

Flattened (tabled) rete ridges

A

Dermatofibroma

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41
Q

‘Saw-toothed’ rete ridges

A

LP

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42
Q

Vacuolar interface change

A

LE, LP, GVHD, dermatomyositis, acute FDE, lichen nitidus, erythema dyschromicum perstans (ashy dermatosis), lichenoid keratosis, lichen sclerosus, EM, PLEVA

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43
Q

Thick basement membrane

A

LE

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44
Q

Grenz zone

A

Lepromatous leprosy, granuloma faciale, lymphocytoma cutis (bottom heavy), leukemia cutis (top heavy)

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45
Q

Subtle amorphous pink deposits in papillary dermis

A

Macular amyloidosis

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46
Q

Band-like lymphocytic infiltrate

A

LP, EM, lichen sclerosus, benign lichenoid keratosis, lichen striatus, halo nevus

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47
Q

Upper dermal edema

A

Polymorphous light eruption (PMLE), Sweet’s syndrome, lichen sclerosus, langerhans cell histiocytosis

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48
Q

Melanin incontinence

A

Macular amyloidosis, LE, atrophic LP, ashy dermatosis, FDE, dermatomyositis, postinflammatory hyperpigmentation, +/- IP

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49
Q

Subepidermal split with prominent eosinophils

A

Bullous pemphigoid, pemphigoid gestationis, bullous drug eruption

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50
Q

Subepidermal split with prominent neutrophils

A

Dermatitis herpetiformis, bullous SLE, linear IgA bullous disease (LABD)

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51
Q

Neutrophils in dermal papillae

A

Dermatitis herpetiformis

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52
Q

Subepidermal split with prominent lymphocytes

A

Bullous LP, PMLE, lichen sclerosus

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53
Q

Subepidermal vesicles with scant inflammation

A

Porphyria cutanea tarda (PCT)

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54
Q

Subepidermal vesicles with mast cells

A

Bullous mastocytosis

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55
Q

Fibrous stroma

A

Syringoma, trichoepithelioma, morpheaform BCC, microcystic adnexal carcinoma

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56
Q

‘Bubble gum’ pink stroma

A

Neurofibroma

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57
Q

Lymphocytes around sweat glands

A

Lichen striatus

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58
Q

Sweat glands with neutrophils

A

Neutrophilic eccrine hidradenitis

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59
Q

Necrosis of sweat glands

A

Coma blister

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60
Q

Invaginated pilosebaceous unit with dark-staining ducts

A

Supernumerary nipple

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61
Q

Extravasated red blood cells

A

Pityriasis rosea, PLEVA, stasis dermatitis, pigmented purpuric dermatoses, vascular neoplasms, vasculitis, granuloma faciale (GF)

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62
Q

Hemosiderin

A

Hemochromatosis, pigmented purpuric dermatosis, stasis dermatitis, GF, pityriasis lichenoides, vascular neoplasms, vasculitis

63
Q

Vertically-oriented collagen

A

Acquired digital fibrokeratoma

64
Q

Collagen trapping at periphery

A

Dermatofibroma

65
Q

Keloidal collagen

A

Dermatofibroma, keloid

66
Q

Necrobiosis

A

Granuloma annulare (GA), necrobiosis lipoidica diabeticorum (NLD), rheumatoid nodule, necrobiotic xanthogranuloma (NXG)

67
Q

Horizontal ‘sandwich’ necrobiosis without palisading

A

NLD

68
Q

Dermal fibrosis

A

Angiofibroma, fibrous papule, hypertrophic scar, blue nevus, keloid, radiotherapy, morpheaform BCC, desmoplastic trichoepthelioma, syringoma

69
Q

Dermal necrosis

A

Epithelioid sarcoma, malignant atrophic papulosis (Degos)

70
Q

Clumped calcified elastic fibers

A

Pseudoxanthoma elasticum (PXE)

71
Q

Vasculitis

A

GF, erythema elevatum diutinum (EED), polyarteritis nodosa (PAN), Henoch-Schonlein purpura, urticarial vasculitis, acute hemorrhagic edema of infancy

72
Q

Nuclear dust

A

Sweet’s syndrome, leukocytoclastic vasculitis, GF, PAN, pyoderma gangrenosum (PG)

73
Q

Deep pink nodules

A

Nodular amyloidosis

74
Q

Smooth muscle bundles

A

Supernumerary nipple, leiomyoma (fascicles and bundles)

75
Q

Calcification

A

Pilomatricoma, PXE, calciphylaxis, osteoma cutis, cysts, panniculitis, calcinosis cutis, subepidermal calcified nodule

76
Q

Increased mucin deposition

A

LE, dermatomyositis, scleromyxedema, scleredema diabeticorum, BCC (some), mucopolysaccharidosis, reticular erythematous mucinosis, GA (not NLD), pretibial myxedema, focal mucinosis, follicular mucinosis

77
Q

Pool of mucin

A

Myxoid cyst, mucocele, focal cutaneous mucinosis, mucinous carcinoma

78
Q

Ductal cells floating in mucin

A

Eccrine mucinous carcinoma

79
Q

Tadpole-shaped ducts

A

Syringoma

80
Q

Extracellular pool of lipid

A

Eruptive xanthoma

81
Q

Empty vacuoles in dermis and epidermis

A

Freeze artifact

82
Q

Pink to purple reticular network in dermis

A

Gel foam artifact

83
Q

Drag marks

A

Cutting artifact (knife mark artifact)

84
Q

Tiny black particles around blood vessels

A

Argyria

85
Q

Black amorphous deposits around blood vessels

A

Lead tattoo

86
Q

Tiny wispy gold to black granules in mouth

A

Amalgam tattoo

87
Q

Nerve bundles

A

Amputation neuroma, supernumerary digit

88
Q

Stromal retraction

A

BCC

89
Q

Basaloid islands (jigsaw puzzle)

A

Cylindroma

90
Q

‘Cluster of grapes’ (low power)

A

Merkel cell carcinoma

91
Q

Hyalinized droplets

A

Cylindroma

92
Q

‘Cannon’ or ‘blue balls’ in dermis

A

Eccrine spiradenoma

93
Q

Circular basaloid rosettes

A

Eccrine spiradenoma

94
Q

Spindle and epithelioid melanocytes ‘raining’ down

A

Spitz nevus

95
Q

Lichenoid infiltrate

A

LP, lichenoid drug eruption, lichen sclerosus, secondary syphilis (with plasma cells), GVHD, pityriasis lichenoides, lichen striatus, CTCL

96
Q

Interstitial dermatitis

A

GA, Well’s syndrome, Sweet’s syndrome, interstitial drug reaction, urticaria

97
Q

Coat-sleeving or perivascular cuffing of lymphocytes

A

Erythema annulare centrifugum (no epidermal change)

98
Q

Superficial and deep lymphocytic infiltrate

A

PMLE, secondary syphilis, gyrate erythemas, athropod bites, LE (latter includes periadnexal infiltrate)

99
Q

Deep infiltrate around sweat glands

A

Lichen striatus

100
Q

‘Naked’ granulomas

A

Sarcoidosis, tuberculosis, tuberculoid leprosy

101
Q

Single filing or ‘indian’ filing of cells

A

GA, congenital melanocytic nevus, lymphoma, leukemia, glomus cell tumor, metastatic breast carcinoma

102
Q

Increased mast cells

A

Urticaria, neural tumors (i.e. neurofibroma), mucinous areas

103
Q

Increased plasma cells

A

Mucous membrane (normal), secondary syphilis, syringocystadenoma papilliferum, hidradenitis suppurativa, acne keloidalis nuchae, NLD, LE, Rosai-Dorfman disease

104
Q

Basaloid cells

A

BCC, SK, trichoepithelioma, eccrine tumors

105
Q

Diffuse dermal mast cells

A

Mastocytosis (ie. urticaria pigmentosa)

106
Q

Cells with reniform nuclei

A

Langerhans cell histiocytosis (abundant pale cytoplasm)

107
Q

Spindle-shaped cells with elongated, wavy nuclei

A

Neurofibroma

108
Q

Round monotonous cells

A

Glomus cell tumor, poroma, mastocytosis (blue-purple granules)

109
Q

Pink granular cytoplasm

A

Granular cell tumor

110
Q

Clear cells

A

Clear cell acanthoma, trichilemmoma, clear cell hidradenoma, metastatic renal cell carcinoma, clear cell SCC, balloon cell nevus, Paget’s disease, clear cell syringoma, eccrine carcinoma

111
Q

Small cells

A

Lymphocytoma cutis, cutaneous B cell lymphoma, metastatic small cell carcinoma, CTCL, merkel cell carcinoma

112
Q

Foamy macrophages

A

Xanthomas (eruptive, tuberous, tendinous, planar), verruciform xanthoma, xanthelasma, xanthoma disseminatum, AFX, juvenile xanthogranuloma (JXG), NXG, leprosy, pancreatic panniculitis

113
Q

Touton giant cell

A

Xanthelasma, AFX, NXG

114
Q

Ground glass giant cell

A

Multicentric reticulohistiocytosis, reticulohistiocytic granuloma

115
Q

Purple osteoclast-like giant cell

A

Giant cell tumor of tendon sheath, malignant fibrous histiocytoma

116
Q

Bizarre multinucleated giant cell

A

Malignant fibrous histiocytoma, pleomorphic lipoma

117
Q

Parasitized histiocytes His GiRL

A

Histoplasmosis, granuloma inguinale, rhinoscleroma, leishmaniasis

118
Q

Ghost cells

A

Pilomatricoma

119
Q

Fibroblast with red inclusion body

A

Infantile digital fibromatosis

120
Q

Bizarre spindle cells

A

Liposarcoma, leiomyosarcoma, AFX, radiation dermatitis

121
Q

Melanin clumps (casts) in follicle

A

Trichotillomania

122
Q

Trichomalacia (deformed shaft)

A

Trichotillomania

123
Q

Necrosis of hair follicles

A

HSV

124
Q

Tiny vellus hairs

A

Accessory tragus (rim periphery), xanthelasma, vellus hair cyst

125
Q

‘Swarm of bees’ (lymphocytic inflammation at hair bulb)

A

Alopecia areata

126
Q

Lymphocytes and plasma cells around follicles

A

Acne keloidalis nuchae

127
Q

Free hair shafts surrounded by multinucleated giant cells

A

Acne keloidalis nuchae, folliculitis decalvans

128
Q

Eosinophils around hair follicle

A

Eosinophilic folliculitis

129
Q

Mucin within follicle

A

Follicular mucinosis

130
Q

Cartilage often present

A

Accessory tragus, chondrodermatitis nodularis helicis (CNH), chondroid syringoma

131
Q

Degenerated cartilage

A

Relapsing polychondritis, CNH

132
Q

Ghost-like fat cells

A

Pancreatic panniculitis (with basophilic calcium deposition)

133
Q

Cystic spaces in fat

A

Cold panniculitis

134
Q

Fat necrosis

A

Erythema induratum (basophilic), lupus panniculitis (latter with lymphoid follicle-like aggregates, lymphoplasmacytic infiltrate)

135
Q

“Needle-shaped” clefts in fat

A

Subcutaneous fat necrosis, sclerema neonatorum, post-steroid panniculitis

136
Q

‘Swiss cheese’ appearance

A

Paraffinoma or sclerosing lipogranuloma

137
Q

Fat high up in lesion

A

Accessory tragus

138
Q

Widened septae with giant cells

A

Erythema nodosum

139
Q

Dense neutrophilic inflammation

A

alpha-l-antitrypsin deficiency

140
Q

Lipomembranous changes

A

Lipodermatosclerosis

141
Q

Chicken wire pattern (linear collapsed vessels)

A

Myxoid liposarcoma

142
Q

Clear multivacuolated cells in fat

A

Hibernoma

143
Q

Hyalinized vessel walls (with thick red color around vessels)

A

Atrophie blanche

144
Q

Promontory sign, slit-like spaces

A

Kaposi sarcoma

145
Q

Atypical endothelial cells with dissecting vascular spaces

A

Angiosarcoma

146
Q

Intravascular thrombi

A

Cryoglobulinemia, purpura fulminans, antiphospholipid syndrome, disseminated intravascular coagulation, coumadin necrosis, atrophie blanche

147
Q

Telangiectatic vessels in pale acellular dermis

A

Radiation dermatitis

148
Q

Hob nailing (endothelial cells protrude into vessel)

A

Angiolymphoid hyperplasia with eosinophilia

149
Q

Staghorn appearance

A

Hemangiopericytoma

150
Q

Recanalizing thrombus

A

Masson’s tumor (intravascular endothelial hyperplasia)

151
Q

Spindle cells with RBCs ‘sandwiched’ in between

A

Kaposi sarcoma

152
Q

Polypoid collection of vessels

A

Pyogenic granuloma

153
Q

Proliferation of thick-walled vessels with hemosiderin

A

Stasis dermatitis

154
Q

Dilated engorged vessels with surrounding edema

A

Granulation tissue

Medical Derm Revision (51 decks)

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