Histology

Question 1

normal epidermis but thickened dermis with broad bands of collagen that appear separated on histology due to mucin between the bundles

Answer 1

Scleredema

Question 2

normal epidermis, perivascular mononuclear cell infiltrate, mucin deposition in papillary dermis, fibroblast proliferation and fibrosis

Answer 2

Scleromyxedema

Question 3

typically has inflammation and fibrosis in all layers (except epidermis which is normal), they are most intense in subcutis and fascia. Inflammatory infiltrate consists of abundant lymphocytes, plasma cells, histiocytes. Eosinophilic infiltration can be seen

Answer 3

Eosinophilic Fasciitis

Question 4

 Increased number of dermal fibroblasts, increased dermal collagen, increased mucin deposition, no inflammatory cells, increased CD34+ fibrocytes and CD68+ monocytes

Answer 4

Nephrogenic Systemic Fibrosis

Question 5

CD8+ T cells invading healthy muscle fibers, increased MHCI on muslces, red-ragged fibers, red-rimmed autophagocytic vacuoles, amyloid deposits

Answer 5

Inclusion Body Myositis

Question 6

mixed inflammatory infiltrate in walls of medium arteries with areas of fibrinoid necrosis

Answer 6

PAN

Focal and segmental transmural necrotizing vasculitis of medium and small arteries

Question 7

Hyerkeratosis, epidermal atrophy, vacuolar interface dermatitis (liquefactive degeneration of basal layer of epidermis), superficial/perivascular and perifollicular mononuclear cell inflammatory infiltrate, BM thickening

Answer 7

Cutaneous lupus

Question 8

Hyperkeratosis and follicular plugging, BM thickened

Answer 8

Discoid lupus

Question 9

Lupus Tumidus

Answer 9

absent interface changes at dermal-epidermal junction

Question 10

caclification, fibrointimal hyperplasia and thrombosis in microvessels in the subcutaneous adipose tissue and dermis

Answer 10

Calciphylaxis

Pt will have ESRD, hyperphos, hyperPTH and painful skin lesions (ulcerative/nodular/necrotic) of lower extremities and trunk

Calcifications can be intravascular or extra

Question 11

aggregates of multinucleated giant cells and histiocytes that have a granular ground glass appearance

Answer 11

MRH

histiocytes also called tissue macrophages

Question 12

Nodule biopsy: spindle shaped myofibroblasts

Answer 12

Fibroblastic rheumatism

Palmar thickening is a hallmark, inability to extend fingers. Symmetric polyarthritis similar to MRH.

Question 13

marked lymphocyte and plasma cell infiltrate, storiform or swirling fibrosis, obliterative phlebitis. Plasma cells

Answer 13

IgG4

Can present: AI pancreatitis/cholangitis, oribital disease, salivary glands, kidney disese

Can see: elevated serum IgG4, polyclonal gammopathy

Plasma cells: >40% IgG4+, >10/hpf