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Pathology (Guide) > Histopathology - Skin Pathology > Flashcards

Histopathology - Skin Pathology Flashcards

1
Q

What are the different layers of the epidermis from superficial to deep?

A

Come Let’s Get Sun Burnt
- (Stratum) Corneum
- (Stratum) Lucidum
- (Stratum) Granulosum
- (Stratum) Spinosum
- (Stratum) Basale
- Basement membrame of epidermis

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2
Q

What is the dermis and what components is it made up of?

A

A vascularised supporting structure
- Collagen fibres
- Elastin fibres
- Adnexal structures
- Eccrine glands
- Sebaceous glands
- Hair follicles

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3
Q

What are some features of the epidermis?

A
  • Thin, avascular outer layer (15-30 day turnover)
  • Functions as barrier
  • Squamous epithelial cells
  • Comprised of keratinocytes
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4
Q

What cell types are seen in the epidermis?

A
  • Stratum disjunctum
  • Corneocyte
  • Granular keratinocyte
  • Langerhans cells
  • Spinous keratinocyte
  • Epidermal basal cell
  • Melanocyte
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5
Q

What is hyperkeratosis?

A

Increase/thickening of S. Corneum
- Increase in keratin

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6
Q

What is parakeratosis?

A

Nuclei in S. corneum
- Thickening of skin when scratching it

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7
Q

What is acanthosis?

A

Increase in S. spinosum

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8
Q

What is acantholysis?

A

Decrease in cohesions between keratinocytes

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9
Q

What is spongiosis?

A

Intercellular oedema (between keratinocytes)

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10
Q

What is lentiginous?

A
  • Linear pattern of melanocyte proliferation within epidermal basal cell layer (reactive or neoplastic)
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11
Q

What is lichenoid?

A

Sheeny plaque appearance on surface of skin

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12
Q

What is psoriaform?

A

Thickened skin

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13
Q

What are the two aetiological theories of dermatitis/eczema?

A

Inside-out:
- Immune system (autoimmune) causes IgE sensitisation resulting in skin barrier dysfunction

Outside-in:
- Defective skin barrier with an allergen exposure reesults in IgE sensitisation

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14
Q

What are the six inflammatory reaction patterns?

A
  • Lichenoid
  • Psoriaform
  • Spongiosis
  • Vesicobullous
  • Vasculitis
  • Granulomatous
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15
Q

What is vesicobullous?

A

Forms bullae

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16
Q

What is vasculitis?

A

Associated with vasculitis

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17
Q

What is granulomatous?

A

Associated with granulomas

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18
Q

What is the acute histology of dermatitis?

A
  • Fluid collection in dermis (spongiosis)
  • Eosinophil infiltrate in dermis
  • Dilated dermal capillaries
  • Thickening of epidermis
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19
Q

What is the chronic histology of dermatitis?

A
  • Acanthosis
  • Crusting
  • Scaling
  • T cells
  • Eosinophils
  • Hyperparakeratosis
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20
Q

What are the three types of dermatitis?

A
  • Atopic
  • Contact
  • Seborrhoeic
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21
Q

What are the clinical features of Atopic Dermatitis?

A

Infants:
- Face
- Scalp
- Extensor surfaces
- Persists into adulthood in those with FHx of atopy

Adults:
- Flexural areas

Chronic:
- Lichenification

IgE-Mediated (Type 1)

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22
Q

What are the clinical features of Contact dermatitis?

A
  • Type IV hypersensitivity (e.g. to nickel, rubber)
  • Erythema
  • Swelling
  • Pruritis
  • Commonly affects ear lobes + neck (from jewellery), wrist (leather watch straps), feet (shoes)
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23
Q

What are the clinical features of Seborrhoeic dermatitis?

A
  • Inflammatory reaction to a yeast (Malassezia furfur)

Infants:
- Cradle cap
- Large, yellow scales on scalp
- Nappy sites

Young adults:
- Mild erythema
- Fine scaling
- Mildly pruritic
- Affects face, eyebrow, eyelid, anterior chest, external ear

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24
Q

What is psoriasis?

A
  • Chronic inflammatory dermatosis with erythematous, well demarcated scaly plaques (salmon-pink)
  • Early (15-25yrs) + Late (50-60yrs) bi-modal distribution
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25
Q

What is the pathophysiology of psoriasis?

A
  • Type IV T cell hypersensitivity reaction within epidermis
  • Further T cell recruitment
  • Release of pro-inflammatory cytokines (TNF-α, IFN-gamma)
  • Keratinocyte hyperproliferation
  • Epidermal thickening
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26
Q

What is seen on histology of psoriasis?

A
  • PARAKERATOSIS
  • Neutrophilia
  • Loss of granular layer (Stratum Granulosum)
  • Clubbing of Rete Ridges - Test tubes in rack appearance
  • Munro’s microabscesses (neutrophil recruitment)
  • Dilated blood vessels
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27
Q

What are the five types of psoriasis and which is most common?

A
  • Chronic plaque psoriasis (Most common)
  • Flexural psoriasis
  • Guttate psoriasis
  • Erythrodermic/pustular psoriasis (Emergency)
  • Koebner phenomenon
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28
Q

What are the features of chronic plaque psoriasis?

A
  • Salmon pink plaques
  • Silver scales
  • Affects Extensor aspects of knees, elbows + scalp
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29
Q

What are the features of flexural psoriasis?

A
  • Seen in later life
  • Usually groin, natal cleft + sub-mammary areas
30
Q

What are the features of Guttate psoriasis?

A
  • Rain-drop plaque distribution
  • Often in children
  • On trunk
  • Usually 2wks post Group A Β-haemolytic Strep infection
31
Q

What are the features of Erythrodermic/pustular psoriasis?

A
  • Emergency
  • Severe widespread disease
  • Systemic Sx
  • Can be limited to hands + feet (palmo-plantar psoriasis)
32
Q

What are the features of Keobner phenomenon?

A
  • Plaques form at/along trauma sites
33
Q

What is Auspitz’ sign?

A

Rubbing psoriatic plaques causes pin-point bleeding

34
Q

What is psoriasis associated with?

A

(POSHDASS)
Nail changes:
- P: Pitting
- O: Onycholysis
- S: Subungual H: Hyperkeratosis

Arthritis (5-10%)
- D: DIP Disease
- A: Arthritis multilans “Telescoping”
- S: Spondylopathy
- S: Symmetrical polyarthritis

35
Q

What is the appearnce of Lichen Planus lesions?

A

5Ps:
- Pruritic
- Purple
- Polygonal
- Papules
- Plaques

With:
- Mother-of-pearl sheen
- Fine white network on surface (Wickam’s striae)

36
Q

Where is lichen planus typically seen?

A
  • Inner surfaces of wrists
  • ?Oral mucous membrane (lesions have lacy appearance)
37
Q

What is the pathophysiology of lichen planus?

A
  • Accumulation of T cells attacking basement membrane
38
Q

What is seen on histology for lichen planus?

A
  • Hyperkeratosis
  • SAW-TOOTHING OF RETE RIDGES
  • Basal cell degeneration
39
Q

What is the typical appearance of erythema multiforme and where is it most commonly seen?

A
  • Annual target lesion
  • Pleomorphic lesions
  • Combination of macules, papules, urticarial weals, vesicles, bullae + petechiae
  • Commonly on extensor surfaces of hands + feet
40
Q

What are the causes of erythema multiforme?

A

Infections:
- HSV
- Mycoplasma

Drugs (SNAPP):
- S: Sulphonamides
- N: NSAIDs
- A: Allopurinol
- P: Penicillin
- P: Phenytoin

41
Q

What is the spectrum of disease severity in regards to erythema multiforme?

A
  1. Erythema multiforme
  2. Steven Johnson’s syndrome (SJS)
  3. Toxic epidermal necrolysis
42
Q

What is Steven Johnson’s syndrome/toxic epidermal necrolysis?

A
  • Dermatological emergency
  • Sheets of skin detachment (<10& in SJS + >30% in TEN)
  • Prominent mucosal involvement
  • Nikolsky sign +ve
43
Q

What is tehe common cause of Steven Johnson’s syndrome/toxic epidermal necrolysis?

A

Drugs
- Sulfonamide Abx
- Anticonvulsants

44
Q

What are the different types of bullous disease?

A
  • Dermatitis herpetiformis
  • Bullous pemphigoid
  • Pemphigus vulgaris
  • Pemphigus foliaceus
45
Q

What is the pathophysiology of dermatitis herpetiformis?

A
  • A/W: Coeliac
  • IgA Abs bind to basement membrane, leads to subepidermal bulla
46
Q

What are the clinical features of dermatitis herpetiformis?

A
  • Itchy vesicles on extensor surfaces of elbows + buttocks
47
Q

What are the histological features of dermatitis herpetiformis?

A
  • Microabscesses which coalesce to form subepidermal bullae
  • Neutrophil + IgA deposits at tips of dermal papillae
48
Q

What is the pathophysiology of Bullous Pemphigoid?

A
  • IgG Abs + C3 bind to hemidesmosomes (adhesion molecule of basement membrane)
  • Epidermis lifts off
  • Fluid accumulates in space
  • SUBepidermal bulla
49
Q

What are the clinical features of Bullous Pemphigoid?

A
  • Large, tense bullae on erythematous base
  • Often on flexural surfaces (forearms, groin + axillae)
  • ELDERLY
  • Bullae do not easily rupture as easily as pemphigus
50
Q

What are the histological features of Bullous Pemphigoid?

A
  • Subepidermal bullae
  • EOSINOPHILIA
  • Linear deposition of IgG along basement membrane
51
Q

What is the pathophysiology of Pemphigus Vulgaris?

A
  • IgG Abs bind to desmoglein 1 + 3 (adhesion molecules) between keratinocytes in S. Spinosum
  • Acantholysis
  • INTRAepithelial bulla
52
Q

What are the clinical features of Pemphigus Vulgaris?

A
  • Bullae are easily ruptured
  • Raw, red surface
  • Flaccid blisters
  • Found on skin + mucosal membranes
  • Nikolsky’s sign +ve
  • Mucosal involvement
53
Q

What are the histological features of Pemphigus Vulgaris?

A
  • Intraepithelial bulla
  • Netlike pattern of intercellular IgG deposits
  • Acantholysis
54
Q

What is the pathophysiology of Pemphigus Foliaceus?

A
  • IgG against desmoglein 1 in epidermis
  • Detachment of superficial keratinocytes
  • Attacks outer layer of keratinocytes in S. Corneum
55
Q

What are the clinical features of Pemphigus Foliaceus?

A
  • Very rare
  • No intact bullae
  • Appears excoriated
  • Affects elderly population
56
Q

What are the histological features of Pemphigus Foliaceus?

A
  • 3 levels of split
57
Q

What is a type of benign cutaneous neoplasm?

A

Seborrhoeic keratosis

58
Q

What are the characteristics and histological features of seborrhoeic keratosis?

A

Character:
- Rough plaques
- Waxy
- “Stuck on”
- Appear in middle age/elderly

Histo:
- Keratin horns in epidermis
- Orderly proliferation

59
Q

What are the premalignant cutaneous neoplams?

A
  • Actinic (Solar/Senile) Keratosis
  • Keratoacanthoma
  • Bowen’s disease (SCC in situ)
60
Q

What are the characteristics and histological features of Actinic Keratosis?

A

Character:
- Rough
- Sandpaper like texture
- Scaly lesions
- On sun-exposed areas

Histo (SPAIN):
- S: Solar elastosis
- P: Parakeratosis
- A: Atypical cells
- I: Inflammation
- N: Not full thickness

61
Q

What are the characteristics and histological features of keratoacanthoma?

A

Character:
- Rapidly growing
- Dome-shaped nodule
- ?Necrotic, crusted centre
- Grows over 2-3wks
- Clears spontaneously

Histo:
- Similar to SCC, hard to differentiate

62
Q

What are the characteristics and histological features of Bowen’s disease?

A

Character:
- Intra-epithelial squamous cell carcinoma in situ
- Flat
- Red
- Scaly
- Patches
- Sun-exposed areas

Histo:
- Full thickness
- Atypia/dysplasia
- Basement membrane intact (not invading dermis)

63
Q

What are the two types of malignant skin cancer and which is most common?

A
  • Squamous Cell Carcinoma (2nd most common)
  • Basal Cell Carcinoma (Most common)
64
Q

What are the characteristics and histological features of Squamous Cell Carcinoma?

A

Character:
- When Bowen’s has spread to involve dermis
- Ulcerative
- Crusting
- Hyperkeratotic
- +/- Rolled edges
- Moderately growing
- Can metastasise
- Locally destructive

Histo:
- Atypia/dysplasia throughout epidermis
- Nuclear crowding + spreading through basement membrane into dermis

65
Q

What are the characteristics and histological features of Basal Cell Carcinoma?

A

Character:
- Rodent ulcer
- Slow growing tumour
- Rarely metastastic
- Locally destructive
- Sun-exposed areas
- Well-defined
- Rolled edges
- Pearly surface
- Often telangietasia

Histo:
- Mass of basal cells pushing down into dermis
- Palisading (nuclei align in outermost layer)

66
Q

What is a benign melanocytic condition and its features?

A

Melanocytic naevi (moles)
- Junctional
- Compound
- Intradermal

67
Q

What are the histological features of Malignant Melanomas?

A
  • Atypical melanocytes
  • Initially grow horizontally in epidermis (radial growth phase)
  • Then grow vertically into dermis (vertical growth phase)
  • Vertical growth produces BUCKSHOT APPEARANCE (Pagetoid cells)
68
Q

What is Breslow thickness?

A

Most important prognostic factor based off depth (every mm worsens prognosis)

69
Q

What is the spread of malignant melanomas?

A

More commonly to lymph nodes than blood

70
Q

What are some worrying symptoms associated with malignant melanomas?

A
  • Bleeding
  • Itching
  • Growing
71
Q

What are the four types of malignant melanomas, their prevalence and basic features ?

A

Superficial spreading
- Most common
- Irregular borders
- Variation in colour

Nodular
- 2nd most common
- Can occur on all sites
- More common in younger age group

Lentigo maligna
- Occurs on sun exposed areas of elderly caucasians
- Flat
- Slow growing black lesion

Acral lentiginous
- Rare
- Occurs on palms, soles + subungual areas

72
Q

What are the features of pityriasis rosea?

A
  • Salmon pink rash appears first (HERALD PATCH), followed bu oval macules in christmas tree distribution
  • Appears after HHV6 + HHV7 infections
  • Remits spontaneously

Pathology (Guide) (84 decks)

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