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Yr 2 - Clinical Pathology > Inflammatory Skin & Tumours > Flashcards

Inflammatory Skin & Tumours Flashcards

1
Q

What are the 4 major types of tissue reaction patterns seen in inflammatory skin disease?

A
  1. Spongiotic reaction pattern
  2. Psoriasiform reaction pattern
  3. Lichenoid reaction pattern (’interface dermatitis’)
  4. Vesiculobullous reaction pattern
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2
Q

What type of tissue reaction pattern is ‘eczema’?

A

Spongiotic reaction pattern

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3
Q

What type of tissue reaction pattern is ‘psoriasis’?

A

Psoriasiform reaction pattern

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4
Q

What type of reaction pattern is Licen planus?

A

Lichenoid reaction pattern

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5
Q

What type of reaction pattern is lupus erythematosus?

A

Lichenoid

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6
Q

What type of reaction pattern is lupus erythematosus?

A

Lichenoid

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7
Q

What are the 3 clinical stages of eczema? Describe the appearance of the skin for each

A
  1. Acute dermatitis; skin red, weeping serous exudate +/- small vesicles
  2. Subacute; skin is red, less exudate, itching ++, crusting
  3. Chronic; skin thick and leathery secondary to scratching
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8
Q

What characterises a ‘spongiosis’ reaction?

A

Characterised by intercellular oedema within the epidermis (spongiosis)

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9
Q

How is the epidermis affected in chronic eczema?

A

Epidermal hyperplasia and hyperkeratosis – mild in acute dermatitis, marked in chronic dermatitis

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10
Q

What other 2 conditions is atopic eczema typically associated with?

A

Asthma and hayfever

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11
Q

What type of hypersensitivity reaction is atopic eczema?

A

Type 1 reaction to allergen

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12
Q

Define atopic

A

denoting a form of allergy in which a hypersensitivity reaction such as eczema or asthma may occur in a part of the body not in contact with the allergen.

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13
Q

What are the 2 types of contact dermatitis?

A
  1. Contact irritant
  2. Contact allergic
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14
Q

mechanism behind contact irritant dermatitis?

A

direct injury to skin by irritant

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15
Q

What irritants can cause contact irritant dermatitis?

A

acid, alkali, strong detergent, etc

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16
Q

Mechanism behind contact allergic dermatitis? What hypersensitivity reaction is this?

A
  • Act as haptens which combine with epidermal protein to become immunogenic
    • This is a delayed ‘type 4’ hypersensitivity reaction
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17
Q

What allergens are responsible for contact allergic dermatitis?

A

Nickel, dyes, rubber

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18
Q

What are the 2 morphological subtypes of ‘dermatitis of unknown aetiology’?

A
  1. Seborrhoeic dermatitis
  2. Nummular dermatitis
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19
Q

What areas does seborrhoeic dermatitis affect?

A

affect areas rich in sebaceous glands: scalp, forehead, upper chest

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20
Q

How does nummular dermatitis appear?

A

Coin shaped lesions

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21
Q

Presentation of psoriasis?

A
  • Well defined, red oval plaques on extensor surfaces; knees, elbows, sacrum
  • Fine silvery scale
  • ‘Auspitz sign’
  • +/- sero-negative arthritis
  • Oral manifestations
  • Can cause alopecia
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22
Q

What is an ‘Auspitz sign’?

A

refers to a bleeding point that can occur when the surface of a scaling rash has been removed

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23
Q

What is parakeratosis?

A

Parakeratosis is defined as the presence of nucleated keratinocytes in the stratum corneum

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24
Q

What is the histological appearance of psoriasis?

A

“Psoriasiform hyperplasia”

  • i) Regular elongated club shaped rete ridges
  • ii) Thinning of epidermis over dermal papillae.
  • iii) Parakeratotic (contain nuclei) scale.
  • iv) Collections of neutrophils in scale (Munro micro abscesses)
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25
Q

What are Munro micro abscesses?

A

This is a collection of neutrophils (abscess) in the stratum corneum of the epidermis due to infiltration of neutrophils from papillary dermis.

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26
Q

Describe the cell turnover time in psoriasis

A

Massive cell turnover –> causes clinical and microscopic features

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27
Q

Environmental trigger factors for psoriasis?

A

Infection, stress, trauma, drugs

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28
Q

What are the psoriasis susceptibility genes?

A

PSORS genes (many in region of major histocompatibility complex on Chromosome 6p2 implicated)

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29
Q

Associated co-morbidities of psoriasis?

A
  • Arthropathy, 5-10% associated
  • Psychosocial effects
  • Cardiovascular disease; 2-3x risk.
    • May be due to inflammation/drugs/stress/smoking
  • Increased risk of non-melanoma skin cancer e.g. BCC, lymphoma
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30
Q

How do the treatment and asociated comorbidity risk of skin cancer conflict in psoriasis?

A

One main treatment of psoriasis is UV light –> increases risk of non-melanoma skin cancer

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31
Q

What characterises a ‘Lichenoid’ reaction pattern?

A

Characterised by epidermal basal cell damage

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32
Q

What is Lichen planus?

A

Lichen planus is an inflammatory skin condition, characterised by an itchy, non-infectious rash that affects the flexor surfaces, mucous membranes and genitals

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33
Q

What type of hypersensitivity reaction is Lichen planus?

A

Type 4

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34
Q

How long does Lichen planus typically last?

A

1-2 years but longer in oral cavity

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35
Q

What other conditions can Lichen planus be associated with?

A

Viral hepatitis, HIV (and some drugs)

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36
Q

What is lupus erythematosus?

A
  • Auto-immune disorder primarily affecting connective tissues of the body; connective tissue disorder
  • May affect any part of the body, but importantly kidneys (major predictor of outcome)
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37
Q

What is the type of lupus that affects the skin only?

A

Discoid lupus erythematosus (SDE)

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38
Q

how does DLE present?

A

Red scaly patches on sun-exposed skin +/- scarring, scalp involvement causes alopecia.

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39
Q

What is the characteristic facial feature of SLE?

A

Butterfly rash on cheeks and nose

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40
Q

What type of hypersensitivity reaction is lupus?

A

Type III

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41
Q

What is epidermal atrophy?

A

Epidermal atrophy is characterised by the reduction in the number of epidermal cells leading to the reduced thickness of the epidermis.

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42
Q

How does lupus erythematosus present microscopically?

A
  • Thin atrophic epidermis
  • Inflammation and destruction of adnexal structures.
  • IgG deposited in basement membrane
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43
Q

Which antibody is deposited in basement membrane in lupus?

A

IgG

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44
Q

Which technique gives the best diagnostic yield in lupus?

A

Direct immunofluorescence (DIF) of skin in conjunction with histopathology gives the best diagnostic yield

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45
Q

What type of reaction pattern is dermatomyositis?

A

Lichenoid

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46
Q

What is dermatomyositis? What do symptoms include?

A

Dermatomyositis is an autoimmune condition that causes skin changes and muscle weakness.

Symptoms;

  • Peri-ocular oedema and erythema (Heliotropic rash)
  • Erythema in photosensitive distribution
  • Myositis; proximal muscle weakness (check for creatinine kinase)
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47
Q

In adults, what are 25% of dermatomyositis cases associated with?

A

Underlying visceral cancer

48
Q

Microscopy of dermatomyositis?

A
  • Similar to lupus
  • Often a lot of dermal mucin
49
Q

What characterises a vesiculobullous reaction pattern?

A

The vesiculobullous reaction pattern is characterised by the presence of vesicles or bullae (fluid filled blisters) at any level within the epidermis or at the dermoepidermal junction.

50
Q

What type of reaction pattern in pemphigus?

A

Vesiculobullous reaction pattern

51
Q

What type of reaction pattern in pemphigoid?

A

Vesiculobullous reaction pattern

52
Q

What is pemphigus/pemphigoid?

A
  • Pemphigus is a group of skin disorders that cause blisters or pus-filled bumps.
  • Autoimmune.
  • Can be detected by immunofluorescence (IMF)
  • Can be localised or extensive
53
Q

Pemphigus vs pemphigoid;

a) location of blisters?
b) deposition of autoantibodies?

A

Pemphigus;

a) intra-epidermal blisters
b) intercellular deposition of autoantibodies

Pemphigoid;

a) sub-epidermal bullae
b) Deposition of autoantibodies at basement membrane

54
Q

Describe the difference in blisters present in pemphigus vs pemphigoid?

A

Pemphigus - affects the outer of the skin (epidermis) and causes lesions and blisters that are easily ruptured (very fragile).

Pemphigoid - affects a lower layer of the skin, between the epidermis and the dermis, creating tense blisters that do not break easily.

55
Q

How are blisters formed in pemphigus?

A

Group of disorders characterised by loss of cohesion between keratinocytes resulting in an intraepidermal blister.

56
Q

Pathogenesis behind pemphigus vs pemphigoid?

A
  • Pemphigus - Autoantibodies directed against intercellular material.
  • Pemphigoid - Autoantibodies to glycoprotein in basement membrane
57
Q

Which age group is pemphigus/pemphigoid more commonly seen in?

A

Elderly

58
Q

What type of tissue reaction pattern is dermatitis herpetiformis?

A

Vesiculobullous reaction pattern

59
Q

What is dermatitis herpetiformis? Symptoms?

A
  • A rare, chronic, autoimmune skin condition
  • Symptoms;
    • severely itchy blisters
    • raised red skin lesions
60
Q

What age group does dermatitis herpetiformis usually affected?

A

Young patients

61
Q

What disease is dermatitis herpetiformis associated with?

A

Coeliac disease

62
Q

In which inflammatory skin condition is there IgA deposition in the dermal papillae on IMF?

A

Dermatitis herpetiformis

63
Q

Histopathology of dermatitis herpetiformis?

A

Neutrophil microabscesses in dermal papillae

64
Q

Skin lesions can be signs of systemic disease. What underlying pathology can the following skin conditions indicate;

a) dermatomyositis
b) dermatitis herpetiformis
c) Acanthosis Nigricans (dark warty lesions in armpits)
d) Necrobiosis Lipoidica (red + yellow plaque on legs)
e) Erythema Nodosum (red tender nodules on shins)

A

a) visceral cancer
b) Coeliac disease
c) internal malignancy
d) diabetes mellitus
e) associated with infections elsewhere especially lung, drugs, and other diseases

65
Q

Which inflammatory skin condition is characterised by epidermal hyperplasia and hyperkeratosis?

A

Chronic dermatitis

66
Q

Which type of dermatitis affects areas rich in sebaceous glands: scalp, forehead, upper chest?

A

Seborrhoeic dermatitis

67
Q

Which type of dermatitis presents with coin shaped lesions?

A

Nummular

68
Q

Which type of inflammatory skin condition can present with ‘Auspitz signs’?

A

Psoriasis

69
Q

Which type of inflammatory skin condition can present with a fine silvery scale?

A

Psoriasis

70
Q

Which type of inflammatory skin condition can present with parakeratosis?

A

Psoriasis

71
Q

Which type of inflammatory skin condition can Munro micro abscesses?

A

Psoriasis

72
Q

Which type of inflammatory skin condition involves massive cell turnover?

A

Psorasis

73
Q

Which type of reaction pattern is characterised by epidermal basal cell damage?

A

Lichenoid

74
Q

Which type of inflammatory skin condition is associated with viral hepatitis or HIV?

A

Lichen planus

75
Q

Which type of inflammatory skin condition can present with IgG deposited in basement membrane?

A

Lupus

76
Q

Which type of inflammatory skin condition can present with a thin atrophic epidermis?

A

Lupus

77
Q

Which type of inflammatory skin condition can present with peri-ocular oedema?

A

Dermatomyositis

78
Q

Which type of inflammatory skin condition can present with proximal muscle wasting?

A

Dermatomyositis

79
Q

Which type of inflammatory skin condition is caused by a loss of cohesion between keratinocytes?

A

Pemphigus

80
Q

Which type of inflammatory skin condition is caused by autoantibodies to glycoprotein in basement membrane?

A

Pemphigoid

81
Q

Which type of inflammatory skin condition can present with IgA deposition in dermal papillae?

A

Dermatitis herpetiformis

82
Q

Which type of inflammatory skin condition can present with neutrophil micro abscesses in dermal papillae?

A

Dermatitis herpetiformis

83
Q

What is the commonest malignant skin tumour?

A

Basal cell carcinoma

84
Q

Does BCC tend to metastasise?

A

no

85
Q

Aetiology of BCC?

A
  • Sun exposed site, especially face
  • Occasional secondary to radiotherapy
  • Pale skin that burns easily
  • Immunosuppression
  • Rare; Gorlin’s syndrome (increases risk of developing various cancerous and non-cancerous tumours)
86
Q

What is Gorlin’s syndrome?

A

a condition that affects many areas of the body and increases the risk of developing various cancerous and noncancerous tumors.

87
Q

Presentation of BCC lesion?

A

rodent ulcer with rolled edge

88
Q

Microscopically, what would a tumour composed of islands of basaloid cells with peripheral palisade indicate?

A

BCC

89
Q

What cell type does squamous cell carcinoma arise from?

A

Keratinocytes

90
Q

Causes of SCC?

A
  • U.V. irradiation
  • Usually occurs in sun exposed sites
  • Increased risk in tropical countries.
  • Radiotherapy
  • Hydrocarbon exposure - tars, mineral oils, soot
    • Percival Pott noted SCC scrotum in chimney sweeps
  • Chronic scars/ulcers - SCC arises within these (Marjolins ulcer).
  • Immunosuppression - renal transplant patients at increased risk.
  • Drugs, some newer drugs for melanoma (BRAF inhibitors)
91
Q

Presentation of SCC lesion?

A

Nodule with ulcerated, crusted surface

92
Q

Microscopically, what would invasive islands and trabeculae of squamous cells showing cytological atypia indicate?

A

SCC

93
Q

What is known as the ‘pre-malignant’ form of SCC?

A

Actinic (solar) keratosis –> dry scaly patches of skin that have been damaged by the sun;

  • Dysplasia to squamous epithelium
  • Very common on chronic sun exposed sites.
  • Scaly lesion with erythematous base
  • Only rarely progresses to invasive disease.
  • May spontaneously resolve
94
Q

Where are melanocytes derived from?

A

Neural crest

95
Q

Function of melanocytes?

A

To form melanin which is transferred to epidermal cells to protect the nucleus from UV radiation

96
Q

Melanocytes can give rise to benign or malignant tumours. What are the names of each?

A

Benign - naevi (moles)

Malignant - melanoma

97
Q

What are naevi?

A
  • Local benign collections of melanocytes
  • Diameter <6mm
  • Several types;
    • Superficial; congenital or acquired
    • Deep; blue naevi (mongolion spot)
98
Q

What is atypical mole syndrome? What can it increase your risk of?

A
  • Multiple clinically atypical moles
  • Histologically atypical/dysplastic naevi
  • Increased risk of developing melanoma
99
Q

Does melanoma metastasise?

A

Very dangerous malignancy which can metastasise widely

100
Q

Size of melanoma lesion?

A

>6mm

101
Q

Aetiology of melanoma?

A
  • a) Sun exposure - especially short intermittent severe exposure
  • b) Race - Celtic with red hair, blue eyes, fair complexions who tan poorly most at risk. Melanoma rare in dark skinned people.
  • c) Family history – Atypical mole syndrome (multiple large atypical moles)
  • d) Giant congenital naevi - small risk of turning malignant (<5%)
102
Q

What is the most common form of melanoma?

A

Superficial spreading melanoma –> a type of skin cancer that slowly grows horizontally across the top layer of skin before moving to the deeper layers (Proliferation of atypical melanocytes which invade epidermis and dermis).

103
Q

What specific gene mutation havs been detected in many superficial spreading melanomas?

A

BRAF mutations (target for anticancer agents)

104
Q

Microscopy of nodular melanoma?

A

Invasive atypical melanocytes invade dermis to produce nodules of tumour cells.

105
Q

What is lentigo maligna?

A
  • Lentigo maligna is an early form of melanoma in which the malignant cells are confined to the tissue of origin
  • Typically arises on face in elderly people
  • Slow growing, flat, pigmented patch
106
Q

Microscopy of lentigo maligna?

A
  • Micro: Proliferation of atypical melanocytes along basal layer of epidermis. Skin also shows signs of chronic sun damage.
  • Late in disease, melanocytes may invade dermis (lentigo maligna melanoma) with potential to metastasise.
107
Q

Are BRAF mutations seen in lentigo maligna?

A

Typically no

108
Q

What is acral lentiginous melanoma?

A

is a type of melanoma arising on the palms or soles (occasionally sublingual)

109
Q

What is the commonest form of melanoma in afro-carribeans?

A

Acral lentiginous melanoma

110
Q

Microscopy of acral lentiginous melanoma?

A

Micro: Similar to lentigo maligna except no marked sun damage.

111
Q

Naevus vs melanoma

A
112
Q

What is pagetoid spread?

A

An individual cell proliferation in the upper levels of the epidermis.

113
Q

Which type of melanoma exhibits pagetoid spread?

A

Superficial spreading melanoma

114
Q

60% melanoma’s have mutation in which gene?

A

BRAF

115
Q

What syndrome can be associated with an increased risk of BCC?

A

Gorlin’s syndrome

116
Q

What is a heliotrope rash? What condition is it associated with?

A
  • A heliotrope rash is a reddish purple rash on or around the eyelids
  • Heliotrope rash is caused by dermatomyositis

Yr 2 - Clinical Pathology (80 decks)

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