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Histopathology Dan > Lesions > Flashcards

Lesions Flashcards

1
Q

Which lesions may show peripheral pallisading?

A

BCC
Trichoepithelioma, Trichoblastoma
Trichofolliculoma
Trichilemomma

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2
Q

In what lesions can you see Pagetoid spread?

A 
Paget's disease
Melanoma
Special site naevi
Pigmented spindle cell naevus of Reed
Pagetoid Bowens disease
Sebaceous carcinoma
Apocrine carcinoma
Merkel cell carcinoma - rarely
NB atypical lymphocytes in epi in MF can resemble Pagets but usually referred to as epidermotropism and not pagetoid
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3
Q

What is DD of malignant spindle cell tumours of the dermis?

How do you distinguish?

A

SLAM DUNK
Spindle cell SCC - CK5/6
Leiomyosarcoma - desmin, smooth muscle actin (SMA)
Angiosarcoma - CD31 + 34
Melanoma (spindle/desmoplastic) - S100 + MelanA
DFSP - CD34 (factor 13a neg)
Undifferentiated pleomorphic sarcoma (AFX)-CD10, CD99
Nodular fasciitis - HSP47, actin
Kaposi’s sarcoma - HHV8 (also CD31 + 34)

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4
Q

Causes of Big blue balls in the dermis?

A 
Cylindroma 
Spiradenoma
Hidradenoma 
Sebaceous tumours
BCC
Trichilemomma
Glomus tumour
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5
Q

What is the differential for a blue cell tumour in the dermis?

A

Merkel cell carcinoma CK20 or CAM 5.2 paranuclear dot positivity
Lymphoma LCA
Pseudolymphoma
Metastatic small cell carcinoma of the lung TTF1
BCC
Melanoma S100, HMB45
SCC - if areas of squamous differentiation CK5/6

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6
Q

Which tumours show stroma-stroma clefting

A

Classicially;
Trichoepithelioma
Trichoblastoma

Occassioanllly seen in other lesions

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7
Q

What is DD for dirty socks appearance of epi?

A 
Solar lentigo
PUVA lentigo
Seb keratosis
Large cell acanthoma
Dermatofibroma
Lentigo maligna
Dowling Degos disease or Galli-Galli disease
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8
Q

Extramammary Paget’s disease IHC

A

CD23 +ve in mammary and extramammary Paget’s
EMPD is positive for pankeratin markers AE1/3, EMA, CEA, CK7
Do melanoma stains to exclude melanoma
Negative for S100, other MM markers and CD44
Pos GCDFP-15 and neg CK20 favours primary EMPD or cutaneous tumour
Pos CK20 and neg GCDFP-15 favours secondary disease of endodermal origin (internal malignancy)
Main DDs are MM and IEC

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9
Q

What are the poor prognostic histo features for Merkel cell carcinoma ?

A 
5DDD
tumour 5mm or larger
Dense mononuclear inflammatory cell infiltrate
Deep extension into subcutis
Diffuse growth pattern
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10
Q

IHC for mammary Paget’s disease

A

positive for CEA, EMA, CAM 5.2 and usually positive for S100 (nb EMPD is S100 -ve)
PAS +ve and diastase resistant
CD23 +ve in mammary and extramammary Paget’s

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11
Q

What are important points in leiomyosarcoma?

A

Painful
Any mitoses at all in a dermal smooth muscle tumour is enough to call it leiomyosarcoma
If confined to dermis - no metastatic potential
If extends into fat - risk of mets
stain w/ desmin or smooth muscle actin

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12
Q

How do you distinguish Glomus tumour and Glomulovenous malformation?

A

If mainly solid tumour with a few vascular channels its a glomus tumour
If mainly vascular spaces and little solid tumour its a glomulovenous malformation (glomangioma is old name)

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13
Q

What are the DDs for a dilated pore of Winer?

A

Pilar sheath acanthoma - shallow

Trichofolliculoma - large and branching

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14
Q

What are the features of Langerhans cell histiocytosis?
what are the special stains?
What special test can be done and what is the finding?

A

Papillary dermal infiltrate of blue cells
cells have reniform, coffee bean nuclei
can be Langerhans cell epidermotropism
May have pseudo-pautrier (Langerhans cell) microabscesses
Overlying epi may be eroded
stains +ve for S100, CD1a, Langerin (CD207)
NB EM shows cytoplasmic Birbeck ganules expressing CD207 (tennis racket shaped inclusions)

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15
Q

How do you distinguish sebaceous adenoma and sebaceoma?

A

Sebaceos adenoma has mainly clear sebaceous cells (adenoid means glandular)
sebaceoma hs mainly dark blue cells and only scattered clear cells

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16
Q

Acantholytic dyskeratosis – DDs

A

Grovers - only one thats significantly spongiotic; varying degree of FOCAL Acanth & Dysk
Dariers – some acantholysis, lots of dyskeratosis, can be benign AK-like change in adjacent epi
Hailey-Hailey – lots of acantholysis, little dyskeratosis (dilapidated brick wall)
Epidermal naevus
Warty dyskeratoma
Acantholytic dyskeratoma
NB pemphigus vulgaris has acantholysis w/out dyskeratosis (tombstoning)

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17
Q

Which tumours arise from an organoid naevus?

A 
SCAP
trichoblastoma
BCC
SCC
KA
18
Q

What are the features of a neurofibroma?

A 
bland wavy neural spindle cell dermal tumour
fibrillar stroma - 'shredded carrot'
Mast cells
Grenz zone
S100 +ve
19
Q

Which lesions can appear to be attached to the epidermis by struts

A

T-FIRE
Tumour of the follicular infindibulum - most typical
Fobroepithelioma of pinkus (pink between struts-pinkas)
Inverted follicular keratosis
Reticulated seborrhoeic keratosis
Eccrine poroma

20
Q

What are the features of an inverted follicular keratosis?

A

well circumscibed dermal tumour (benign architecture)
kertin cysts
squamous eddies - characteristic
may be follicular structures
Some mitoses and atypia but not malignant
Basically an endophytic irritated seb K

21
Q

What are the features of a Spitz naevus?

A

Nests of cells in epi but no pagetoid spread
Composed usually of spindle shaped melanocytes but can be epithelioid cells or mixed
Clefting around nests
shoals of fish or ‘raining down’ growth pattern
kamino bodies in epi
few mitoses, little pleomorphism
P16 +ve (like benign naevi)
HMB45 +ve in junctional but not deeper part (like benign naevi)

22
Q

Which stains are positive in BCC?

histo viva 2014

A

BerEp4 most specific (but alos posiitve in trichoepithelioma or DTE
Bcl2 also positive

23
Q

Many plasma cells lesion differential?

A

SCAP
Kaposis sarcoma
cutaneous plasmacytoma

24
Q

Grenz zone DDs

A 
Granuloma faciale
AFX
Neurofibroma
Dermatofibroma
Colloid milium
Acrodermatitis chronica atrophicans
Lepromatous leprosy
Pseudolymphoma 
Borrelial lymphocytoma
Lymphoma - types;
- CD30+ cALCL
- MF (rarely)
- Marginal zone B cell lymphoma
- Follicle centre B cell lymphoma
- Diffuse large B cell lymphoma, leg type
25
Q

What is the DD for a spindle cell Tumour which looks shelled out from the dermis?

A

A Nice S(c)hell
Angioleiomyoma
Neurilemmoma
Schwannoma

26
Q

What is the histo of elastosis perforans serpiginosa?

A

claw like epidermal down growths surrounds basophilic debris, fibrin, inflammatory & granulation tissue
epidermis hyperplastic & acanthotic
plug of crusting/ HK and variable PK
aggregates of Neuts or Lymphocytes
within plugs is horny material in upper 1/3, amorphous debris in lower 2/3
Foreign body giant cell rxn underlying plug
brightly eosinophilic elastic tissue +++ in sup dermis
Van geison stain = black

27
Q

What are Clark’s levels?

A 
L1 = in situ (in epidermis)
L2 = into papillary dermis
L3 = filling papillary dermis (to superficial vascular plexus)
L4 = into reticular dermis
L5 = into subcutis
28
Q

What is the DD for lesion with multiple small cysts and strands of cells in upper dermis?

A

Desmoplastic trichoepithelioma - merkel cells
Syringoma
Microcystic adnexal carcimoma
Morphoeic (infiltrating/sclerosing) BCC

29
Q

Papule on finger DD

A 
Common wart
Digital fibrokeratoma
Mucoid cyst
Skin cancer
Rare;
Glomus tumour (subungual, painful)
Storiform collagenoma - plywood
Neonates/Infants; Infantile digital fibroma
30
Q

Where are the types of/conditions associated with angiofibromas?

A

Benign fibrous papule of face
Multiple facial angiofibromas in TSC or MEN1
Pearly penile papules or vestibular papillomatosis
Rare;
Perifollicular fibroma
Familial myxovascular fibromas
Multinucleate cell angiohistiocytoma

31
Q

Where are the types of angiokeratomas?

A

My Ford Car Solely Plays CDs (K for Ka - as in Ford Ka and angioKeratoma)

Angiokeratoma of Mibelli
Angiokeratoma of Fordyce (scrotal angiokeratoma)
Angiokeratoma Circumscriptum
Solitary Papular angiokeratoma
Angiokeratoma Corporis Diffusum
32
Q

What is the ‘promontary sign’?

In what lesions is it seen?

A

protrusion of native vascular structures into the lumina of ectatic neoplastic channels
characteristic of Kaposis sarcoma

33
Q

What diameter is the field on the Olympus x2 lens?

A

11mm

34
Q

How much shrinkage occurs in skin samples with processing?

A

Up to 30%

35
Q

Which cysts have stratified squamous epithelium?

A

Epidermoid cyst (small+superficial = Milium)
Vellus hair cyst (contains hairs)
Dermoid cyst (hair follicles + glands)
Tricholemmal (Pilar) cyst (no granular layer)
Steatocystoma (eosinophilic cuticle + seb glands)
Pigmented follicular cyst
Ear pit cyst
Pilonidal cyst

36
Q

Which cysts have non-stratified epithelium?

A 
Hidrocystoma
-eccrine (1-2 layers, no apocrine secetion)
-apocrine (2+ layers, apocrine secretion)
Bronchogenic cyst
Thyroglossal duct cyst
Branchial cleft cyst
Ciliated cyst of vulva
Median raphe cyst
37
Q

Which cysts have no lining?

A

Mucocele
Digital myxoid cyst
Ganglion

38
Q

Which cyst has squamous epidermal type epithelium but without a granular layer?

A

Trichilemmal cyst

Contains dense compact keratin often with calcification

39
Q

Lesions with horn cyst?

A 
Seb k
Inverted follicular keratosis
Trichoepithelioma
Trichoadenoma
Keratotic BCC
MAC
Rarely in;
Melanocytic naevus
Nodular hidradenoma
40
Q

What is DD for papillomatous lesions

A 
Wart
Seb k
Epidermolytic hyperkeratosis
IEC or SCC
Acral melanoma
Porokeratosis ptychotropica

Histopathology Dan (2 decks)

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