Malignancy

Question 0

Nodular BCC

Answer 0

Large atypical basaloid tumor islands
Peripheral palisading retraction clefting
Pigmented- melanin pigment tumor/stroma- dendritic melanocytes
Epidermal ulceration

Question 1

Bowen

Answer 1

Thickened epidermis
Complete replaced full thickness atypical pleomorphic cells
Numerous apoptotic keratinocytes, abnormal mitotic figures
Basement membrane intact, absent dermal invasion

Question 2

Superficial BCC

Answer 2

Multifocal tumor islands high papillary dermis
Attached undersurface epidermis
Peripheral pallisading, retraction clefting

Question 3

Morpheic

Answer 3

Infiltrative cords cells single-few layered thickness
Cords dissect collagen within sclerotic stroma( hyalinised- morpheic)
Perineural invasion

Question 4

Squamous cell carcinoma

Answer 4

Hyperkeratosis papillomatosis
Tongues of squamous proliferations
invading dermis
Tumor cells large pale atypical keratinocytes, keratotic differentiation
(Single cell keratinisation, keratin cysts)
Infiltrative lower border, mixed inflammatory infiltrate

Question 5

EMPD

Answer 5

Nested proliferation
Large Pale neoplastic Paget’s cells (with atypical nuclei)
Basal epidermis, varying levels throughout epidermis
Groups flatten basal cells. multifocal with skip areas
no dyskeratosis

Question 6

Bowens stains

Answer 6

negative for CK7, EMA, CEA

positive for high molecular weight keratins

Question 7

EMPD stains

Answer 7

PAS+ diastase resistant CEA EMA CK+
Alcian blue, mucicarmine
Gross cystic disease fluid protein

Question 8

Clear cell acanthoma

Answer 8

• Scale-crust
• Neutrophils in epidermis, microabscesses stratum corneum
• Psoriasiform proliferation pale (“clear”)keratinocyte, sharp demarcation
• glycogen PAS-positive, diastase labile
• Perivascular lymphocytes, Dilated blood vessels edematous pale dermal papillae

Question 9

Epidermal nevus

Answer 9

Hyperkeratosis, papillomatosis, acanthosis, hypergranulosis
Epidermolytic hyperkeratosis rarely
Acantholytic dyskeratosis rarely
Perivascular lymphocytes often

Question 10

Epidermal nevus etiology

Answer 10

post-zygotic somatic mosaicism for mutations in the FGFR3 gene or PIK3CA gene

Question 11

Porokeratosis

Answer 11

Cornoid lamella (angulated column of parakeratosis)
under which hypogranulosis
dyskeratosis keratinocytes or pale staining
Epidermis normal, hyperplastic, atrophic
Perivascular (1.109) or lichenoid (1.72) lymphocytes,

Question 12

AK

Answer 12

-hyperkeratosis, ulceration
-Parakeratosis overlying atypical keratinocytes sparing epidermis over adnexa (“alternating” pink and blue hue in stratum corneum “flag sign”)
-Atypical keratinocytes deeper epithelium
loss maturation, hyperchromatism, pleomorphism, increased mitoses, dyskeratosis
-Multiple buds into papillary dermis
-Perivascular lichenoid lymphocytes, plasma cells
-Solar elastosis in the dermis

Question 13

features of malignancy

Answer 13

Atypical( keratinocytes, basaloid cells) 
hyperchromatic, pleomorphic, 
atypical mitoses, dyskeratosis
Loss of maturation with descent 
Dermis invasion, perineural

Question 14

sebaceous neoplasms plus KA

Answer 14

Muir–Torre syndrome

Question 15

KA

Answer 15

• Dome shaped lesion -Keratin-filled crater btw epidermal lips
• Thickened epidermis Pale, eosinophilic, glassy, well-differentiated epithelial proliferation
• squamous eddies or keratin pearls
• microabscesses neutrophils within epithelium
• mild Cytologic atypia of keratinocytes
• Elastic fibers within epithelium base
• Perivascular or lichenoid infiltrate of lymphocytes, eosinophils, plasma cells