Neoplastic Derm Flashcards
1
Q
Primary cutaneous b cell neoplasm are usually staining positive for
A
CD20 and 79a (1979- china instituted 1 boy policy)
2
Q
priamry cutaneous diffuse large b cell lymphoma, leg type stain
A
BCL6 and BCL2 positive, MUM1 positive (elderly mum)
3
Q
ppl with intravascular b cell lymphoma can also have what clincal features
A
thrombosis in CNS, causing neuro deficits
4
Q
dermatofibroma staining (4 postives and 1 negative)
A
CD34 negative. Positive for (factor 13, CD10, stromelysin, D2-40)
5
Q
DFSP associated w what fusion gene
A
DFSP affects people 17 to22yo Called Pat t(7,22) COL1A1-PDGFB fusion
6
Q
Metastatic DFSP tx?
A
imatinib (46% response rate)
7
Q
what pediatric disease has the same translocation as DFSP?
A
Giant cell fibroblastoma
8
Q
Spindled SCC stains for
A
CK5/6, p63 (mucinous carcinoma primary cutaneous, poor prognosis for merkel), p40
9
Q
Desmin positive in
A
leiomyosarcoma, angioleiomyosarcoma
10
Q
Angiofibromas have 2 other names
A
fibrous papule, peraly penile papule
11
Q
Facial and periungal angiofibromas a/w what 3 sundromes
A
TS, MEN1, and Birt Hogg Dube
12
Q
Sclerotic fibromas associated with
A
Cowden
13
Q
Acral fibrokeratoma vs supernumeray digit: histology
A
supernumery digit has nerve fascicles
14
Q
Inclusion body fibromatosis, prognosis?
A
50% recurrence
15
Q
Inclusion body fibromatosis, inclusions are?
A
Actin, stain red with trichrome
16
Q
Deep desmoid tumor a/w what tumor?
A
Gardner’s syndrome
17
Q
Nodular fasciitis histology:
A
Well-circumscribed deep noudde with myoid stroma, frequent mitoses and extravasated RBCs
18
Q
Fibrous hamartoma of infancy histology:
A
mature fat, immagure mesenchymal cell, spindle cells in fascicles
19
Q
Infantile myofibromatosis is the most common fibromatosis in kids. Histology:
A
biphasic population with staghorn vessels
20
Q
Neoplasm with numerou osteoclastic giant cell?
A
Giant cell tumor of the tendon sheath
21
Q
Pyogenic granuloma of prengnacy appears where?
A
gingiva
22
Q
Angiosarcoma stains?
A
CD31, CD34, ERG, FLI-1
23
Q
The spindle cells in Spindle cell lipoma stain for?
A
CD34 positive
24
Q
Spindle cell lipoma vs pleomorphic lipoma on histology?
A
pleomorphic lipom as floret giant cells
25
Most common location for a spindle cell lipoma?
shoulder/posterior neck of men
26
Syringofibroadenoma looks like what on pathology?
Looks like a finger comb (fingers of the comb have ductal differentiation)
27
What is syringofibroadenoma associated with?
Chronic staiss dermatitis, Schopf-Schulz Passarge, Clouston syndrome
28
Mucinous carcinomas on the face are almost always primary. Ones on the trunk d/t
metastasis of visceral malignancy (breast, lung, ovaria, GI)
29
Adenoid cystic carcinoma can be primary or a cutaneous metastasis from ? Prognosis?
salivary gland. If metastatic, then highly aggressive and high mortality
30
Adenoid cystic carcinoma of primary cutaneous occur on? Prognosis
Occur on scalp, indolent tumor, no mets but high local recurrence rate
31
SPAP has abundant what type of cells?
plasma cells
32
Primary cutaneous mucinous carcinoma stains for what? Positive for?
AE1/AE3, CAM5/2, EMA, CEA, CK7, ER, PR, Neuroendocrine markers
33
How do you confirm the cutaneous origin for mucinous carcinoma?
by finding a myoepithelial layer (stain for p63, SMA, calponin)
34
Primary cutaneous mucinous carcinoma stains for what? NEgative for?
CK20
35
GI metastasis of Mucinous carcinoma would stain positive for?
CK20, sulfomucin NOT sialomucin (in primary cutaneous mucinous carcinoma)
36
Schimmelpenning syndrome
extensive nevus sebaceous, seizeures, mental retardation
37
Birt Hogg Dube a/w what cancers?
RCC and medullary carcinoma of the thyroid and pneumothroax, pulonary cysts
38
Trichoepithelioma found where?
On the central face like the nose, NLF, lip
39
Trichoepithelioma stains with what?
Scattered CK20 merkel cells within tumor, PHLDA1, peripheral Bcl2
40
Trichoep vs BCC staining: Bcl2
Bcl2 is diffusely positive in BCC, but only stains the periphery on trichoep
41
Trichoep stroma stains for
CD34+ and CD10+
42
Trichoep vs BCC staining: Androgen Receptor
Androgen Receptor is posivie in most BCC negative in trichoep
43
Trichoep vs BCC staining: CD10
BCC stroma is negative for CD 10
44
Syndromes with multiple trichoepitheliomas?
Brooke Spiegler and Rombo syndrome (atrophoderma, acrofacial vasodilation and cyanosis)
45
Trichoep vs BCC staining: PHLDA1
positive in Tricho ep (stains benign follicular tumor) and negative in BCC
46
BCC stains positive for ? Negative for?
Positive for BCL2, negative for CK20, Phlda1, CD10 (stroma)
47
Desmoplastic trichoep stains positive for
CK20 and PHLDA (which would be negative in morpheaform BCC)
48
Trichilemmomma clear cells derived from glycogen that resembles the ? Stains for
outer root sheath. Stains for CD34
49
desmoplastic trichoemmoma vs invasive SCC, how do you differentiate on pathology?
Look at the peripherla to identify conventional trichilemmoma features
50
juxtaclavicular beaded lines is what?
sebaceous hyperplasia
51
Most common sebaceous neoplasm associated with muir torre?
sebacenous adenoma
52
How is a sebaceous adenoma different from a sebaceoma on location?
sebaceous adenoma opens broadly to the skin surface while a sebaceoma is purely intradermal
53
Sebaceoma has what percent basaloid cells compared to sebaceous adenoma
Sebaceoma has greater than 50% basaloid cells
54
mucosal neuromas in MEN2B similar to what neural neoplasm
palisaded encapsulated neuroma
55
Schwannomas stain with what? Negative for?
Schwann cells (S100) and Perineurial Capsul (EMA) with NO AXONS (negative for neurofilaments).
56
How does schwannoma staining differ from NF/PEN/Traumatic neuroma
NO AXONS (negative for neurofilaments). Vs NF, PEN, traumatic neuromas, which have axons
57
neurothekeoma found where on the body
found on the fingers
58
how is neurothekeoma staining different from cellular neurothekeoma staining?
cellular neurothekeoma is always S100 negative, but positive for S100A6+, NKI/C3+, PGP9.5+
59
Cellular neurothekeoma looks like?
fascicles of epitheliod cells recembling spitz nevus cells
60
Granular cell inclusion callsed
pustulo-ovoid bodies of milian which are aggregated lysosomes
61
Merkel cell associated with what virus?
merkel cell polyomavirus
62
Merkel cell vs small cell lung cancer
Small cell lung cancer is TTF 1 positive and CK7 positive
63
what portends a worse prognosis in merkel cell?
p63 expression and diameter greater than 2cm
64
Angioleiomyoma vs myopericytoma staining?
Angioleiomyoma is desmin positive
65
Do leiomyosarcomas have a high risk of metastasis?
Dermal LMS has a 10% metastatic rate. Subcutaneous LMS is more aggressive
66
Hypopigmented MF markers
CD8 pos CD4 neg
67
Ppl with granulomatous slack skin at risk of
NHL 30%
68
Adult T cell leukemia looks like what on pathology? Stains for
Looks like a clover leaf. CD 25+
69
LyP mnemonic
Read more than 30 and you'll be great. Reed, MF, 30+ ALCL, CD8
70
Tx for LyP
MTX
71
LyP patient at at risk for
20% have MF, ALCL, Hodgkin's lymphoma
72
Primary cutaneous ALCL vs systemic ALCL
primary cutaneoue ALCL lack ALK translocation.
73
Subcutanoue panniculitis like Tcell lymphoma stain for
Positive for (CD8, TIA, Granzyme B) Negative for (CD4, CD56)
74
CD56 stains
Mommy born in 1956 and is Natural Killer
75
Primary cutaneous gamma-delta T cell lymphoma stains for
Positive for (CD56, Granzyme, TIA) Negative for (CD4,CD8, BF1)
76
Seborrheic keratosis associated with
sun exposure and FGFR3 and PIK3CA mutations
77
Porokeratosis of Mibielli onset? Presnetation?
Onset in infancy or childhood with 3cm large circinate plaque on extremities
78
Linear Porokeratosis presents as?
Onet in newborns. Follow lines of blashko
79
Histology for porokeratotic eccrine ostial and dermal duct nevus?
Abundant cornoid lamellae arising from acrosyringium
80
Risk of tranformation to SCC in porokeratosis?
Highest in linear porokeratosis, lowest in punctate, DSAP is second lowest
81
Stucco keratosis associated with which HPV?
HPV 23b
82
Inverted follicular keratosis most commonly found on
cheek and upper lip
83
Histology for IFK?
Endophytic SK with prominent squamous eddied
84
Nevus comedonicus see on what part of the body? Worsens during?
See as a linear array on face. Worsens during puberty
85
Flegel disease presents as ? Histology
discs on distal extremities. Absent/altered lamellar granules (odland bodies) on EM
86
What does UV cause AK? Which UV A or B
UVB causes thymidine dimers (C T or CT)
87
Increasing risk of metastases in Invasive SCC at how much of a breslow depth?
greater than 2mm
88
Increased risk of SCC in pt taking what medications?
voriconazole, vemurafenib, RA pts on MTX and etanercept
89
Verrucous carcinoma HPV
HPV 6 and HPV 11
90
What type of Kas do not involute?
subungal KAs
91
Ferugson Smith onset of KA? Natural history?
Onset in 30's on sunexposed areas. Resolves spontaneously
92
Grzybowski onset of KA? Natural history?
Oneset later in adulthood and can involave airway.
93
most common mutations in BCC?
Patch and p53
94
BCC syndrome mnmonic
Green Berets Rarely Buy Xtra Shoes, but the get a lot of BCCs from being in the sun
95
BCC syndromes
Gorlins, Bazex Dupre, Rombo, Brooke Spiegler, XP, Schopf Schulz Passarge
96
Pilar cyst inherited?
AD inheritance
97
Steatocystoma muliplex are inherited how?
Inherited AD
98
Hidrocytomas can be associated with what syndrome?
Schopf Scheulz Passarge, also no teeth, hair, PPK (AR inheritance)
99
bronchogenic cyst: where? Histology?
suprasternal notch, see cartilage, smooth muscle and GOBLET cells
100
acral mucosal melanoma mutation?
ckit, CDK4
101
BAP1 mutation can be associated with what cancers?
Uveal melanoma, mesothelioma, RCC, malignant cellular blue, epithelioid spitzoid nevi
102
What is the natural history of a porocarcinoma?
frequent metastasis (20 percent to LN) and 10 percent mortality
103
clear cell syringoma associated wit?
diabetes mellitus
104
Mixed tumor most commonly see on what part of body?
nose, cheek, upper lip
105
Spiradenoma is apocrine or eccrine?
apocrine
106
Spiradnoma hyaline droplets are made of what? Stains with?
BMZ type 4 collagen. PAS positive
107
Papillary eccrine adenoma seen in who?
black women on the legs. Looks like many dilated ducts in a fibrotic stroma
108
tubular apocrin adenoma (TAA) is often indistinguishable from?
From papillary eccrine adenoma.
109
tubular apocrin adenoma (TAA) found where, asscoiated with?
Forund on the scalp. Associated with nevus sebaceus
110
brachial cleft cyst: where? Histology?
Lateral neck, dense lymphoid follicles
111
Cafeau lait are also associated with what 3 syndromes? Mnemonic ?
Black no milk. Bloom, Noonan, MEN1
112
ppl with nevus of Ota are at increased risk for?
10 percent develop glaucoma, and rarely also uveal melanoma
113
Blue nevus mutatoin?
Blue jeans. GNAQ GNA11
114
Malignant blue neuvs arrises from what type of blue nevus, where? mutation?
cellular blue on scalp. In addition to GNAQ, also have BAP1 loss
115
Drug induced halo neuvs?
infliximab
116
Atypical eithelioid spitz have what mutatoins?
HRAS mutation, BRAF mutation, BAP 1 mutation
117
Spitz nevus immunostains?
Positive for S100A6, S100, p16
118
What stain is lost in spitzoid melanoma?
p16 positive
119
What gene locus is helpfu in risk stratification of spitz?
Homoyzgous loss of 9p21 (p16, CDKN2a) have increased risk of metastasis
120
Congenital melanocytic nevus mutation?
NRAS
121
Acquired melanocytic nevus mutation?
BRAF
122
What does CDKN2A gene encode?
p14 and p16
123
Non-sun damaged skin mutation?
BRAF
124
Sun damaged skin mutation?
NRAS
