Path Flashcards by Daniel Long

Increased melanin pigmentation along basal layer of epidermis (stratum basalis) but without acanthosis of epidermis

Ephelis (Freckle)

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Similar to ephelis but with acanthosis of epidermis with elongation of rete ridges and increased melanin pigmentation at base of rete ridges

Lentigo

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Nests of melanocytes at dermo-epidermal junction only

Junctional melanocytic Nevi

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Nests of melanocytes in dermis only

Intradermal melanocytic Nevi

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Nests of melanocytes both at dermo-epidermal junction and in dermis

Compound melanocytic nevi

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Spindle-shaped melanocytes usually with lots of melanin pigmentation usually in dermis

Blue melanocytic nevi

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Nests of melanocytes at dermo-epidermal junction stretching from rete ridge to adjoining rete ridge, surrounding lamellar fibrosis and peri-vascular chronic inflammation

Dysplastic Melanocytic Nevi

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Localized loss of skin pigmentation due to autoimmune destruction of melanocytes

Vitiligo

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Cells showing Melanocytic differentiation. Positive for S-100 antigen and HMB-45 antigen, melanosomes and pre-melanosomes in cytoplasms on transmission electron microscopy

Malignant melanoma

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This usually begins de novo with atypical nested proliferation at dermo-epidermal junction then with PAGETOID GROWTH within epidermis (in situ) then invades dermis

Malignant melanoma histologic Dx

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What is the greatest neoplastic depth of invasion in mm from granular layer of epidermis (measurement scale in malignant melanoma)

Breslow’s levels

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Malignant Melanoma in situ (in epidermis only - should NOT metastasize). = Clark’s level _____

One

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Clarks Level _____: Neoplasm invading but not filling papillary dermis

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Clark’s Level _____: Neoplasm invading and filling papillary dermis

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Clark’s Level ____: Neoplasm invading into reticular dermis

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Clark’s Level _____: Neoplasm invading into adipose tissue of subcutis

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Cells showing Melanocytic differentiation. Positive for S-100 antigen and HMB-45 antigen, melanosomes and pre-melanosomes in cytoplasms on transmission electron microscopy

Malignant melanoma

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This usually begins de novo with atypical nested proliferation at dermo-epidermal junction then with PAGETOID GROWTH within epidermis (in situ) then invades dermis

Malignant melanoma histologic Dx

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What is the greatest neoplastic depth of invasion in mm from granular layer of epidermis (measurement scale in malignant melanoma)

Breslow’s levels

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Malignant Melanoma in situ (in epidermis only - should NOT metastasize). = Clark’s level _____

One

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Clarks Level _____: Neoplasm invading but not filling papillary dermis

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Clark’s Level _____: Neoplasm invading and filling papillary dermis

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Clark’s Level ____: Neoplasm invading into reticular dermis

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Clark’s Level _____: Neoplasm invading into adipose tissue of subcutis

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A subtype of Malignant Melanoma: predominantly horizontal growth

Superficial spreading

A subtype of Malignant melanoma: Vertical growth

Nodular

A subtype of malignant melanoma: Occurs on hands/feet

Acral-Lentiginous... Note: Acral = hands/feet

A subtype of Malignant Melanoma: Spindle cell differentiation - malignant form of blue melanocytic nevus - usually does not show epidermal involvement

Neurotropic

INTRADERMAL BULLA WITH EOSINOPHILS as predominant inflammatory cell. Direct immunofluorescence: LINEAR deposition of IgG BETWEEN KERATINOCYTES IN EPIDERMIS

Pemphigus

SUBEPIDERMAL bulla with EOSINOPHIL as predominant inflammatory cell. Direct Immunofluorescence: LINEAR deposits of IgG ALONG BASEMEMT MEMBRANE (Dermo-epidermal junction)

Bullous Pemphigoid

SUBEPIDERMAL bulla with INFILTRATES OF NEUTROPHILS mostly in PAPILLARY DERMIS (Papillitis). Direct Immunofluoresnce: Deposits of IgA mostly in Papillary dermis

Dermatitis Herpetiformis

SUBEPIDERMAL bulla with NEUTROPHILS and/or EOSINOPHILS. | Direct immunofluoresnce: LINEAR deposition of IgA along Basement membrane (Dermo-epidermal junction)

Linear IgA Bullous Dermatosis - A cross between Bullous Pemphigoid and Dermatitis Herpetiformis

Masklike zone of facial hyperpigmentation commonly seen in pregnancy and oral contraceptive use

Melasma

2 Histologic types of melasma

1. Epidermal: increased melanin deposition along the basal layer of the epidermis. 2. Dermal type: characterized by macrophages which have melanin pigment in their cytoplasm (melanin pigment incontinence)

Precursor of malignant melanoma

Dysplastic melanocytic nevus: either junctional or compound which shows nests of melanocytes which stretch from rete ridge to rete ridge.

In a malignant Melanoma - the depth with delinates a good prognosis from bad is ____

0.76 mm of tumor invasion

Round, flat, coinlike plaques. arise spontaneously. Epidermis shows proliferation of benign basaloid keratinocytes with hyperkeratosis and horn pseudocyst formation.

Seborrheic keratoses

Sign of Leser-Trelat.

Explosively large number of Seborrheic keratoses indicative of paraneoplsatic syndrome (GI)

Thickened and hyperpigmented zones of skin involving most commonly teh flexural areas.

Acanthosis Nigricans. Benign: Puberty Malignant: middle age. Assocaition with internal adenocarcinoma

Soft, flesh-colred baglike tumor attached to the skin surface by a stalk. Has a fibrovascular core.

Fibroepithelial Polyp/ Skin Tag Acrochordon/ Squamous papilloma

Formed by the down growth and cystic expansion of the epidermis or the keratinizing epithelium forming the hair follicle. Filled with keratin and variable amounts of admixed lipid-containing debris derived from sebaceous glands.

Epithelial cyst (Wen)

Type of Epithelial cyst: lined with bening epithelium resembling the normal epidermis

Epidermal inclusion cyst

Type of Epithelial cyst: lined by epithelium resembling the follicular eptihelium without a granular layer and are not filled with keratin. Are filled with homogenous eosinophilic material with can undergo dystrophic calcification

Pilar or Trichilemmal cysts

Type of Epithelial cyst: epidermal eappendages srrounding the wall of the cyst

Dermoid cyst

Type of Epithelail cyst: lined by epithelium resembling a sebaceous gland duct in which there are numerous compressed lobules of sebaceous galnds

Steatocystoma multiplex

Charactertic "Glassy" eosinophilic cytoplasm - central, keratin-filled crater. Rapidly devleoping. Spontaneously healing. Benign. Flesh-colored, dome-shaped nodule with a central, keratin-filled plug

Keratoacanthoma

Rough-sandpaper-like consistency lesion of less than 1 cm in diameter. May have so much keratina cutaneous horn devleops. Cytologic atypia. Increased elastin fibers in teh dermis (solar elastosis)

Actinic Keratosis

in-situ: Red scaling plaque. Invasive: nodular, variable keratin production, hyperkeratotic lesion that may ulcerate. Oral = Leukoplakia.

Squamous Cell Carcinoma

Slow growing cutanous carcinoma. Presents as PEARLY PAPULES and often show prominent dilated dermal blood vessels (telangiectasia. Advanced tumors may ulcerate(local invasion of bone or facial sinuses = "rodent ulcer". Palisaded growth of basaloid epithelial cells

Basal Cell Carcinoma

***What is the worst subtype of Basal Cell carcinoma?

Morphea (Sclerosing) subtype

Potentially lethal tumors composed of small, round, malignant cells which contain neurosecretory-type cytoplasmic granules ****

Merkel Cell Carcinoma (Cutaneous Neuroendocrine Carcinoma)

Heterogenous family of realted bening dermal neoplasms of fibroblasts and histiocytes. Seen on LEGS. Benign proliferation of fibroblasts with deposits of dense collagen. Infiltrate of histiocytes = Foamy macrophages.

Benign Fibrous Histiocytoma (Dermatofibroma = most common kind)

Slow growing, locally aggressive. Most common on TRUNK. develop as aggregated "protuberant" tumors within a firm, indurated plaque and can ulcerate. atypical fibroblasts arranged in a basket-weave pattern = "Storiform"

Dermatofibrosarcoma Protuberans

Tumor like collections of foamy histiocytes within the dermis.

Xanthoma

Sudden showers of yellow papules which increase and decrease secondary to variations in plama triglyceride - butt, posterior thigh, knee, elbow

Eruptive Xanthoma

Birbeck granules on electron microscope. Eosinophils - lesion is an eosinophilic granuloma.

Langerhans cell Histiocytosis, Histiocytosis X

Cutaneous lesions show scaly, red-brown patches; raised. Seeding of blod by malignant T-lymphoid cells accompanied by diffuse erythema and scaling of the entire body surface (erythroderma) = SEZARY SYNDROME (CD4 +); PAUTRIER'S MICROABSCESSES

Mycosis Fungoides

Localized mast cell degranulation and resultant dermal microvascular hyperpermeability which results in pruritic edematous wheals

Urticaria

Uticaria locatiosn

Trunk, distal extremities, ears

Rash resulting froma ntigen-induced release of vasoactive mediators from mast cell granules after sensitization of specific IgE antiboides

Urticaria

Red, papulovesiculr, oozing and crusted lesions and with persistence will change into raised scaling plaques

Eczematous Dermatitis

Self-limiting skin disorder which is believed to be a hypersensitivity response to certain infections and drugs. TARGET LESIONS. HALLMARK = NECROTIC KERATINOCYTES IN THE EPIDERMIS

Erythema Multiforme

Extensive and symptomatic febrile from of erythema multiforme - more common in children. Cutaneous erosions and hemorrhagic crusts involve teh lips and oral mcuosa and the conjuctiva, urethra, and genital

Steven-Johnson sydnrome

Diffuse necrosis and sloughing of the entire cutaneous and mucosal epithelial surface. related to erytehma multiforme

Toxic epidermal necrolysis

Inflammatory reaction of teh subcutaneous adipose tissue which can affect either principally the connective tissue septa separating lobules of fat or predominantly the lobules of fat themselves.

Panniculitis

Most common form of Panniculitis. Acute presentation. Ass with B hemolytic strep, TB, leprosy, drug admin (sulfonamids, OC)

Erythema nodosum

Panniculitis usually involves ____

lower legs

relapsing febrile nodular panniculitis. lobular, nonvasculitic panniculitis. Erythematous plaques or nodules. Lower extremities. Foamy histiocytes mixed with lymphocytes, neutorphoils, and giant epitheloid phistiocytes

Weber-Christian Disease

well-demarcated pink plaque covered by loosely adherent silver-white scale. Mostly on elbows, knees, calp, lumbosacral, intergluteal cleft, and glans penis

Psoriasis

Yellow-brown discoloration with pitting, dimpling, separation of the nail plate from underlying bed

Onycholysis - in Psoriasis

A self-limiting dermatosis leaving a zone of post-inflammatory hyperpigmentation. Lesion was pruritic, violaceous flat-topped papule

Lichen Planus

Version of Lupus Erythematousus NOT systemic

Discoid lupus erythematosus

Gets worse with sun exposure. See telangiectasia through atrophitic skin. Vaculoar degeneration. CHARACTERISTIC granular deposition of Ig and complememtn along the basement membrane

SLE

Autoimmune blistering disorder which occurs because of the lossof normal intercellular attachemtns between normal keratinocytes of the epidermis and squamous mucosal epithelium. 40-60 yo IgG, eosinophils

Pemphigus

Most common form of Pemphigus. Ruptures Easily!

Pemphigus vulgaris - scalp, face, axilla, groun, trunk, points of pressure.

IgG, eosinophils, subepidermal, nonacantholytic blisters with tense bullae (no rupture), inner aspects of thighs, flexor surface of arms, axillae, groin, and lower abdomine

Bullous Pemphigoid

IgA, neutorphils/fibrin. Extremely pruritic - bilaterally. Extesnor surfaces of elbows, knees, upper back and butt. Characterized by uticaria and vesicls. Celiac disease

Dermatitis Herpetiformis

Heal with scaring. exacerbated by exposure to sun. subepidermal vesicle with thickening surrounding the superficial blood vessels in dermis

Porphyria cutanea tarda

Blisters at sites of pressure

Epidermolysis bullosa