Pathology Flashcards
This is the condition where there is partial or complete autoimmune loss of pigment producing melanocytes.
Vitiligo
What is the condition that results in the inability to produce melanin pigment because of the loss of tyrosinase?
Albinism
This is a pigmented lesion of childhood and gingers, appear after skin exposure, and there is increased malanosomes.
Freckle (Ephelis)
Are the melocytes normal or increased in # in Ephelis?
Normal in #, slightly enlarged
This is the condition where there is masklike zone of facial hyperpigmentation of the cheeks, commonly seen in prengnacy and with use of oral contraceptives.
Melasma
True or False: Melasma typically resolves spontaneously after pregnancy.
True
Which type of melasma is there increased melanin deposition along the basal layer of the epidermis?
Epidermal type
Which type of cell has increased melanin in the dermal type of Melasma?
Macrophages
This is the first disorder which involves a proliferation of benign melanocytes, and refers to the hyperplasia of melanocytes which occurs at all ages and there is no gender or racial predilectation.
Lentigo.
True or False: like freckles, lentigines darken with exposure to sunlight.
False
They do not
What is the morphology of the individual melanocytes along the basal layer of the epidermis in Lentigo?
Melanocyte hyperplasia
What happens to the epidermis in lentigo?
Acanthosis (thickening) and elongation of rete ridges
These are benign neoplasma of melanocytes and show a nested prolfieration of melanocytes at the dermo-epidermal jxn ONLY.
Benign Melanocytic Nevus (Pigmented Mole)
What is is called where there is a Benign Melanocytic Nevus within the dermis only?
Intradermal melanocytic nevus
What is the general appearance of the Benign Melanocytic Nevus?
Flat macule or raised papule with symmetry, sharp borders, even color, and small diameter (<6mm).
What does a congenital nevus often present with at birth?
A hair
These are flat macules or slightly raised plaques with various pigmentationa nd irregular borders, and have an increased risk of developing malignant melanoma.
Dysplastic nevi
What are the histological features of Dysplastic nevi?
Junctional or compount
Surrounding lamellar fibrosis
Mild superficial perivascular infiltrate of lymphocytes and histiocytes
What % of pts with Dysplastic nevi develop malignant melanoma over an 8-yr follow up?
5%
What is the inheritance for dysplastic nevi, which is on p1 near Rh?
AD
This is the malignant deadly neoplasm of melanocytes.
Malignant melanoma
What 2 factors are malignant melanomas + for?
S-100 +
HMB-45 Ag
What is the treatment for malignant melanomas?
Surgical removal
What type of growth is described for a malignant melanoma if it grows along the skin surface?
Radial growth
This is the type of radial malignant melanoma of the face of sun-damaged old people.
Lentigo meligna
What is the prognosis of the superficial spreading type of radial malignant melanoma?
Great!
What type of growth of a malignant melanoma has an increased risk for mtastasis?
Vertical growth
What measure can u use for vertical malignant melanomas, which measures the thickness, which is the most importnat prognostic factor in predicting metastasis?
Breslow thickness
What type of malignant melanoma growth shows early vertical growth and has a poor prognosis?
Nodular growth
At what depth (in mm) does the risk of metastasis of a malignant melanoma becomes great?
> 0.76mm
This is the type of malignant melanoma which arises on the palms or soles, often in dark-skinned individuals, and is not related to UV exposure?
Acral lentiginous
Describe the following Clark levels for malignant melanomas:
I II III IV V
I- only epidermis II- into paillary dermis III- filling the papillary dermis IV- into reticular dermis V- into subQ
Which is worse: ocular spindle cell malignant melanomas, or ocular epithelioid malignant melanomas?
Ocular epithelioid
metastasis to liver
These are common benign tumors of hte squamous epidermis, typically in the elderly, and appear as round, waxy, flat, coin-like plaques.
Suborrheic keratosis
What are the histologyical features of Suborrheic keratosis around the hair follicle?
Benign basaloid keratinocytes with hyperkeratosis and horn pseudocyst formation.
This is a variant of Suborrheic keratosis, where there is an explosive # of Suborrheic keratosis and suggests an underlying carcinoma of the GI tract.
Leser-Trelat
This is the thickened and hyperpigmented skin (like velvet), and are common over flexural areas like the axillae, groin, and groin.
Acanthosis nigricans
What is the inheritance of Acanthosis nigricans?
AD
What endocrine abnormalitis is Acanthosis nigricans associated with?
DM
What other cancer is associated with Acanthosis nigricans, typically in persons of middle-age or older?
Internal adenocarcinoma (gastric carcinoma)
This is the lesion (aka acrochordon, squamous papilloma, or skin tag), around the neck.
Fibroepithelial polyp
What are the histological features of Fibroepithelial polyps?
Fibrovascular cores, covered by benign squamous epithelium
What 2 things are Fibroepithelial polyps assocaited within your body?
DM
Intestinal polyposis
These are lesions formed by the down growth and cystic expansion of the epidermis or keratinizing epitheloum forming the hair follicle.
Epithelial cyst (Wen)
What are Web filled with?
Keratin and various amts of admixed lipid containing debris from sebaceous glands.
Which form of Epithelial cyst are lined by benign epithelium resembling normal epidermis?
Epidermal inclusion cyst
Which form of Epithelial cyst are lined by epithelium resembling the follicular epithelium without a granular layer and are fileld with homogenous eosinophilic material that can undergo dystrophic calcification?
Pilar or Trichilemmal cysts
Which form of Epithelial cyst are similar to the epidermal inclusion cysts but it also shows epidermal appendages surrounding the wall of the cyst?
Dermoid cyst
Which form of Epithelial cyst are lined by epitheloum resembling a sebasceous gland duct in which there are numerous compressed lobules of sebaceous glands?
Stetocytoma multiplex
This is a rapidly developing neoplasm of the epidermis, resembles squamosu cell carcinoma, but is benign and heals spontaneously.
Keratoacantoma
What filles the fleshy dome Keratoacantomas?
Keratin (cup shaped)
This is the class of tumors which arise from the epidermal appendages (hair follicels, sebaceous glands, eccrine sweat glands and ducts, and apocrine sweat glands and ducts).
Adnexal (appendage) tumors
This is the lesion to sun-exposed skin that precedes invasive squamous cell carcinoma.
Actinic keratosis
What are the gross features of Actinic keratosis?
<1cm
Tan-brown/red/skin colored
Sandpaper consistency
This si the most common malignant tumor arising form sun-exposed areas in elderly pts.
Squamous cell carcinoma (SCC)
What are the risk factors for SCC?
Sun
Aresnic exposure
Chronic cutaneous ulcers
Xeroderma pigmentosum
True or False: SCC are sharply-defined, have red-scaling plaques, hyperkeratoic lesions, and have invasion through the BM.
False
They dont invade through the BM
Which lip does SCC present on?
Lower lip
What is it called when there is insitu SCC, and can presents as leukoplakia?
Bowen’s disease
These are common, slow-growing, cutanous carcinomas which rarely metastisize, often in sun-exposed areas, oftne in XP patients.
Basal cell carcinoma (BCC)
What is the gross appearance of BCC?
Pearly papules
Telangiectasias
Possible ulceration and invasion (rodent ulcers)
Which lip do BCC present on?
UPPER lip
“”"”B”””
(__S__)
Which cell layer of the epidermis does BCC resemble?
Basal layer
lol
What are the histplogical features of BCC?
Palisated growht of basaloid epithelial cells surrounded by a benign proliferation of fibroblasts.
Which type of BCC is aggressive and is composed of small nests of malignant cells surrounded by desmoplastic fibrous connective tissue?
Fibroblastic or Morphea subtype
What is teh Tx for BCC?
CUT IT OUT
This is the rare malignant neoplasm derived from Merkel cells, NCC derived.
Merkel cell carcinoma (cutaneous neuroendocrine carcinoma)
What ar ethe histological features of Merkel cell carcinoma?
Small, round, malignant cells which contain neurosecretory-type cytoplasmic granules
This is the heterogenous family of related benign dermal neoplasms of fibroblasts and histiocytes, seen in adults and seen in the legs of young and middle aged women?
Benign Fibrous Histiocytoma
What are the gross features of Benign Fibrous Histiocytoma?
Tan-brown firm papules
Slightly tender
What type of Benign Fibrous Histiocytoma is a benign prolfieration of fibroblasts with deposition of dense collagen and may show an infiltrate of histiocytes including foamy macrophages or even giant epitheloid histiocytes?
Dermatofibroma
This is a well-differentiated primary fibrosarcoma of the skin, slow growing, locally aggressive, and rarely metastasize.
Dermatofibrosarcoma Protuberans
What are the common location for theese firm, solid Dermatofibrosarcoma Protuberans?
Trunk
What can Dermatofibrosarcoma Protuberans form, which there is a firm, indurated plaque and ulceration?
Protuberant tumors
What are the histological features of Dermatofibrosarcoma Protuberans?
Atypical fibroblasts arranged in a basket-weave pattern (storiform)
What is the Tx for Dermatofibrosarcoma Protuberans?
CUT IT OUT
These are tumor-like collections of foamy histiocytes within the dermis, often assocaited with hyperlipidemia or lymphoproliferative malignancies.
Xantoma
What type of xanthomas occur as sudden showers of yellow papules which increase and decrease secondary to variations in plasma triglyceride and lipid content, and occur on buttocks, posterior thighs, knees, and elbows?
Eruptive xanthomas
type I, IIB, III, IV, and V
What type of xanthomas occur as yellow nodules and the tendinous type frequently are found on the Achilles tendon and extensor tendons of the fingers?
Tuberous and tendinous
What type of xanthomas are linear yellow lesions in the skin folds, particularly the palmar creases?
Plane xanthomas
Waht is the term for the soft yellow plaques on the eyelids?
Xanthelasma
These are benign vascular neoplasms, malformations, multifocal angioproliferative, and malignant vascular tumors.
Dermal vascular tumors
This is the disease where there is solitary or multiple lesions from papules to nodules to scaling erythematous plaques which in infants may resemble seborrheic dermatitis.
Histiocytosis X
aka Langerhans cell histiocytosis
What are the histological features of Histiocytosis X?
Infiltration of skin by histiocytes which show Birbeck granules and eosinophilic granulomas
This is the lymphoproliferative disorder, where there is scaly, red-brown pathces, raised, scaling plaques, and fungating nodules.
Mycosis fungiodes
cutaneous T-cell malignant lymphoma
What is the condition in Mycosis fungiodes where there is malignant T-lymphoid cells accompaniesd by diffese erythema and scaling of the entire body surface?
Sezary syndrome
What is the buzzoword for the Sezary cell hsitological features?
Cerebriform contour
What is the treatment for early Mycosis fungiodes?
Topical glucocorticoids or UV light
This is the spectrum of various cutaneous disorders which are characterized by the infiltration of mast cells in the skin.
Mastocytosis
What is the form of Mastocytosis where there is a localized cutaneous form of this disease which predominantly affects children and accounts for more than 50% of all cases?
Urticaria pigmentosa
What are the gross features of Urticaria pigmentosa?
multiple and widely distributed red-brown non-scaling papules and small plaque (can be solitary too)
This is a sign of Urticaria pigmentosa where there is a localized area of dermal edema and erythema (wheal) which occurs when lesional skin is rubbed.
Darier’s sign
This is a sign of uticaria pigmentosum where there is an area of dermal edema resembling a hive which occurs in normal skin as the result of localized stroking with a pointed instrument.
Dermatographism
Which stains can see uricaria pigmentosums?
Metachromatic stains (toluidine blue or Giemsa)
This a common disorder of skin characterized by localized mast cell degranulation and resultant dermal microvascular hyperpermeability which results in pruritic edematous plaques known as wheals.
Uticaria (hives)
What is the thing that is closely related to uticaria and is characterized by edema of deeper dermis and subcutaneous adipose tissue?
Angioedema
What are the gross features of Uticaria?
small, pruritic papules to large edematous plaques
What are the histological features of uticaria?
there is a very sparse, superficial, peri-vascular infiltrate of lymphocytes, histiocytes, eosinophils, and rare neutrophils
What type of HS rxn is uticaria?
type I
IgE stuff
What is the condition where there is an inherited deficiency of C1 activator (C1 esterase inhibitor) which results in uncontrolled activation of early components of the complement system?
Hereditary angioneurotic edema
This is the conditon where there is red, papulovesicular, oozing, and crusted lesions, and with persistence will change into raised, scaling plaques.
Eczematous dermatitis
What type of HS rxn is Eczematous dermatitis?
Type I
What 2 conditions is Eczematous dermatitis associated with?
Asthma and allergic rhinitis
This is a rare, self-limited skin disorder which is believed to be a hypersensitivity response to certain infections and drugs, has a cytotoxic rxn pattern and can affect anyone.
Erythema multiforme
What infections can cause Erythema multiforme?
Mycoplasma HSV Histoplasmosis Coccidiomyosis Typhoid fever Leprosy
What drugs can cause Erythema multiforme?
Sulfonamides
PCN
Barbs, sailcylates, hydantoins, and antimalarials
What cancers can cause Erythema multiforme?
Carcinomas
Malignant lymphomas
What collagen vascular diseases can cause Erythema multiforme?
SLE
Dermatomyositis
PAN
What is the typical gross morphology of erythema multiforme?
target lesion which consists of red macule or papule with a pale vesicular or eroded center
What is the condition of erythema multiforme where there is an extensive and symptomatic febrile issue in kids?
Stevens-Johnson syndrome
Where are the lesions in Stevens-Johnson syndrome?
Oral mucosa
conjuntiva, urethra, junk
What is the severe variant of Stevens-Johnson syndrome where there is diffuse necrosis and sloughing of the entire cutaneous and the mucosal epithelial surfaces, and can result in a clinical syndrome analogous to an extensive burn?
Toxic epidermal necrolysis
This is an inflammatory reaction of the subcutaneous adipose tissue which can affect either principally the connective tissue septa separating lobules of fat or predominantly the lobules of fat themselves.
Panniculitis
What is the most common form of panniculitis and usually shows an acute presentation, and is often associated with various infections, drugs, sarcoidosis, IBD, cancers, and idiopathic?
Erythema nodosum
Where does panniculitis usually affect?
Lower legs
What are the Sx to erythema nodosum?
Poorly defined, tender, fever, malaise, eventually flatten and do not leave scars.
This is a rare type of panniculitis which usually occurs in adolescence and menopausal women, occurs as the result of a primary vasculitis which affects the deep blood vessels.
Erythema iduratum
What are the Sx to erythema iduratum?
erythematous, slightly tender nodule which usually goes on to ulcerate
This is a rare form of lobular, nonvasculitic panniculitis which is most often seen in children and adults, consists of erythematous plaques or nodules, occurs predominantly on lower extremities, and shows aggregates of foamy histiocytes which are admixed with lymphocytes, neutrophils and giant epithelioid phistiocytes
Weber-Christian disease
relapsing febrile nodular panniculitis
This is the form of panniculitis from trauma.
Factitial panniculitis
What are the initial histological features of erythema nodosum?
widening of the connective tissue septa in early lesions secondary to edema, fibrin deposition and infiltrate of neutrophils
What are the later histological features of erythema nodosum?
infiltration with lymphocytes, histiocytes, multi-nucleated epithelioid histiocytes.
Vasculitis is not present in erythema nodosum.
What are the histological features of erythema induratum?
fat lobule showing granulomatous inflammation and zones of caseous necrosis, and early lesions show necrotizing vasculitis which affects small to medium-sized arteries in deep dermis and subcutis
What ar ethe common locations for psoriasis?
elbows, knees, scalp, lumbosacral areas, intergluteal cleft, and the glans penis (all areas of trauma)
What are the gross features of psoriasis?
well-demarcated pink (salmon) plaque covered by loosely adherent silver-white scale
What is the rare form of psoriasis where there are multiple small pustules, local or systemic, and potentially life-treatening?
Pustular psoriasis
What are the histological fetures of psoriasis?
Acanthosis
Squirting papillae
Parakeratoic scale
What is the sign for psoriasis where the parakeratoic scale bleeds when lifted?
Auspitz sign
What is the term in psoriasis where neutrophils form small aggregates in the perakeratoic scale of the stratum corneum?
Munro’s microabscesses
What HLA is psoriasis associated with?
HLA-C
What is the Tx of psoriasis?
Corticosteroids, UVA with psoralen, or immune-modulating therapy
What is the condition where there is Pruritic, flat Papules which form Plaques?
Lichen “P”lanus
What is the term for the white dots or lines of the Papules in Lichen Planus?
Wickham’s striae
Where are the common locations for Lichen Planus?
Extremitis and glans penis
Why do we say there is a “saw-tooth” appearance to the Lichen Planus on histology?
Vacuolar degeneration dermoepidermal junction and moderate to severe band-like infiltrate of lymphocytes and histiocytes which hugs the dermoepidermal junction
What infeciton is assocaited with Lichen Planus?
HCV
What form of Lichen Planus affects the epithelium of hair follicles, particularly in the scalp?
Lichen Planopilaris
What are the gross characteristics of the cutaneous lesions in SLE?
consist of either poorly defined malar erythema on the face (usually seen in SLE) or large, sharply demarcated erythematous scaling plaques
Exposure to what makes things worse in SLE?
The sun
In SLE, what is identified at the dermo-epidermal junction along with a mild superficial and deep peri-vascular and peri-appendageal ?
Vacuolar degneration
What structure does acne surroung?
Hair follicle
What is teh noninflammatory type of acne where there a small follicular papule containing a central black keratin plug and the color is the result of oxidation of the melanin pigment and not dirt?
Comedones
What substance rapidly expand in comedones, which causes dilation of the hair follicle, inflammatory infiltrate, and rupture of the follicle?
Keratin and lipid material
What enzyme does P. acnes release to cause release of proinflammatory fatty acids, resulting in pustule or nodule formation?
Lipases
How does benzoyl peroxide treat acne?
Antimicrobial
How does vitamin A treat acne?
Reduces keratin production
This is a rare autoimmune blistering disorder which occurs because of the loss of normal intercellular attachments between normal keratinocytes of the epidermis and squamous mucosal epithelium.
Pemphigus
What is the msot common pemphigus, which are superficial vesicles and bullae which rupture easily and leave shallow erosions covered with serum and crust, typically from the oral region?
Pemphigus vulgaris
What is the rare form of pemphigus which presents not with blisters, but with moist verrucous (wart-like) plaques usually associated with pustules on groin, axilla, and flexural surfaces of the skin?
Pemphigus vegetans
Waht form of pemphigus is epidemic to south america, and the bullae are very superficial so that zones of erythema and crusting from sites of previous rupture are identified on physical examination?
Pemphigus foliaceus
What form of pemphigus is a localized, less severe form of pemphigus foliaceus which can involve the malar area of the face similar to lupus erythematosus?
Pemphigus erythematosus
What happens to the dermis in all forms of pemphigus?
Acantholysis
Which layer of the epidermis has acantholysis in pemphigus vulgaris and vegetans?
Striatum spinosum
Which type of pemphigus has suprabasal layers, and the basal layer reamins attached to the BM via hemidesmosomes (tombstone appearance)?
Pemphigus folicaeus and erythematosus
What Ig is seen along the borgers of keratinocytes in the epidermis in pemphigus?
IgG
What is the term/sign where the tin-walled bulale rupture easily, leading to shallow erosions with dried crust in pemphigus?
Nikolsky sign
Where will the IgG’s be directed to cause Pemphigus?
Demoglein (cement substance)
What is the pattern of IgG on IF in Pemphigus that surroudns the keratinocytes?
Fish Net pattern
This is an autoimmune bullous disease (against hemidesmosomes between basal cells and the underlying BM) usually affecting elderly patients.
Bullous pemphigoid
Do the bullae rupture more or less easily in Bullous pemphigoid than Pemphigus?
Less easily
Know these things
malignant melanoma (granular layer down will determine the rate of metastasis)
merkel cell carcinoma (it’s a neuroendocrine proliferation)
morphea subtype of BCC is the most aggressive
mycoses fungiodes is CD3/CD4+
Koebner phenomenon is psoriasis at the point of trauma
What is the gross presentation of Bullous pemphigoid?
a subepidermal, nonacantholytic blister
What is the pattern of IgG deposition in Bullous pemphigoid on IF?
linear basement zone deposition
This is the Autoimmune deposition of IgA at the tips of dermal papillae.
Dermatitis herpetiformis
What GI condition is Dermatitis herpetiformis associated with?
Celiac disease
What is the treatment for Dermatitis herpetiformis?
Gluten-free diet
What is the major Sx to the lesions of Dermatitis herpetiformis?
Extremely pruritic
What form of pophyrias have urticaria and vesicles which heal with scarring and are exacerbated by exposure to sunlight?
Porphyria cutanea tarda
What is is a group of disorders which have in common blisters which develop at sites of pressure, rubbing or trauma at or soon after birth?
Epidermolysis bullosa
What form of Epidermolysis bullosa has blisters that occur in histologically normal skin at the level of lamina lucida?
Junctional type
What form of Epidermolysis bullosa has blisters that develops beneath lamina densa supposedly with defective anchoring fibrils to the dermis?
Scarring dystrophic type
What form of Epidermolysis bullosa has degeneration of basal cell layer of epidermis results in bullae?
Simplex type
