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Pathology > Pathology: Dermatopathology > Flashcards

Pathology: Dermatopathology Flashcards

1
Q

Functions of Normal Skin

A

barrier protection
thermoregulation
perception - touch, pain, pressure
immunoregulation

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2
Q

Normal Skin - Divisions

A

epithelial - epidermis, adnexa
dermis
subcutis

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3
Q

Epidermis Layers

A

statum corneum
granular layer
spinous (malpighian) layer
basal cell layer (melanocytes)

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4
Q

Stratum Corneum

A

anucleated keratinocytes

parakeratosis

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5
Q

Granular Layer

A

keratohyal granules

filagrin precursor

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6
Q

Spinous Layer

A

numerous “spiny” process - desmosomes

glassy, eosinophilic cytoplasm

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7
Q

Basal Layer

A

higher N:C ratio
basophilic
hemidesmosomes

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8
Q

Melanocytes

A

UV barriers
pheomelanin (red), eumelanin (yellow, brown, black)
skin color depends on location and density of melanosomes

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9
Q

Actinic Keratosis Clinical

A 
very common
sun exposed areas
scaly, erythematous plaques
10-20% transform
cumulative exposure to sunlight
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10
Q

Actinic Keratosis Histopathology:

A 
parakeratosis 
hypogranulosis 
downward budding epidermis
keratinocyte atypia
solar elastosis
SCC in situ
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11
Q

Squamous Cell Carcinoma Clinical

A 
2nd most common skin cancer
sun damaged skin
areas of chronic inflammation
organ transplant patients (renal)
older patients 
shallow ulcers with keratinous crust
UV-B radiation most important factor, less important UV-A, radiation, arsenic, coal tar, hydrocarbons
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12
Q

Squamous Cell Carcinoma Histopathology

A 
nests of squamous cells - from epidermis
eosinophilic cytoplasm
vesicular nuclei
horn pearl formation
can have acantholysis
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13
Q

Basal Cell Carcinoma

A 
most common skin cancer (5:1 with SCC)
sun exposed skin, fair complexion
have one, increased risk for more
older people
slow growing, non-aggressive
etiology: UV-B; arsenic, x-rays, stasis, PUVA therapy, immunosuppression
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14
Q

Basal Cell Carcinoma Clinical

A 
papulonodular with pearly translucent edge
ulcer
pale plaque
erythematous plaque
some pigmented
clinical accuracy - 60-70%
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15
Q

Basal Cell Carcinoma Types

A 
multifocal superficial
nodular
micronodular
infiltrating
desmoplastic
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16
Q

Basal Cell Carcinoma Histopathology

A 
islands/nests basaloid cells
peripheral palisading
attachment to epidermis
myxoid stroma
retraction artifact
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17
Q

Nevoid Basal Cell Carcinoma

A 
young - can be prior to puberty
multiple BCC
odontogenic keratocysts
pits on palms/soles
cutaneous cysts
skeletal and neurologic anomalies
18
Q

Nevoid Basal Cell Carcinoma Syndrome - Clinical

A

autosomal dominant
9q
BCC occur anywhere, harmless
few to hundreds of BCC

19
Q

Solar Lentigo

A 
not melanocytic
small dark brown macules
sun exposed skin
middle age to elderly
multiple
20
Q

Solar Lentigo - Histopathology

A

elongated rete ridges - bulb shaped/finger like
basal hyperpigmentation - dirty feet, increased melanocytes
solar elastosis

21
Q

Melanocytic Nevi

A

develop during childhood and adolescence
increased with sun
boys > girls
fair skin > darker skin

22
Q

Melanocytic Nevi - Maturation

A 
flat macular (junctional) - uniform, symmetrical
cells "drop off" (compound) - elevated
intradermal - most by early adult, less pigment
23
Q

Melanocytic Nevi - Clinical

A

less nevi with age
young adult: 15-40
more nevi&raquo_space; risk

24
Q

Malignant Melanoma

A 
lifetime risk 1/87
early treatment is key
risk factors:
multiple moles
atypical moles
freckling
history of severe sunburn
easy burning
light hair with blue eyes
25
Q

Familial Atypical Mole and Melanoma Syndrome

A

melanoma in 1st or 2nd degree relative
>50 moles, some atypical
histologically atypical
9p deletion

26
Q

Malignant Melanoma - Clinical

A 
Asymmetry
Border Irregularity
Color variegation
Diameter
Elevation, enlargement, rapid change
27
Q

Malignant Melanoma - Lentigo Maligna (5-15)

A

face of elderly

28
Q

Malignant Melanoma - Superficial Spreading (50-75%

A

any party of body

29
Q

Malignant Melanoma - Nodular Melanoma (15-35%)

A

polpoid

30
Q

Malignant Melanoma - Arcal Lentigous (5-15%)

A

palmar, plantar, subungul

African-American, Japanese

31
Q

Malignant Melanoma - Desmoplastic (rare)

A

head and neck

indurated

32
Q

Malignant Melanoma - Histopathology

A 
asymmetry
confluent spread
pagetoid spread
cytologic atypia
lack of maturation
dermal mitotic figures
33
Q

Predictive Factors for Melanoma

poorer prognosis

A

tumor thickness - greater thickness
mitotic rate - faster
inflammation - absent
anatomic site - subungal

34
Q

Psoriasis

A

hyperproliferation of epidermis (7 vs. 53 days)

35
Q

Psoriasis Clinical

A

2% of population
~25 years old
signs: well circumscribed erythematous patches with white scale, Auspitz sign
locations: extensor surfaces, sacral region, scalp, nails, sites of trauma (Koebner reaction)
-polyarthritis
-chronic course

36
Q

Psoriasis Clinical Variants

  • Guttate
  • Erythrodermic
  • Sebopsoriasis
A

guttate: small papules, strep A
erythrodermic: high morbidity

37
Q

Psoriasis Histopatholgoy

A 
psoriasiform acanthosis
thin suprapapillary plates
mounds/confluent parakeratosis
hypogranulosis
munro microabsecess - intracorneal neutrophils
38
Q

Bullous Pemphigoid

A 
#1 subepidermal bullous disorder
elderly
erethmatous macules - tense bullae - rupture = crusted erosions, urticarial plaques
39
Q

Bullous Pemphigoid - Clinical Features

A 
lower abdomen, groin, flexor surface
oral cavity (10-40%)
other mucosal surfaces are rare
chronic course - autoimmune (BP AG1 - 90%, hemidesmosomes or BP AG2 - transmembrane protein)
40
Q

Bullous Pemphigoid - Histology

A

subepidermal blister

eosinophils - prominent dermis/cavity

Pathology (4 decks)

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