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Histopathology Dan > Rashes > Flashcards

Rashes Flashcards

1
Q

Causes of neuts in the horn

A 
Psoriasis
Seb Derm
Tinea
Impetigo
Candida
Syphylis

Poo STICS
NB You MUST always ask for a PAS if you see neuts in the horn to exclude tinea!!!!

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2
Q

Causes of acantholytic dyskeratosis

A 
Grovers
Dariers
Hailey hailey
Warty dyskeratoma
Acantholytic dyskeratoma
Some PRP
Some epidermal naevi

Grovers - only one thats significantly spongiotic; varying degree of FOCAL Acanth & Dysk
Dariers – some acantholysis, lots of dyskeratosis, can be benign AK-like change in adjacent epi
Hailey-Hailey – lots of acantholysis, little dyskeratosis (dilapidated brick wall)
NB pemphigus vulgaris has acantholysis w/out dyskeratosis (tombstoning)

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3
Q

List the main invisible dermatoses

A 
remember VITAMU CLAP
Vitiligo
Icthyosis vulgaris
Tinea and Pit versic
Argyria
Morphoea
Urticaria
CALM
Lichen (or macular) amyloidosis
Anetoderma
Porokeratosis esp DSAP
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4
Q

What are the causes of a combined lichenoid and spongiotic reaction pattern?

A 
Lichen striatus
Drug eruption
Fixed drug eruption
Gianotti-Crosti syndrome
late stage pityriasis rosea
Lichenoid contact derm
Discoid eczema
Eczematous GvHD
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5
Q

Septal panniculitis differential

A

ASPEN migration + infection

Alpha1 antitrypsin deficiency (usually lobular)
Scleroderma/ morphoea profunda
Polyarteritis nodosa (rarely)
Erythema nodosum (most common)
Necrobiosis lipoidica or deep GA
Migration - migratory thrombophlebitis (rarely)
Infective causes – bacteria, myco, fungi, helminths

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6
Q

What’s the DD for a subepidermal bulla with neutrophils?

microabscesses

A 
Top 5;
DH - often also many eos
Linear IgA bullous dermatosis (eos or neuts)
EBA
Bullous SLE
Pemphigoid - esp p200 BP or MMP
Also;
Bullous vasculitis
Bullous sweets
Bullous urticaria
Erysipelas, cellulitis
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7
Q

What’s the DD for a subepidermal blister with eosinophils?

A 
Top 5;
Bullous pemphigoid or pemphigoid gestationis
Bullous bite rcn
bullous drug eruption
Mucous membrane pemphigoid
EBA (usuallly neuts)
Also;
Linear IgA (eos or neuts)
DH (usually neuts)
Wells syndrome
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8
Q

What’s the DD for subepidermal bulla with lymphocytes?

A 
Top 5;
SJS/TEN
Bullous EM
Paraneoplastic pemphigus
Bullous LP or LPP
Bullous LS
Also;
PMLE
Bullous allergic contact dermatitis 
Bullous fixed drug eruption
Bullous MF
Bullous infection - fungal, leprosy
Bullous bite rcn
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9
Q

What’s the DD for a cell poor subepidermal bulla?

A 
PCT,
Pseudoporphyria
EB
Bullous scleroderma
Diabetic bullae
Burn
Suction injury
ischaemia/necrosis
amyloid
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10
Q

Causes of band like infiltrate in papillary dermis?

A 
LUMP
Lichenoid reaction
Urticaria pigmentosa
Mycosis fungoides
Pigmented purpuric dermatosis
esp lichen aureus or Gojerot and Blum
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11
Q

What are the causes of a superficial and deep perivascular lymphocytic infiltrate?

A 
8 Ls and DRUGS
Lupus (and other autoimmune inflammatory)
Lues (syphilis)
Lymphocytic (infiltrates; lymphoma, pseudolymphoma etc)
Lipoidica (NLD, GA)
Leprosy
Lepidoptra (insect bite, scabies)
Light (photodermatoses)
Lichen - striatus or pit lichenodis
Drug eruption
Dermatophyte
Reticular erythematous mucinosis
Urticaria
Gyrate erythemas
Scleroderma
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12
Q

What are the histological features of PLEVA and PLC?

A

PLEVA 8

P = parakeratosis; focal in PLC variable in PLEVA
L = lichenoid-interface type; PLC>PLEVA
E = extravasation of erythrocytes-mild; PLC
V = vasculitis (lymphocytic); PLEVA>PLC
A = apoptotic keratinocytes high in epidermis; PLEVA>PLC
“eight” (mostly CD8 T cells)

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13
Q

Which conditions show epidermolytic hyperkeratosis?

A 
BE Happy Carjal Von Hysterical
Bullous icthyosiform erythroderma (AKA epidermolytic hyperkeratosis)
Epidermolytic verrucous epidermal naevus
Hereditary painful callosities
Carvajals syndrome
Vorner’s palmoplantar keratoderma
Icthyosis hystrix

Also;
Lesions – solitary epidermolytic acanthoma, DF, in walls of cysts and in some inflammatory, actinic or melanocytic lesions
In normal oral mucosa

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14
Q

What are types of micro abscesses?

In what conditions are they seen?

A

Munros micro abscesses = neutrophils in SC
- typical of psoriasis
- can be in Netherton’s
Spongiform pustule of Kojog = neuts in epi
- psoriasis
Pautrier micro abscesses = atypical lymphocytes in epi
- MF
PseudoPautrier micro abscesses = langerhans cells
- contact dermatitis (esp allergic)
- drug eruption
- pityriasiform spong pattern
- Langerhans cell histiocytosis

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15
Q

What are the key features in herpes infections?

A

Viral cytopathic changes; 3 Ms =
moulding
margination of chromatin
multinucleated keratinocytes
Also;
Epidermal necrosis and balloon degeneration
Large, pale, steel grey keratinocyte nuclei
pink keratohyalin intranuclear inclusions (Lipschutz bodies)
IHC can distinguish HSV1/HSV2/ZVZ

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16
Q

What are Pan lymphoma, Pan T-cell and pan B-cell markers?

A

Pan lymphoma = LCA (CD45)
Pan T = CD3
Pan B = CD20

17
Q

Many plasma cells rash differential?

A 
Calvin's Zone has 8 Luscious Roses
Folliculitis de Calvans or acne keloidalis nuchae
Plasma cell balanitis (Zoons) 
\+ 8 L's + Rosacea;
Lupus vulgaris (Tb)
Lues (syphylis also Yaws, Pinta)
Lymphoma, lymphocytoma cutis, MF, myeloma
Lipoidica - NLD
Leprosy
Leishmaniasis
LGV and granuloma venereum
Lyme (erythema chronicum migrans or acrodermatitis chronica atrophicans)
Also;
Morphoea 
Chancroid – plasma cells in deep zone
seb derm in HIV pts has plasma cells
ie first 5 Ls are same as in 8Ls and DRUGS list except first is lupus vulgaris rather than lupus and in that list the last 3 are;
Light, Lichen, Lepidoptera
18
Q

What are the features of and main DDs for the Pityriasiform spongiosis reaction pattern?

A 
Focal Para, Spong, Lymphs, Red cells;
Mounds of FOCAL parakeratosis
Focal spongiosis with PAV;
- Pseudopautrier microabscesses 
- focal Acanthosis
- Often spongiotic Vesicles 
Superficial perivascular lymphocytic infiltrate
- Often lymphocyte exocytosis
Extravasated RBCs in pap dermis 
Rare eos, rare dyskeratosis

DDs
Pit rosea
Pityriasiform drug eruption
Superficial type of EAC
Pit lechenoides; pityriasiform spongiosis+lichenoid pattern
Sometimes – discoid eczema, lichen striatus

19
Q

Which organisms cause chromoblastomycosis?

what is histo?

A 
pigmented (‘demitaceus’) fungi e.g.
Fonsy Cuddles Philippa (Fonsy has a motorbike with lots of chrome - chromo..)
Fonsecaea spp
Cladosporium carrionii
Phialophora verrucosa
Histo;
pseudoepitheliomatous hyperplasia
granulomatous infiltrate
Medlar bodies (copper pennies)
20
Q

Which organisms cause Phaeohyphomycosis?

A 
pigmented (‘demitaceus’) fungi  e.g.
ABC or Curvy, Bipolar Alternative
Alternaria
Bipolaris
Curvularia Spp.
21
Q

What is the alternative name for pseudoepitheliomatous hyperplasia?

A

reactive epithelial hyperplasia
Looks a bit like SCC
Nb - not quite the dame as basaloid induction/follicular induction of epi seen overlying dermatofibroma which looks a bit like BCC (and is BerEP4 +ve)

22
Q

What is your panel of special stains for a suppurative granuloma or other likely inefction?

A 
1st look for clues e.g. plasma cells, Medlar bodies, hyphae
PAS (fungus)
gram (bacteria)
Ziehl-Neelsen (Myco;AFB)
Wade-Fite (M. leprae)
Grocott (silver, fungus)
Giemsa (spirochetes, leishmaniasis)
\+/- Spirochete IHC (Treponemes)
23
Q

How can the diagnosis of vitiligo be confirmed?

A

SOX-10 stain
shows no or few melanocytes
Good if uninvolved skin also present to compare

24
Q

What are the stains for Mucin?

A

PAS and diastase
Alcian blue pH2.5
Colloidal iron

25
Q

What are the stains for Amyloid?

A

Crystal violet

Congo red

26
Q

What are the stains for mast cells?

A

CD117 (c-kit)
Giemsa
methylene blue
tolouidine blue

27
Q

DD for many eos going deep into dermis

A 
Bite reaction
(pre-bullous) pemphigoid
Fungal infections 
Wells syndrome 
Cutaneous lymphoma
28
Q

In what conditions is the Splendore-Hoeppli phenomenon seen?

A

fungal infections;
sporotrichosis, pityrosporum folliculitis, zygomycosis, candidiasis, aspergillosis and blastomycosis
bacterial infections;
botryomycosis, nocardiosis and actinomycosis
parasitic conditions;
orbital pythiosis, strongyloidiasis, schistosomiasis and cutaneous larva migrans
non-infective pathology;
hypereosinophilic syndrome and allergic conjunctival granulomas

29
Q

What causes the Church-spire pattern of acanthosis and hyperkeratosis?

A

Variation of papillomatosis so think of warts and things which are wart-like or have verruciform/verrucous in name
verruca vulgaris, veruca plana, epidermodysplasia veruciformis
acrokeratosis verruciformis of Hopf (classical) or ACV in Dariers
Non-epidermolytic verrucous epidermal naevus - 10%
arsenic keratosis, tar keratosis, AK, stucco keratosis
acanthosis nigricans
confluent and reticulated papillomatosis
erythrokeratoderma variabilis
church spire type change with EHK seen in icthyosis hystrix and hystrix type areas of BCIE

30
Q

In what conditions are increased catagen follicles seen?

A

Only in 2 conditions;
alopecia areata
trichotillomania

31
Q

What malignancy looks like an infiltrate but has pleomorphic atypical cells?

A

Lymphoma

cells look malignant but architecture of rash not tumour

32
Q

What stains to do in infectious granulomas (granulomas with neuts and/or plasma cells)?

A

PAS - superficial fungal
Gram - bacteria
Grocott or GMS (silver stains) for deep fungal
Giemsa for spirochetes/ leishmaniasis
ZN and/or Wade-fite for acid fast bacilli (mycoplasma)
Spirochete stain (or Warthin-Starry) for syphylis
+
Should always polarize the image to look for foreign bodies
NB don’t need stains for demitaceous (brown) fungi - chromo or phaeo hyphomycosis but look for splinter or similar fb

33
Q

Causes of intraepidermal vesicles/bullae

A

PV (tombstoning, eos)
PF (acantholysis, eos)
Pemphigus herpetiformis (eos and/or neuts)
Bullous impetigo (bulla in gran layer w/ acantholysis like PF; often cell poor, neuts nearby)
Herpes (viral cytopathic features)

34
Q

what is DD for psoriasiform epidermal hyperplasia?

A 
psoriasis
psoriasiform drug
chronic/rubbed eczema inc discoid eczema  and contact dermatitis
lichen simplex chronicus
pityriasis rubra pilaris
secondary syphylis
pit rosea
scabies
tinea coporis
ILVEN
35
Q

What is DD for interface obscuring lichenoid reaction pattern?

A 
EM
SJS/TEN
FDE
Pit lichenoides; PLC>PLEVA
GVHD

Histopathology Dan (2 decks)

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