Robbins XXII - The Skin

Question 1

This term is the accumulation of edema fluid within the epidermis. Characterizes all forms of eczamatous dermatitis.

Answer 1

Spongiosis

Question 2

An uncommon, usually self-limited disorder that seems to be a hypersensitivity response to certain infections and drugs. Patients present with an array of “multiform” lesions, including macules, papules, vesicles, and bullae, as well as the characteristic targetoid lesion consisting of a red macule or papule with a pale vesicular or eroded center.

Answer 2

Erythema Multiforme

Question 3

In this skin disorder, there is marked epidermal thickening (acanthosis), and loss of the stratum granulosum with extensive overlying parakeratotic scale. The most typical lesion is a well-demarcated, pink to salmon-colored plaque covered by loosely adherent silver-white scale.

Answer 3

Psoriasis

Question 4

This sign is described as bleeding upon removal of scales from the lesions of psoriasis.

Answer 4

Auspitz sign

Question 5

Small aggregates of neutrophils within the parakeratotic stratum corneum in psoriasis.

Answer 5

Munro microabscesses

Question 6

Small aggregates of neutrophils within the spongiotic superficial epidermis in psoriasis.

Answer 6

Pustules of Kogoj

Question 7

Layer of the skin which is affected in psoriasis.

Answer 7

S. granulosum

Question 8

“Pruritic, purple, polygonal, planar papules, and plaques” describes this disorder of the skin and mucosa. The pattern of inflammation of this disorder is characterized by angulated, zigzag contour (“sawtoothing”) of the dermoepidermal junction.

Answer 8

Lichen Planus

Question 9

Anucleate, necrotic basal cells seen in the inflamed papillary dermis of patients with lichen planus are called?

Answer 9

Colloid bodies or Civatte bodies

Question 10

Presents as roughening of the skin that takes on an appearance reminiscent of “lichen on a tree”. It is a response to local repetitive trauma such as continual rubbing or scratching.

Answer 10

Lichen Simplex Chronicus

Question 11

Common lesions of children and adolescents, caused by human papillomavirus (HPV). Histologic features include epidermal hyperplasia that is often undulant in character, and cytoplasmic vacuolization (koilocytosis).

Answer 11

Verrucae (warts)

Question 12

The most common type of wart. Occurs anywhere but are found most frequently on the hands, particularly on the dorsal surfaces and periungual areas, where they appear as gray-white to tan, flat to convex, 0.1- to 1-cm papules with a rough, pebble-like surface.

Answer 12

Verruca vulgaris

Question 13

These warts are common on the face or dorsal surfaces of the hands. These warts are flat, smooth, tan macules.

Answer 13

Verruca plana/flat wart

Question 14

These warts occur on the soles and palms. Described as rough, scaly lesions that may reach 1 to 2 cm in diameter, coalesce, and be confused with ordinary calluses.

Answer 14

Verruca plantaris and verruca palmaris

Question 15

These warts occurs on the penis, female genitalia, urethra, and perianal areas.

Answer 15

Condyloma acuminatum (venereal wart)

Question 16

A rare autoimmune blistering disorder resulting from loss of integrity of normal intercellular attachments within the epidermis and mucosal epithelium. Caused by a type II hypersensitivity reaction

Answer 16

Pemphigus

Question 17

Common histologic denominator in all forms of pemphigus, described as the lysis of the intercellular adhesion sites.

Answer 17

Acantholysis

Question 18

In this variant of pemphigus, acantholysis selectively involves the layer of cells immediately above the basal cell layer, giving rise to a suprabasal acantholytic blister. There is uniform deposition of immunoglobulin and complement along the cell membranes of keratinocytes, producing a characteristic “fishnet” appearance.

Answer 18

Pemphigus vulgaris

Question 19

In this variant of pemphigus, acantholysis selectively involves the superficial epidermis at the level of the stratum granulosum.

Answer 19

Pemphigus foliaceus

Question 20

An autoimmune disease in which the characteristic finding is linear deposition of IgG antibodies and complement in the basement membrane zone. Characterized by a subepidermal, nonacantholytic full-thickness epidermal fluid-filled blister.

Answer 20

Bullous pemphigoid

Question 21

A rare disorder characterized by urticaria and grouped vesicles. Fibrin and neutrophils accumulate selectively at the tips of dermal papillae, forming small microabscesses, which coalesce to form a subepidermal blister. On immunofluorescence, granular deposits of IgA are localized at the tips of dermal papillae.

Answer 21

Dermatitis herpetiformis

Question 22

These common epidermal tumors occur most frequently in middle-aged or older individuals. The lesions consist of an orderly proliferation of uniform, benign basaloid keratinocytes with a tendency to form keratin microcysts (horn cysts), which has a “stuck-on” appearance on the skin.

Answer 22

Seborrheic keratosis

Question 23

These are rare tumors that primarily occur in the head and neck region of older individuals. They usually present as flesh-colored papules and can be a marker for an internal malignancy.

Answer 23

Sebaceous Adenoma

Question 24

These lesion is usually the result of chronic exposure to sunlight and is associated with hyperkeratosis. The dermis contains thickened, blue-gray elastic fibers or “solar elastosis” which is the result of chronic sun damage.

Answer 24

Actinic keratoses

Question 25

Acronym for remembering the histologic features of actinic keratoses.

Answer 25

“Sunny” SPAINS - solar elastoses (dermal sun damage)P - parakeratosisA - atypia (keratinocytic)I - inflammationN - not full thickness atypia

Question 26

A common tumor arising on sun-exposed sites in older people, with higher incidence in women. Arise from prior actinic keratoses. Characterized by highly anaplastic, rounded cells with foci of necrosis and only abortive, single-cell keratinization (dyskeratosis).

Answer 26

Squamous cell carcinoma

Question 27

This is the most common human cancer, which is a slow-growing tumor that rarely metastasizes. tends to occur at sites subject to chronic sun exposure and in lightly pigmented people. h

Answer 27

Basal cell carcinoma

Question 28

These tumors present as pearly, smooth-surfaced papules, often containing prominent, dilated subepidermal blood vessels (telangiectasia). The cells have scant cytoplasm, small hyperchromatic nuclei, and a peripheral palisade with clefting from the stroma.

Answer 28

Basal cell carcinoma

Question 29

This refers to any benign congenital or acquired neoplasm of melanocytes.

Answer 29

Melanocytic nevus

Question 30

These are large nevi and may occur as hundreds of lesions on the body surface. They are flat macules to slightly raised plaques, with a “pebbly” surface. Considered as a marker of melanoma risk.

Answer 30

Dysplastic nevi

Question 31

This cancer of the skin may develop from a dysplastic nevus, and results from excessive sun exposure. Malignant cells have large nuclei with irregular contours having chromatin characteristically clumped at the periphery of the nuclear membrane and prominent eosinophilic nucleoli often described as “cherry red”. Has both radial and vertical growth phases.

Answer 31

Melanoma

Question 32

This determines the biologic behavior of melanomas.

Answer 32

Nature and extent of the vertical growth phase

Question 33

What is the most common type of all autoimmune blistering disordering of the skin (pemphigus)?

Answer 33

Pemphigus Vulgaris

Question 34

Histologically, what is the most common denominator in all forms of pemphigus?

Answer 34

Acantholysis

Question 35

Morphology: Subepidermal nonacantholytic blisters

Answer 35

Bullous Pemphigoid

Question 36

Morphology: Suprabasal acantholytic blister

Answer 36

Pemphigus Vulgaris

Question 37

Morphology: Characteristically, fibrin and neutrophils accumulate selectively at the tips of the dermal papillae forming small microabscesses

Answer 37

Dermatitis Herpetiformis

Question 38

Morphology: accumulation of neutrophils beneath the stratum corneum

Answer 38

Impetigo

Question 39

Munro microabscesses is classically seen in?

Answer 39

Psoriasis

Question 40

Auspitz sign is associated with what condition?

Answer 40

Psoriasis

Question 41

Pearly papules often containing prominent, dilated subepidermal blood vessels (telangiectasias)

Answer 41

Basal Cell Carcinoma

Question 42

What is the most commonly accepted exogenous cause of squamous cel carcinoma of the skin?

Answer 42

Exposure to UV light

Question 43

Cutaneous horns are seen in what condition?

Answer 43

Actinic Keratosis

Question 44

What factor is the most important in the determining the biological behavior of malignant melanoma? Vertical or Radial growth?

Answer 44

Vertical growth

Question 45

Morphology: characterized by loss of melanocytes

Answer 45

Albinism

Question 46

In albinism, melanocytes are present but melanin pigment is not produced due to what enzyme deficiency or defect?

Answer 46

Tyrosinase

Question 47

Q: + for melanocyte-associated proteins such as tyrosinase or Melan-A or S

Answer 47

Vitiligo

Question 48

The early developmental stage in melanocytic nevi is called?

Answer 48

Junctional nevi

Question 49

Most junctional nevi grow into the underlying dermis as nests or cords of cells and are calle

Answer 49

compound nevi

Question 50

When all the epidermal nests of compound nevi are lost entirely they form what

Answer 50

intradermal nevi

Question 51

Appears to play an important role in the development of skin malignant melanoma

Answer 51

Sunlight

Question 52

What are the 5 clinical warning signs of melanoma?

Answer 52

1. enlargement of a pre-existing mle2. itching or pain in pre-existing mole3. development of a new pigment lesion during adult life4. irregularity of the borders of a pigment lesion5. variegation of color within a pigmented

Question 53

Morphology: proliferations of basaloid cells with formation of prominent keratin filled “horn” cysts

Answer 53

Seborrheic keratosis

Question 54

Appears clinically as flesh-colored, dome shaped nodules with central, keratin filled plug, imparting a crater like topography

Answer 54

Keratoacanthoma

Question 55

Morphology: Central, keratin filled crater surrounded by proliferating epitheal cells that extend upward in a lip-like fashion over the sides of the crater and downward into the dermis as irregular tongues

Answer 55

keratoacanthoma

Question 56

The most important clinical sign of malignant melanoma

Answer 56

change in color, size, or shape in a pigmented lesion

Question 57

In Malignant Melanoma, what type of growth indicated the tendency of a melanoma to grow horizontally within the epidermal and superficial dermal layers, often for a prolonged period of time?

Answer 57

Radial growth

Question 58

In Malignant Melanoma, what are the determinants of a more favorable prognosis?

Answer 58

1. Tumor depth of less than 1.7 mm2. Absence or low numbers of mitoses3. Presence of a brisk TIL response (Tumor Infiltrating Leukocytes)4. Absence of regression 5. Female gender6. Location on extremity skin