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PATHOLOGY > Rosai Chapter 3 - Tumors and Tumorlike Conditions of the Skin > Flashcards

Rosai Chapter 3 - Tumors and Tumorlike Conditions of the Skin Flashcards

1
Q

Most frequent pattern of Seborrheic Keratosis

A

Acanthotic pattern

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2
Q

Other names of Acrochordon (4):

A
  • Fibroepithelial papilloma
  • Fibroepithelial polyp
  • Fibroma molle
  • Skin tag
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3
Q

Clue to the diagnosis of Acrochordon

A

Absence of adnexal structures in the underlying dermis

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4
Q

Actinic keratosis vs. Bowen disease

-Atypical squamous cells are found in the LOWER portions of the epidermis including the basal layer

A

Actinic keratosis

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5
Q

Actinic keratosis vs. Bowen disease

-Atypical squamous cells are found in ALL portions of the epidermis but with preservation of the basal cells, which are arranged in palisades

A

Bowen disease

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6
Q

Large majority of squamous cell (epidermoid) carcinomas of the skin

A

Actinically induced

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7
Q

Incidence of SqCCA of the skin is directly related to (2)

A
  • amount of Sun exposure to the sun

- lack of Pigmentation of the skin

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8
Q

Positive IHCs of SqCCA of the Skin (6)

A
  • HMWK
  • Involucrin
  • EMA
  • CEA
  • p63
  • Vimentin
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9
Q

Negative IHCs of SqCCA of the skin (if used to differentiate with BCCA)

A
  • Ber-EP4
  • CD10

*both positive in BCCA

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10
Q

Positive IHC of SqCCA of the Skin, but mostly in poorly-differentiated type

A

-Vimentin

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11
Q

Most important distinguishing features of Spindle SqCCA (3)

A
  • Continuity of tumor cells with the basal layer of the epidermis
  • Foci of clear-cut squamous change
  • Positive HMWK
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12
Q

Most common location of Verrucous carcinoma of the skin

A

Sole of the foot

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13
Q

Best prognostic factors of SqCCA of the skin (3)

A
  • Staging
  • level of Dermal invasion
  • Vertical tumor thickness
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14
Q

Pseudoepitheliomatous Hyperplasia vs. SqCCA

Main distinguishing features:

-Width of the Strands - Thin

A

Pseudoepitheliomatous Hyperplasia

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15
Q

Pseudoepitheliomatous Hyperplasia vs. SqCCA

Main distinguishing features:

-Degree of Keratinocytic Atypia - Lesser

A

Pseudoepitheliomatous Hyperplasia

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16
Q

Pseudoepitheliomatous Hyperplasia vs. SqCCA

Main distinguishing features:

-Width of the Strands - Broad

A

SqCCA

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17
Q

Pseudoepitheliomatous Hyperplasia vs. SqCCA

Main distinguishing features:

-Degree of Keratinocytic Atypia - Greater

A

SqCCA

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18
Q

Most frequent form of skin cancer that occurs predominantly on sun-exposed skin

A

Basal cell carcinoma

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19
Q

other name of Gorlin syndrome

A

Basal cell nevus syndrome

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20
Q

Components of Gorlin syndrome (6)

A
  • multiple BCCA
  • Palmar pits
  • Calcification of dura
  • Keratocysts of the jaws
  • Skeletal abnormalities
  • occasional abnormalities of CNS, Mesentery, and Endocrine organs
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21
Q

Positive IHCs of BCCA (5)

A
  • LMWK
  • CD10
  • Ber-EP4
  • Androgen receptors
  • BCL2
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22
Q

Negative IHCs of BCCA (4)

A
  • EMA
  • CEA
  • Involucrin
  • CK20
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23
Q

BCCA vs. SqCCA

Positive for Ber-EP4

A

BCCA

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24
Q

BCCA vs. SqCCA

Negative for Ber-EP4

A

SqCCA

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25
Q

BCCA vs. Actinic keratosis and SqCCA

BCL2 - positive

A

BCCA

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26
Q

BCCA vs. Actinic keratosis and SqCCA

BCL2 - Negative

A

Actinic keratosis and SqCCA

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27
Q

BCCA vs. Merkel cell CA and Trichoepitheliomas

CK20 - negative

A

BCCA

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28
Q

BCCA vs. Merkel cell CA and Trichoepitheliomas

CK20 - positive

A

Merkel cell CA and Trichoepitheliomas

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29
Q

Key pathogenic event in BCCA

A

Dysregulation of the hedgehog pathway

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30
Q

Most common location of BCCA with high local recurrence (3)

A
  • Nasolabial fold
  • Inner canthus
  • Postauricular region
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31
Q

Metastases in BCCA are more likely (3)

A
  • Basosquamous types
  • Perineurial spread
  • located on sunlight-protected skin
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32
Q

Better predictor of local recurrence in BCCA than presence or absence of tumor at the surgical margins

A

Evaluation of the pattern of tumor growth

widely dispersed vs. tightly clustered nests

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33
Q

Main DDX of Eccrine poroma (2)

A
  • BCCA

- Seborrheic keratosis

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34
Q

other name of Purely intraepidermal eccrine poroma

A

Hydroacanthoma simplex

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35
Q

other name of Purely intradermal eccrine poroma

A

Dermal duct tumor

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36
Q

other name of Hidradenoma

A

Eccrine acrospiroma

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37
Q

Mixed Tumor (Chondroid Syringoma)

IHCs for the Inner Cell layer (3)

A
  • CK
  • CEA
  • EMA
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38
Q

Mixed Tumor (Chondroid Syringoma)

IHCs for the Outer Cell layer (6)

A
  • Vimentin
  • S100
  • Actin
  • Calponin
  • p63
  • GFAP
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39
Q

Vulvar vs. Perianal
Paget disease

-GCDFP-15 - Positive

A

Vulvar Paget disease

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40
Q

Vulvar vs. Perianal
Paget disease

-Hormone receptors - Positive

A

Vulvar Paget disease

AR > ER/PR

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41
Q

Vulvar vs. Perianal
Paget disease

-CK20 - Positive

A

Perianal Paget disease

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42
Q

Most common nodular lesion of the sebaceous glands

A

due to Hyperplasia

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43
Q

Positive vs. Negative

IHC of Sebaceous carcinoma

-Keratin & CK

A

Positive

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44
Q

Positive vs. Negative

IHC of Sebaceous carcinoma

-EMA

A

Positive

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45
Q

Positive vs. Negative

IHC of Sebaceous carcinoma

-Leu-in1 (CD15)

A

Positive

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46
Q

Positive vs. Negative

IHC of Sebaceous carcinoma

-AR

A

Positive

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47
Q

Positive vs. Negative

IHC of Sebaceous carcinoma

-Adipophilin

A

Positive

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48
Q

Positive vs. Negative

IHC of Sebaceous carcinoma

-CEA

A

Negative

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49
Q

Positive vs. Negative

IHC of Sebaceous carcinoma

-S100

A

Negative

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50
Q

Preferred location of inverted follicular keratosis

A

face of elderly patients particularly the eyelid

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51
Q

Most distinctive feature of inverted follicular keratosis

A

presence of squamous eddies

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52
Q

Main DDX of Trichoepithelioma

A

BCCA

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53
Q

Most helpful features of Trichoepithelioma (3)

A
  • Frond-like arrangement of the basaloid cells
  • presence of Epithelial tracts comprising two or more layers of basaloid cells
  • formation of Papillary mesenchymal bodies
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54
Q

Main DDX of Desmoplastic Trichoepithelioma

A

Morphea-like form of BCCA

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55
Q

Trichoepithelioma vs. BCCA

CK20 - Positive

A

Trichoepithelioma

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56
Q

Trichoepithelioma vs. BCCA

BCL2 - positive at periphery

A

Trichoepithelioma

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57
Q

Trichoepithelioma vs. BCCA

Stromelysin-3 (matrix metalloproteinase) - negative

A

Trichoepithelioma

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58
Q

Trichoepithelioma vs. BCCA

CK20 - negative

A

BCCA

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59
Q

Trichoepithelioma vs. BCCA

BCL2 - diffusely positive

A

BCCA

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60
Q

Trichoepithelioma vs. BCCA

Stromelysin-3 (matrix metalloproteinase) - positive

A

BCCA

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61
Q

other name of Cowden Disease

A

Multiple Hamartoma syndrome

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62
Q

Cowden disease (5)

A
  • Multiple Trichilemommas
  • Acral Keratoses
  • Sclerotic fibromas of skin
  • Papillomas of the oral mucosa
  • Occasionally, tumors of Breast, Thyroid, and GIT
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63
Q

Characteristics of Trichilemmal-type keratinization with atypical features (3)

A
  • Brisk mitotic activity
  • invasion of reticular dermis
  • ulceration
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64
Q

Most important microscopic feature of keratoacanthoma

A

Architecture of the lesion as seen on cross section on LPO:

  • Overhanging edges
  • Keratin-filled crater
  • Hemispheric shape that is buttressed by a normal-appearing epidermis
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65
Q

Keratoacanthomas with Numerous eruptive lesions

A

Grzybowki type

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66
Q

Keratoacanthomas with multiple ulcerating tumors with atypical distribution

A

Ferguson-Smith type

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67
Q

Epidermal/Epidermoid type vs. Pilar/Trichilemmal type Keratinous cyst

-more common (90%)

A

Epidermal/Epidermoid type Keratinous cyst

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68
Q

Epidermal/Epidermoid type vs. Pilar/Trichilemmal type Keratinous cyst

-lined by Cornified epithelium

A

Epidermal/Epidermoid type Keratinous cyst

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69
Q

Epidermal/Epidermoid type vs. Pilar/Trichilemmal type Keratinous cyst

-has distinct granular layer

A

Epidermal/Epidermoid type Keratinous cyst

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70
Q

Epidermal/Epidermoid type vs. Pilar/Trichilemmal type Keratinous cyst

-contains lamellated keratin without calcification

A

Epidermal/Epidermoid type Keratinous cyst

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71
Q

Epidermal/Epidermoid type vs. Pilar/Trichilemmal type Keratinous cyst

-preferentially on the Scalp

A

Pilar/Trichilemmal type Keratinous cyst

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72
Q

Epidermal/Epidermoid type vs. Pilar/Trichilemmal type Keratinous cyst

-Trichilemmal type Keratinization

A

Pilar/Trichilemmal type Keratinous cyst

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73
Q

Epidermal/Epidermoid type vs. Pilar/Trichilemmal type Keratinous cyst

-Keratin is not lamellated

A

Pilar/Trichilemmal type Keratinous cyst

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74
Q

Epidermal/Epidermoid type vs. Pilar/Trichilemmal type Keratinous cyst

-Some nuclei retained

A

Pilar/Trichilemmal type Keratinous cyst

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75
Q

Epidermal/Epidermoid type vs. Pilar/Trichilemmal type Keratinous cyst

-Focal calcification

A

Pilar/Trichilemmal type Keratinous cyst

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76
Q

Type of Keratinization:

-sudden keratinization without formation of granular layer and an uneven interphase between the keratinized and nonkeratinized cells

A

Trichilemmal type keratinization

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77
Q

former name of Pilomatrixoma

A

Calcified Epithelioma of Malherbe

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78
Q

Key feature of Pilomatrixoma

A

Basaloid cells undergo abrupt keratinization, leading to the formation of “ghost” and “shadow” cells

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79
Q

Key features of Malignant Pilomatrixoma/Pilomatrixoma carcinoma (2)

A
  • Cytologic atypia

- infiltration

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80
Q

Ratio of melanocytes to keratinocytes in the epidermal basal layer depending on the site of the body

A

-1:4 to 1:10

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81
Q

The functional unit /epidermal-melanin unit

A

melanocyte + adjacent keratinocytes receiving melanin

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82
Q

Positive or Negative

IHC for Normal Melanocytes

-Fontana-Masson silver stain (special stain)

A

Positive

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83
Q

Positive or Negative

IHC for Normal Melanocytes

-Tyrosinase

A

Positive

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84
Q

Positive or Negative

IHC for Normal Melanocytes

-DOPA reaction

A

Positive

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85
Q

Positive or Negative

IHC for Normal Melanocytes

-S100

A

Positive

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86
Q

Positive or Negative

IHC for Normal Melanocytes

-NSE

A

Positive

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87
Q

Positive or Negative

IHC for Normal Melanocytes

-Mart-1/Melan A (A103)

A

Positive

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88
Q

Positive or Negative

IHC for Normal Melanocytes

-Microphthalmia Transcription Factor (MiTF)

A

Positive

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89
Q

Positive or Negative

IHC for Normal Melanocytes

-SOX10

A

Positive

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90
Q

Positive or Negative

IHC for Normal Melanocytes

-PAX3

A

Positive

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91
Q

Positive or Negative

IHC for Normal Melanocytes

-Vimentin

A

Positive

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92
Q

Positive or Negative

IHC for Normal Melanocytes

-Neurofilaments

A

Negative

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93
Q

Positive or Negative

IHC for Normal Melanocytes

-GFAP

A

Negative

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94
Q

Positive or Negative

IHC for Normal Melanocytes

-HMB-45

A

Negative

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95
Q

Positive or Negative

IHC for Normal Melanocytes

-Keratin

A

Negative

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96
Q

IHC Negative in Normal Melanocytes but Positive in Activated type melanocytes

A

HMB-45

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97
Q

IHC Negative in Normal Melanocytes but Positive in Neoplastic type melanocytes

A

Keratin

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98
Q

Hallmark of the melanocyte

A

Melanin-synthesizing organelle (melanosome)

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99
Q

Most common location of clusters of benign nevus cells in the capsule of lymph nodes

A

Axillary region

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100
Q

Multiple Lentigines can be seen in what syndromes? (6)

A
  • Peutz-Jeghers syndrome
  • Centrofacial lentiginosis
  • Moynahan syndrome
  • LEOPARD syndrome
  • Carney syndrome
  • Xeroderma pigmentosum
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101
Q

Blue nevus are sometime misdiagnosed as

A

Benign fibrous histiocytoma

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102
Q

Positive or Negative

IHCs for Blue nevus

-Melanin stains

A

Positive

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103
Q

Positive or Negative

IHCs for Blue nevus

-S100

A

Positive

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104
Q

Positive or Negative

IHCs for Blue nevus

-HMB-45

A

Positive

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105
Q

Most common locations of Cellular Blue Nevus (2)

A
  • Buttocks

- Sacrococcygeal area

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106
Q

Characteristics Absent in Cellular Blue Nevus which makes it different microscopically from malignant melanoma (4)

A
  • Junctional activity
  • Epidermal invasion
  • Peripheral inflammation
  • Necrosis
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107
Q

Characteristics Present in Cellular Blue Nevus which makes it different microscopically from malignant melanoma (6)

A
  • Pushing margins
  • Biphasic pattern
  • Fasciculation
  • Neuroid structures
  • inconspicuousness of nuclei
  • relative lack of atypia and mitotic figures
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108
Q

Most typical presentation of Spitz nevus

A

-raised pink or red nodule in the skin of the face that clinically resembles a hemangioma

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109
Q

Features that favor a diagnosis of Spitz nevus over one of malignant melanoma (9)

A
  • Symmetric shape
  • Sharp lateral demarcation
  • maturation in depth
  • arrangement of the spindle cells perpendicularly to the skin surface
  • presence of tadpole and multinucleated giant cells
  • lack of upward epidermal spread of single melanocytes
  • presence of telangiectasia, edema, and fibrosis
  • presence of eosinophilic hyaline bodies along the dermoepidermal junction thought to be made of basement membrane material (Kamino bodies)
  • lack of ulceration
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110
Q

Spitz nevus vs. Malignant melanoma

Cytoplasm - homogeneous acidophilic ground-glass appearance

A

Spitz Nevus

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111
Q

Spitz nevus vs. Malignant melanoma

Cytoplasm - more irregular in configuration and staining reaction

A

Malignant melanoma

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112
Q

Spitz nevus vs. Malignant melanoma

-Consumption of Epidermis

A

Malignant melanoma

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113
Q

Congenital nevus differs from the more common acquired variety because (4):

A
  • generally Large size
  • tendency to involve the reticular dermis and subcutaneous tissue
  • single cell permeation of dermal collagen bundles
  • involvement of skin adnexa, arrector pili muscles, nerves, and vessels
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114
Q

Characteristics of Giant Congenital Nevus (3):

A
  • Extensive size
  • Surface area - 144 cm2 or larger
  • nevus > 20 cm in diameter in adult or > or = to 20% BSA
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115
Q

Giant cell nevus with Meningeal/cerebral melanosis

A

Neurocutaneous melanosis or melanocytosis

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116
Q

Giant cell nevus with numerous satellite nevi

A

Melanophakomatosis

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117
Q

Characteristics of Dysplastic nevus (4)

A
  • clinically Atypical
  • large size (>5 mm)
  • irregular outline
  • variegated appearance
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118
Q

Subungual region cutaneous melanomas

A

Melanotic whitlow

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119
Q

Most common form of Melanoma

A

Superficial spreading melanoma

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120
Q

other names of Superficial spreading melanoma (2)

A
  • Premalignant melanosis

- Pagetoid melanoma

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121
Q

Telltale color of early superficially spreading melanoma

A

shade of Blue admixed with tan, brown, or dark brown

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122
Q

Most commonly affected region of spindle cell melanoma

A

Head and Neck

123
Q

Differential diagnosis of Desmoplastic melanoma (4)

A
  • Hypertrophic scar
  • Atypical Fibroxanthoma
  • Spindle SqCCa
  • Peripheral nerve sheath tumor
124
Q

Clues to the diagnosis at the H&E level of Desmoplastic melanoma (5):

A
  • focal Fascicular pattern of growth
  • Deep invasion
  • Infiltration of nerves
  • Lymphoid aggregates at tumor periphery
  • Presence of a lesion with the features of Lentigo maligna in the overlying epidermis
125
Q

Features suggestive of melanoma in H&E sections (5)

A
  • cells with abundant acidophilic, finely granular cytoplasm
  • pseudonuclear inclusions
  • combination of epithelial and spindle cell patterns of growth
  • fascicular arrangement of tumor cells
  • Pseudoalveolar arrangement
126
Q

Strong indicators that the melanoma is malignant (2)

A
  • Atypical mitoses

- Dermal mitoses

127
Q

Sign of degeneration and is a particularly useful sign of melanoma

A

Melanocytes with an abundant clear cytoplasm having a finely dispersed (“dusty”) chromatin

128
Q

Two situations in which argentaffin stains are particularly useful in melanoma

A
  • Detecting finely dispersed granules that are not immediately apparent in H&E sections
  • Demonstrating that the brown pigment seen in the routine sections is melanin rather than hemosiderin
129
Q

Key enzyme for the production of melanin from tyrosine

A

Tyrosinase

130
Q

Common molecular genetic alteration in melanomas occurring in acral and chronic sun-damaged skin

A

KIT

131
Q

Uncommon molecular genetic alteration in melanomas occurring in acral and chronic sun-damaged skin (2)

A
  • BRAF

- NRAS

132
Q

Best procedure for the initial evaluation of suspicious pigmented skin lesions

A

-Elliptical excisional biopsy with narrow margins (down to the subcutaneous fat)

133
Q

Microscopically, the early stage of regression is characterized by:

A

-a dense infiltrate of lymphocytes

134
Q

Only melanomas that have been found to undergo spontaneous regression

A

Melanomas with an intraepidermal component

135
Q

Accurate staging procedure and a powerful prognostic indicator

A

Sentinel node biopsy

136
Q

Sentinel node biopsy is recommended for (2)

A
  • All melanomas measuring 1 mm or more in thickness

- thinner melanomas with dermal mitotic figures or ulceration

137
Q

Histiocytes vs. Melanoma cells

-Lack nuclear atypia

A

Histiocytes

138
Q

Histiocytes vs. Melanoma cells

IHC

-CD68/PG-M1 - positive

A

Histiocytes

139
Q

Histiocytes vs. Melanoma cells

IHC

-SOX10 - negative

A

Histiocytes

140
Q

Histiocytes vs. Melanoma cells

IHC

-CD68/PG-M1 - negative

A

Melanoma cells

141
Q

Histiocytes vs. Melanoma cells

IHC

-SOX10 - positive

A

Melanoma cells

142
Q

Treatment of choice of most malignant melanomas

A

Wide excision of the primary lesion

143
Q

Most powerful predictors of survival in melanoma (2)

A
  • Tumor thickness (Breslow level)

- Ulceration

144
Q

Level of invasion (Clark’s level)

-Epidermis

A
  • Level I

* Melanoma in situ

145
Q

Level of invasion (Clark’s level)

-Papillary dermis

A

Level II

146
Q

Level of invasion (Clark’s level)

-Filling the papillary dermis

A

Level III

147
Q

Level of invasion (Clark’s level)

-Reticular dermis

A

Level IV

148
Q

Level of invasion (Clark’s level)

-Subcutis

A

Level V

149
Q

Breslow thickness

-<0.76 mm

A

Low

150
Q

Breslow thickness

-5-year disease free survival - 98%

A

Low

151
Q

Breslow thickness

-0.76-1.50 mm

A

Intermediate

152
Q

Breslow thickness

-5-year disease free survival - in-between 63 to 98%

A

Intermediate

153
Q

Breslow thickness

->1.5 mm

A

High

154
Q

Breslow thickness

-5-year disease free survival - 44-63%

A

High

155
Q

More powerful prognostic indicator than ulceration

A

Tumor mitotic rate

156
Q

High risk sites of melanomas (8)

A
  • Scalp
  • Mandibular area
  • Midline of trunk
  • Upper medial thighs
  • Hands
  • Feet
  • Popliteal fossae
  • Genitalia
157
Q

Melanoma with better prognosis

A

dense lymphocytic infiltrate around the melanoma particularly if the lymphocytes are closely intermingled with the neoplastic melanocytes (tumor-infiltrating lymphocytes)

158
Q

Correlates with an increased probability of lymph node metastases

A

numerous plasma cells in the infiltrate

159
Q

Growth of melanoma cells along the external surface of blood vessels

A

Angiotropism

160
Q

Predictor of local recurrence and in-transit metastases

A

Angiotropism

161
Q

Only microscopic change in Hyperpigmentation

A

increased pigmentation of basal melanocytes, accompanied by an increased transfer of melanin into the adjacent keratinocytes and melanophages in the dermis

162
Q

Most common locations of merkel cell Ca (2)

A
  • Face

- Extremities

163
Q

Hematoxyphilic staining of vessel walls and fibrous septa

A

Azzopardi phenomenon

164
Q

Positive vs. Negative

IHC of Merkel Cell Carcinoma

-LMW Keratin

A

Positive

-particularly CK20 (perinuclear dot-like)

165
Q

Positive vs. Negative

IHC of Merkel Cell Carcinoma

-Neurofilaments

A

Positive

166
Q

Positive vs. Negative

IHC of Merkel Cell Carcinoma

-NSE

A

Positive

167
Q

Positive vs. Negative

IHC of Merkel Cell Carcinoma

-TTF-1

A

Negative

168
Q

Most common site of fibrous papule of the face

A

Nose

169
Q

Tuberous sclerosis (3)

A
  • multiple fibromas of the face, scalp, and subungual region
  • Angiofibroma of the face
  • Shagreen patches in the lumbosacral region
170
Q

Sclerotic fibroma vs. Collagenous fibroma

-“Storiform collagenoma”

A

Sclerotic fibroma

171
Q

Sclerotic fibroma vs. Collagenous fibroma

-Heavy disposition of collagen

A

Sclerotic fibroma

172
Q

Sclerotic fibroma vs. Collagenous fibroma

-wood-grain pattern

A

Sclerotic fibroma

173
Q

Sclerotic fibroma vs. Collagenous fibroma

-“Desmoplastic fibroblastoma”

A

Collagenous fibroma

174
Q

Sclerotic fibroma vs. Collagenous fibroma

-fascial involvement

A

Collagenous fibroma

175
Q

other name of Benign Fibrous Histiocytoma (3)

A
  • Dermatofibroma
  • Histiocytoma
  • Sclerosing hemangioma
176
Q

Positive vs. Negative

IHCs of Dermatofibroma

-Factor XIIIa

A

Positive

177
Q

Positive vs. Negative

IHCs of Dermatofibroma

-HMGA1/HMGA2

A

Positive

178
Q

Positive vs. Negative

IHCs of Dermatofibroma

-CD34

A

Negative

179
Q

Dermatofibroma vs. DFSP

-CD34 - positive

A

DFSP

180
Q

POSITIVE vs. NEGATIVE

IHC for Atypical Fibroxantoma

-Vimentin

A

POSITIVE

181
Q

POSITIVE vs. NEGATIVE

IHC for Atypical Fibroxantoma

-Actin

A

POSITIVE

182
Q

POSITIVE vs. NEGATIVE

IHC for Atypical Fibroxantoma

-Calponin

A

POSITIVE

183
Q

POSITIVE vs. NEGATIVE

IHC for Atypical Fibroxantoma

-h-Caldesmon

A

POSITIVE

184
Q

POSITIVE vs. NEGATIVE

IHC for Atypical Fibroxantoma

-CD68

A

POSITIVE

185
Q

POSITIVE vs. NEGATIVE

IHC for Atypical Fibroxantoma

-alpha1-antitrypsin

A

POSITIVE

186
Q

POSITIVE vs. NEGATIVE

IHC for Atypical Fibroxantoma

-alpha1-antichymotrypsin

A

POSITIVE

187
Q

POSITIVE vs. NEGATIVE

IHC for Atypical Fibroxantoma

-Cathepsin-B

A

POSITIVE

188
Q

POSITIVE vs. NEGATIVE

IHC for Atypical Fibroxantoma

-FXIIIa

A

POSITIVE

-focal

189
Q

POSITIVE vs. NEGATIVE

IHC for Atypical Fibroxantoma

-S100

A

POSITIVE

-focal

190
Q

POSITIVE vs. NEGATIVE

IHC for Atypical Fibroxantoma

-CD10

A

POSITIVE

191
Q

POSITIVE vs. NEGATIVE

IHC for Atypical Fibroxantoma

-CD117

A

POSITIVE

192
Q

POSITIVE vs. NEGATIVE

IHC for Atypical Fibroxantoma

-CD99

A

POSITIVE

193
Q

POSITIVE vs. NEGATIVE

IHC for Atypical Fibroxantoma

-Keratin

A

Negative

194
Q

POSITIVE vs. NEGATIVE

IHC for Atypical Fibroxantoma

-EMA

A

Negative

195
Q

POSITIVE vs. NEGATIVE

IHC for Atypical Fibroxantoma

-Desmin

A

Negative

196
Q

Important IHCs for Atypical Fibroxanthoma (2)

A
  • focal S100

- Negative Keratin

197
Q

Microscopic diagnostic characteristics of DFSP (6)

A
  • radial whorls of spindle cells producing the storiform or cartwheel pattern
  • High cellularity
  • Monomorphic appearance
  • Diffuse infiltration of subcutaneous fat
  • Lack of foamy or Hemosiderin-laden macrophages and/or MNGC
  • Lack of peripheral collagen trapping
198
Q

Positive or Negative

IHC for DFSP

-Vimentin

A

Positive

199
Q

Positive or Negative

IHC for DFSP

-Actin

A

Positive

*focally and inconstantly

200
Q

Positive or Negative

IHC for DFSP

-CD34

A

Positive

*strongly and consistently

201
Q

Positive or Negative

IHC for DFSP

-S100

A

Negative

202
Q

Positive or Negative

IHC for DFSP

-HMB-45

A

Negative

203
Q

Positive or Negative

IHC for DFSP

-Keratin

A

Negative

204
Q

Positive or Negative

IHC for DFSP

-FXIIIa

A

Negative

205
Q

Pleomorphic sarcomas that arise in sun-damaged skin of the Head and Neck of elderly patients

A

Pleomorphic dermal sarcoma

206
Q

Pleomorphic dermal sarcoma vs. Atypical fibroxanthoma

-infiltrative growth pattern

A

Pleomorphic dermal sarcoma

*most important

207
Q

Pleomorphic dermal sarcoma vs. Atypical fibroxanthoma

-necrosis

A

Pleomorphic dermal sarcoma

208
Q

Pleomorphic dermal sarcoma vs. Atypical fibroxanthoma

-perineural invasion

A

Pleomorphic dermal sarcoma

209
Q

Flat xanthomas of eyelid

A

Xanthelasma

210
Q

Xanthoma in trunk or extremities of male

A

Papular xanthoma

211
Q

Abrupt onset of crops of yellowish papules with erythematous halos on the extensor surfaces

A

Eruptive xanthoma

212
Q

Papillomatous, verruca-like change of the overlying epidermis

A

Verruciform xanthoma

213
Q

Most common involvement of Xanthogranuloma

A

upper part of the body

214
Q

Positive or Negative

IHC for Xanthogranuloma

-CD68

A

Positive

215
Q

Positive or Negative

IHC for Xanthogranuloma

-alpha1-antichymotrypsin

A

Positive

216
Q

Positive or Negative

IHC for Xanthogranuloma

-lysozyme

A

Positive

217
Q

Positive or Negative

IHC for Xanthogranuloma

-other histiocytic marker

A

Positive

218
Q

Positive or Negative

IHC for Xanthogranuloma

-S100

A

Negative

219
Q

Giant cell reticulohistiocytoma with articular involvement

A

lipoid dermatoarthritis

220
Q

Defining nature of Langerhans cell histiocytosis

A

CD1a positivity

221
Q

Important diagnostic sign of LCH of the skin

A

invasion of the epidermis by the infiltrate

222
Q

Three distinct types of Leiomyomas of the skin

A
  • Genital
  • Pilar
  • Solitary Angioleiomyoma
223
Q

Type of skin leiomyoma

-Located in the nipple or scrotum

A

Genital

224
Q

Type of skin leiomyoma

-multiple superficial nodules of nevoid or hamartomatous type derived from from arrectores pilorum muscle

A

Pilar

225
Q

Type of skin leiomyoma

-with bizarre hyperchromatic nuclei

A
  • Pilar

- Solitary Angioleiomyoma

226
Q

Type of skin leiomyoma

-aka as Vascular Leiomyoma

A

-Solitary Angioleiomyoma

227
Q

Type of skin leiomyoma

-Subcutaneous

A

-Solitary Angioleiomyoma

228
Q

Peripheral nerve sheath tumors with predilection for cutaneous (dermal) involvement (4)

A
  • Neurofibroma
  • Granular cell tumor
  • Dermal nerve sheath myxoma
  • Palisaded encapsulated neuroma
229
Q

other name of Dermal nerve sheath myxoma

A

Myxoid neurothekeoma

230
Q

other name of Palisaded encapsulated neuroma

A

Solitary circumscribed neuroma

231
Q

Most helpful positive IHC stains for Cellular Neurothekeoma (2)

A
  • NKI/C3

- CD10

232
Q

Most peculiar skin lesion characterized by a proliferation of nerve fibers coated by squamous epithelium

A

Epithelial sheath neuroma

233
Q

Patterns of Perineurioma (4)

A
  • Epithelioid
  • Sclerosing
  • Reticular
  • Plexiform
234
Q

Pattern of perineurioma that is often misdiagnosed as epithelioid histiocytoma

A

Epithelioid

235
Q

Pattern of perineurioma that simulates a fibroma and is usually Acral in location

A

Sclerosing

236
Q

Important clue to the diagnosis of Perineurioma

A

EMA positivity

237
Q

other name of Infantile Hemangioma

A

Benign infantile hemangioendothelioma

238
Q

other name of Hobnail Hemangioma

A

Targetoid hemosiderotic hemangioma

239
Q

Hemangiomas of skin with hyaline globules (2)

A
  • Glomeruloid hemangioma

- Papillary hemangioma

240
Q

aka as Superficial lymphangioma of the skin

A

Lymphangioma circumscriptum

241
Q

aka as Deep lymphangioma of the skin

A

Lymphangioma cavernosum

242
Q

aka as Cystic lymphangioma of the skin

A

Cystic hygroma

243
Q

Characteristics of Cutaneous intralymphatic histiocytosis (3)

A
  • dilated vessels
  • CD68 positive in histiocytes
  • rheumatoid arthritis
244
Q

other name of Pyogenic granuloma (2)

A
  • granuloma pyogenicum

- lobular capillary hemangioma

245
Q

Most common locations of Pyogenic granuloma (2)

A
  • Fingers

- Lips

246
Q

Most distinctive feature of Pyogenic granuloma and almost always indicator of a benign process

A

vascular (capillary) lobule

247
Q

This feature of Pyogenic granuloma is defined as a central branching vessel surrounded by a hypercellular proliferation of newly formed endothelial and perithelial cells

A

vascular (capillary) lobule

248
Q

other name Acquired tufted angioma

A

Angioblastoma

249
Q

other names of Masson Hemangioma (3)

A
  • Vegetant intravascular hemangioendothelioma
  • Masson pseudoangiosarcoma
  • Intravascular papillary endothelial hyperplasia
250
Q

other name of Epithelioid Hemangioma (2)

A
  • Histiocytoid hemangioma

- Angiolymphoid hyperplasia with eosinophilia

251
Q

Defining feature of Epithelioid hemangioma

A

peculiar epithelioid or histiocytoid appearance of the endothelial cells

252
Q

Most common locations of the classic form of Kaposi sarcoma (2)

A
  • Foot

- Ankle

253
Q

Most commonly involved organs of Kaposi sarcoma (2)

A
  • Lymph nodes

- GIT

254
Q

Indicators of poor outcome in classic Kaposi sarcoma (2)

A
  • immunosuppression

- age greater than 50 yo

255
Q

Most typical feature microscopically of Kaposi sarcoma

A

presence of spindle cells forming slits containing RBCs

256
Q

Promontory sign of Kaposi sarcoma

A

in early lesions, spindle proliferation may be limited to the papillary dermis and to the vascular plexus with the neoplastic vessels dissecting around dermal structures such as the secretory coil of sweat glands or blood vessels

257
Q

Clues to the diagnosis of Bacillary angiomatosis (2)

A
  • clusters of neutrophils (many of them fragmented)

- presence of a granular purplish-staining extracellular material

258
Q

Bacillary Angiomatosis vs. Verruga peruana

-Bartonella henselae (rickettsia-like)

A

Bacillary Angiomatosis

259
Q

Bacillary Angiomatosis vs. Verruga peruana

-Bartonella bacilliformis

A

Verruga Peruana

260
Q

Most important clue to the diagnosis of Verruga Peruana

A

Rocha-Lim inclusions

261
Q

Three distinct patterns microscopically of Angiosarcoma

A
  1. Undifferentiated foci, which can simulate carcinoma or malignant melanoma
  2. Freely anastomosing channels lined by atypical endothelial cells, surrounding skin adnexa, and dissecting dermal collagen fibers
  3. areas resembling Kaposi sarcoma
262
Q

Tumors notorious for their ability to simulate angiosarcoma (3)

A
  • SqCCA
  • Epithelioid sarcoma
  • Pseudoangiomatous atypical fibroxanthoma
263
Q

consistent features of post-radiation angiosarcoma that is not seen in atypical vascular lesion (2)

A
  • amplification of MYC

- expression of MYC

264
Q

Positive or Negative

IHC for Retiform Hemangioendothelioma

-CD31

A

Positive

265
Q

Positive or Negative

IHC for Retiform Hemangioendothelioma

-CD34

A

Positive

266
Q

Positive or Negative

IHC for Retiform Hemangioendothelioma

-FVIII-related antigen

A

Positive

267
Q

Positive or Negative

IHC for Retiform Hemangioendothelioma

-D2-40 (lymph vessel marker)

A

Negative

268
Q

Positive or Negative

IHC for Retiform Hemangioendothelioma

-VEGFR-3

A

Negative

269
Q

other names of Cutaneous Lymphoid Hyperplasia (5)

A
  • Lymphoplasia
  • Lymphadenoma
  • Lymphocytoma benigna cutis
  • Lymphadenosis benigna cutis
  • Spiegler-Fendt sarcoid
270
Q

Histologic features that have been traditionally been used to favor a diagnosis of lymphoid hyperplasia over one of malignant lymphoma (7)

A
  • multiplicity of cell types
  • formation of lymphoid follicles
  • polarized germinal centers
  • tingible body macrophages
  • vascular proliferations
  • predominantly perivascular or periadnexal distribution of the infiltrate
  • prominent epidermal hyperplasia
271
Q

other clinically benign lymphocytic infiltrates that can microscopically simulate malignant lymphoma (4)

A
  • molluscum contagiosum
  • Syphilis
  • Nodular scabies
  • Actinic reticuloid
272
Q

Most common site of involvement of Primary Cutaneous Follicle Center Lymphoma

A

Head and Neck

273
Q

Most common cutaneous lymphoma subtype

A

Mycosis fungoides

274
Q

Clinical signs associated with poor prognosis in Mycosis fungoides (3)

A
  • presence of generalized plaques or tumors
  • diffuse erythema
  • lymphadenopathy
275
Q

Sézary syndrome vs. Woringer-Kolopp disease

-variant of Mycosis fungoides

A

Sézary syndrome

276
Q

Sézary syndrome vs. Woringer-Kolopp disease

Clinical - infiltratrive erythrodermal with pruritus

A

Sézary syndrome

277
Q

Sézary syndrome vs. Woringer-Kolopp disease

-Lymphadenopathy

A

Sézary syndrome

278
Q

Sézary syndrome vs. Woringer-Kolopp disease

Microscopic - presence of large or small cerebroid cells (Sezary and Lutzner cells) in the peripheral blood

A

Sézary syndrome

279
Q

Sézary syndrome vs. Woringer-Kolopp disease

-Pagetoid Reticulosis

A

Woringer-Kolopp disease

280
Q

Sézary syndrome vs. Woringer-Kolopp disease

Clinical - Solitary erythematosquamous patch, typically on the extremities

A

Woringer-Kolopp disease

281
Q

Sézary syndrome vs. Woringer-Kolopp disease

-extremely slow evolution

A

Woringer-Kolopp disease

282
Q

Sézary syndrome vs. Woringer-Kolopp disease

Microscopic - monomorphic intraepidermal infiltrate of cells with cerebroid nuclei

A

Woringer-Kolopp disease

283
Q

Two most important diagnostic features of lymph nodes in Mycosis fungoides (2)

A
  • preservation or distortion of the nodal architecture

- number of atypical lymphoid cells in T cell-dependent paracortical areas

284
Q

Subcutaneous panniculitis-like T-cell lymphoma vs. Cutaneous gamma/delta+ T-cell lymphoma

  • CD3 - pos
  • CD8 - pos
  • CD4 - neg
  • CD56 - neg
A

Subcutaneous panniculitis-like T-cell lymphoma

285
Q

Subcutaneous panniculitis-like T-cell lymphoma vs. Cutaneous gamma/delta+ T-cell lymphoma

-Excellent 5-year survival

A

Subcutaneous panniculitis-like T-cell lymphoma

286
Q

Subcutaneous panniculitis-like T-cell lymphoma vs. Cutaneous gamma/delta+ T-cell lymphoma

  • CD3 - pos
  • CD8 - neg
  • CD4 - neg
  • CD56 - pos
A

Cutaneous gamma/delta+ T-cell lymphoma

287
Q

Subcutaneous panniculitis-like T-cell lymphoma vs. Cutaneous gamma/delta+ T-cell lymphoma

-very aggressive

A

Cutaneous gamma/delta+ T-cell lymphoma

288
Q

other name of Intravascular (Angiotropic) Lymphoma

A

Malignant (Systemic, Proliferative, Neoplastic) Angioendotheliomatosis

289
Q

10% of Leukemia cutis with…

A

Monocytic leukemia

290
Q

8% of Leukemia cutis with…

A

CLL

291
Q

5% of Leukemia cutis with…

A

Chronic granulocytic leukemia

292
Q

Hamartoma of the scalp with ectopic meningothelial elements

A

Rudimentary meningocele

293
Q

Metaplastic synovial cyst

A

Synovial metaplasia of the skin

294
Q

Most common source of metastatic tumor to the skin in men

A

Lung (25%)

295
Q

Most common source of metastatic tumor to the skin in women

A

Breast (69%)

296
Q

Cutaneous metastases of Gastric carcinoma or Primary Sweat gland carcinoma

-Antibody HIK1083 - Positive

A

Cutaneous metastases of Gastric carcinoma

*detects gastric o-glycan

297
Q

Cutaneous metastases of Gastric carcinoma or Primary Sweat gland carcinoma

-Antibody HIK1083 - Negative

A

Primary Sweat gland carcinoma

298
Q

Sweat gland carcinoma or Metastatic carcinoma from various sites

Podoplanin (D2-40) - Positive

A

Sweat gland carcinoma

299
Q

Sweat gland carcinoma or Metastatic carcinoma from various sites

p63 - Positive

A

Sweat gland carcinoma

300
Q

Sweat gland carcinoma or Metastatic carcinoma from various sites

p40 - Positive

A

Sweat gland carcinoma

301
Q

Sweat gland carcinoma or Metastatic carcinoma from various sites

Podoplanin (D2-40) - Negative

A

Metastatic carcinoma from various sites

302
Q

Sweat gland carcinoma or Metastatic carcinoma from various sites

p63 - Negative

A

Metastatic carcinoma from various sites

303
Q

Sweat gland carcinoma or Metastatic carcinoma from various sites

p40 - Negative

A

Metastatic carcinoma from various sites

304
Q

Most common sites for skin metastases (3)

A
  • Chest
  • Abdomen
  • Head and Neck

PATHOLOGY (26 decks)

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