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Pathology > Skin > Flashcards

Skin Flashcards

1
Q

What is eczema?

A

skin condition causing chronic itch

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2
Q

Where does eczema commonly affect?

A

flexures of elbows and knees

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3
Q

Who does eczema commonly affect?

A

children

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4
Q

What is eczema associated with?

A

other atopic conditions like asthma and hay fever

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5
Q

WHat can be seen in the slide?

A

atopic eczema
top arrow shows spongiosis
bottom arrow shows perivascular inflammation in superficial dermis

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6
Q

What is spongiosis?

A

accumulation of fluid in the epidermis

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7
Q

What cells are seen in atopic eczema?

A

lymphocytes

less common: eosinophils and mast cells

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8
Q

What is chronic plaque psoriasis?

A

well demarcated, red, scaly, thickened areas of skin

silvery scale

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9
Q

Where does chronic plaque psoriasis commonly affect?

A

extensors of knees and elbows

can involve skin and nails

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10
Q

Describe this slide

A

chronic plaque psoriasis
chronic inflammation
thickening of epidermis with epithelial hyperplasia - ACANTHOSIS
hyperkeratosis

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11
Q

What is not normally seen in chronic plaque psoriasis biopsies?

A

eosinophils

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12
Q

What is erythema multiforme?

A

hypersensitivity reaction

acute skin eruption with characteristic targetoid lesions

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13
Q

What causes erythema multiforme?

A

usually infection triggered

rarely drug induced

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14
Q

How is erythema multiforme trated?

A

self limiting

resolves itself without complication usually

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15
Q

What is lichen planus?

A

itchy, purple, polygon-shaped, flat, raised skin lesion

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16
Q

Where does lichen planus normally affect?

A

wrists
ankles
lower back

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17
Q

Why does lichen planus occur?

A

idiopathic

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18
Q

What does lichen planus look like histologically?

A

band-like chronic inflammatory cell infiltrate along dermal-epidermal junction

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19
Q

What is lichen sclerosus?

A

chronic skin condition

white patches on ale anf female genital skin

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20
Q

What symptom does lichen sclerosus cause?

A

itch

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21
Q

What is lichen sclerosus associated with?

A

increased cancer risk?

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22
Q

What is lichen sclerosus called in males?

A

BXO

balantis xerotica obliterans

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23
Q

What does lichen sclerosis look like histologically?

A

band of hyalinisation/sclerosis in superficial dermis

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24
Q

What are 2 CT diseases?

A

lupus

dermatomyositis

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25
Q

What causes these CT diseases?

A

chronic inflammation along dermal-epidermal junction

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26
Q

What is erythema nodosum?

A

red tender nodules on shins

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27
Q

What is the underlying causes erythema nodosum?

A

panniculitis - chronic inflammation of subcutaneous fat

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28
Q

What are some causes for erythema nodosum?

A 
streptococcal throat infection
antibiotics
contraceptive pill
pregnancy
inflammatory bowel disease
sarcoid
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29
Q

What are the 3 autoimmune blistering diseases?

A

pemphigus vulgaris
bullous pemphigoid
dematitis herpetiformis

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30
Q

Which autoimmune disease is seen in this immunofluorescense?

A

pemphigus vulgaris

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31
Q

What is seen in pemphigus vulgaris immunofluroescence?

A

chicken wire pattern due to IgG positivity on surface of epithelial cells
epithelial cells falling apart from each other

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32
Q

Where does pemphigus vulgaris affect and how does it affect them?

A 
severe blistering
mucous membranes
mouth
nose
throat
genitals
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33
Q

Where does the blistering occur in pemphigus vugaris?

A

intra-epidermal

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34
Q

What antibodies are associated with pemphigus vulgaris?

A

anti-desmosome Ab

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35
Q

What autoimmune blistering condition is seen on this immunofluorescence?

A

bullous pemphigoid

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36
Q

What is seen in immunofluorescence of bullous pemphigoid?

A

linear IgG deposition along basement membrane

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37
Q

Where does bullous pemphigoid usually affect?

A

skin

occassionally mouth

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38
Q

Where does the blistering occur in bullous pemphigoid?

A

sub-epidermal

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39
Q

What antibodies are present in bullous pemphigoid?

A

anti-basement Ab

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40
Q

What is dermatitis herpetiformis?

A

itchy blistering skin disease

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41
Q

What is dermatitis herpetiformis associated with?

A

coeliac disease

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42
Q

Where does dermatitis herpetiformis cause blistering?

A

sub-epidermal

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43
Q

What antibodies cause dermatitis herpetiformis?

A

IgA anti-endomysial

IgA tissue transglutamase tTG

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44
Q

What are the 3 types of non-infectious granulomatous inflammation?

A

cutaneous sarcoidosis
granuloma annulare
necrobiosis lipoidica

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45
Q

What are granuloma annulare and necrosis lipoidica grouped together as?

A

necrobiotic granulomatous inflammation

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46
Q

What is cutaneous sarcoidosis?

A

papules and plaques anywhere on the body

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47
Q

Describe what is seen histologically in cutaneous sarcoidosis

A

non-caseating granulomatous inflammation

fungus and mycobacterium stains are negative

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48
Q

What is granuloma annulare?

A

annular pink/purple patches on bony sites

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49
Q

What is seen histologically in granuloma annulare?

A

zones of degenerate collagen surrounded by rim of histocytes or macrophages

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50
Q

What is necrobiosis lipoidica?

A

tender yellow/brown patches on lower legs

overlying skin fragile and prone to ulcerrating

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51
Q

What is a risk factor for necrobiosis lipoidica?

A

type 1 and 2 diabetes mellitus

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52
Q

What viral skin infections can you get?

A

herpes simples virus

molluscum contagiosum virus

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53
Q

What happens skin with HSV?

A

localised intra-epidermal blistering

lips, genitals, rectum

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54
Q

What is seen here?

A

HSV infection

at higher mag: intracellular viral inclusions present

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55
Q

What does cutaneous infection by molluscum contagiosum virus cause?

A

multiple raised lesions with central crater

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56
Q

How do you treat molluscum contagiosum?

A

resolves without treatment

57
Q

What is seen here?

A

molluscum contagiosum viral infection

58
Q

What are 3 bacterial cutaneous infections?

A

fish tank granuloma
impetigo
cellulitis

59
Q

What is impetigo?

A

infection of superficial epidermis

60
Q

What is usually the causative organism for impetigo?

61
Q

What is cellulitis?

A

infection of dermis and subcutaneous fat

62
Q

What are the causes of cellulitis?

A

Strep pyogenes and S. aureus

63
Q

What causes fish tank granuloma?

A

mycobacterium marinum

64
Q

What happens Z-N stain in fish tank granuloma?

65
Q

What type of infection is seen in the slide?

66
Q

What stain is used in fungal infection?

A

PAS (periodic acid Schiff)

67
Q

What is seen histologically in fungal cutaneous infection?

A

fungal spores and hyphae in superficial layer of epidermis

68
Q

3 types of pre-cancers

A

squamous dysplasia
melanocytic
glandular

69
Q

What is acitinic keratosis?

A

mils and moderate dysplasia of sun exposed skin

70
Q

What is severe dysplasia of sun-exposed skin known as?

A

Bowen’s disease or carcinoma in situ

71
Q

How are mild, moderate and severe dysplasias of perineum/vulva classified?

A

intraepithelial neoplasia 1, 2 and 3

72
Q

What are examples of dysplasia in the large intestine?

A

adenomatous polyps

tubulovillous adenomas

73
Q

What is dysplasia in the cervical epithelium known as?

A

cervical intraepithelial neoplasia

74
Q

What are risk factors for squamous dysplasia in sun-exposed skin?

A

chronic sunlight
immunosuppression (renal transplant patients)
previous irradiation
chemical carcinogens

75
Q

What is the risk factor for squamous dysplasia in the groin/perineum?

A

human papilloma virus infection

76
Q

What is the difference between mild, moderate and severe squamous dysplasia?

A

abnormal hyperchromatic nuclei and increased numbers of mitotic figures occupy:
MILD: lower 1/3 epidermis
MODERATE: lower 2/3 epidermis
SEVERE: full thickness epidermis

77
Q

What is full thickness/severe squamous dysplasia known as?

A

carcinoma in situ

78
Q

What is a dysplastic naevus?

A

melanocytic lesion with atypical histological features

no evidence of invasive melanoma

79
Q

If the dysplastic naevus is familial then what tumour suppressor gene can be idetified?

A

cyclin-dependent kinase inhibitor 2A

80
Q

What is lentigo maligna?

A

melanoma in situ of the face when slow growing

81
Q

What is melanoma in situ?

A

severe dysplasia of melanocytes within epidermis

82
Q

What is Paget’s disease of the nipple?

A

abnormal glandular/mucinous cells within epidermis which have migrated along the lactiferous duct

83
Q

What can Paget’s disease of the nipple look like?

84
Q

Where can exta-mammary Paget’s disease occur?

A

hair body parts like groin and axillae

85
Q

What is the breakdown of invasive cancers?

A

epithelial (non-melanoma) skin cancers
malignant melanoma
cutaneous T-cell lymphoma
Kaposi sarcoma

86
Q

What is the origin of BCC?

A

undifferentiated stem cell within basal layer of epidermis

87
Q

Where is high risk for BCC?

A

H-zone of face

88
Q

What is seen histologically in BCC?

A

peripheral pallisading

89
Q

What is peripheral pallisading?

A

cells at periphery of tumour are columnar and parallel to each other

90
Q

What is SCC?

A

invasive tumour showing squamous differentiation

91
Q

What is a risk factor for malignant melanoma?

A

dysplastic naevus

92
Q

What is malignant melanoma?

A

malignant tumour of melanocytes which have invaded the dermis

93
Q

What are risk factors for malignant melanoma?

A

sunlight

sunbeds

94
Q

How does malignant melanoma spread?

A

Pagetoid: upwards
radial: horizontally

95
Q

What must be measures in malignant melanoma?

A

Breslow’s depth or thickness

96
Q

What is Breslow’s depth?

A

distance between granular layer of epidermis and deepest malignant cell

97
Q

What must be done if malignant melanoma is suspected?

A

red flag referral to secondary care for urgent removal

98
Q

What should be checked in malignant melanoma?

A

BRAF oncogene

99
Q

If BRAF oncogene positive what treatment should be given?

A

vemurafenib

100
Q

What is cutaneous T-cell lymphoma?

A

non-Hodgkin lymphoma

Mycosis fungoides involving epidermis and dermis

101
Q

What can mycosis fungoides resemble?

102
Q

What can mycosis fungoides turn into?

A

Sézary syndrome

103
Q

What is Sézary syndrome?

A

more advanced/aggressive lukaemic stage of mycosis fungoides

tumour cells now in circulation as well as skin

104
Q

What is Kaposi sarcoma?

A

malignant vasular poliferation within dermis

105
Q

What 4 clinical settings is Kaposi sarcoma seen in?

A

HIV
tranplant
classic
endemic

106
Q

Where are patients usually from in classic Kaposi?

A

middle east
eastern europe
mediterranean

107
Q

Where are patients from with endemic Kaposi?

A

equatorial Africa

108
Q

What is Kaposi sarcoma caused by?

A

human herpesvirus 8

109
Q

What is a cutaneous cyts?

A

keratin “cheesy” filled spherical structure lined with epithelium within dermis

110
Q

What layer is a cutaneous cyst found?

111
Q

What do clinicians often refer to cutaneous cysts as?

A

sebaceous cyst

112
Q

What are the 2 common types of cutaneous cyst?

A 
epidermal inclusion cyst
pilar cyst (scalp)
113
Q

What is seborrhoeic keratosis?

A

flat based, dark, warty, greasy “stuck on” lesion

114
Q

Who normally gets seborrhoeic keratosis?

115
Q

What is a skin tag also known as?

A

fibroepithelial polyp

116
Q

What is a fibroepithelial polyp?

A

round structure of squamous epithelium encasing connective tissue core

117
Q

Where are fibroepithelial polyps often found?

A

skin fold areas

groin/axilla

118
Q

What is a squamous papilloma?

A

proliferation of squamous epithelium

119
Q

What can cause squamous papilloma?

A

human papillomavirus

120
Q

What is a dermatofibroma?

A

fibroblastic proliferation within dermis

121
Q

What do fibroblasts look like?

A

boomerang shaped nuclei

122
Q

Where does a dermatofibroma often occur?

A

lower legs

123
Q

What is an ulcer?

A

full thickness loss of epidermis

bed of ulcer contains new blood vessels and inflammatory cells (lymphocytes and neutrophils)

124
Q

What are the causes of ulcers?

A 
diabetes
arterial/venous insufficiency
trauma
surgery
immobility
125
Q

What is a pyogenic granuloma?

A

polypoid proliferation of small blood vessels which can ulcerate and bleed

126
Q

What does a pyogenic granuloma look like?

A

raw mince meat

raspberry

127
Q

What are causes of pyogenic granulomas?

A

pregnancy
trauma
infection
medication

128
Q

What is a pilonidal sinus?

A

fragmented hair shaft material within sinus tract in dermis surrounded by inflammatory cells and fibrous scar tissue

129
Q

Where are pilonidal sinuses often seen?

A

sacral/cleft area of hair men’s buttocks

hairdressers hands “barber’s interdigital pilonidal sinus of hand”

130
Q

What is a freckle?

A

increase in basal pigmentation with NO increase in melanocytes

131
Q

What is solar lentigo?

A

flat pigmented lesion
increase in basal pigmentation
small increase in basal melanocytes
no nuclear atypia

132
Q

What is a junctional naevus?

A

nests of benign melanocytes within the epidermis

133
Q

What is an intradermal naevus?

A

nests of benign melanocytes within dermis

134
Q

What is a compound naevus?

A

combined features of junctional and intradermal naevus

135
Q

What is a halo naevus?

A

prominent lymphocytic infiltrate as well as melanocytic lesion

136
Q

Why does the pale halo form in halo naevi?

A

immune-mediated regression of lesion

137
Q

What is a blue naevus?

A

deeply pigmented bluish melanocytes that have stretched out into spindle shape

138
Q

What is a Spitz naevus?

A

in children

present like malignant melanoma

Pathology (5 decks)

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