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patho II > skin > Flashcards

skin Flashcards

1
Q

Patho of Urticaria

A

Immediate (type 1) hypersensitivity reaction -> corss-linkage of IgE on mast cells which cause degranualtion

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2
Q

Microscopic Findings:
* Superficial perivenular infiltrate of mononuclear cells (Lymphatic vessel dilatation)
* Superficial dermal oedema, creating more widely spaced collagen bundles
* Degranulation of mast cells,

features of?

A

Urticaria

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3
Q

Degranulation of mast cells in Urticaria can highlighted using ——– stain

A

Giemsa stain

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4
Q

CP of Urticaria

A

Erythematous, oedematous, and Pruritic wheals(form after the degranulation of mast cells)

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5
Q

cause of Allergic Contact Dermatitis

A

Type IV hypersensitivity reaction secondary to contact allergens (e.g, poison ivy, nickel)

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6
Q

CP of allergic contact dermatitis

A

localized pruritic (itchy) skin lesions, blisters w/ clear fluid

* bullae: blisters w/ clear fluid

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7
Q

Microscopic Findings:
* Spongiosis (epidermal odema)
* Intercellular bridges are stretched
* Superficial perivascular lymphocytic infiltrate
* Oedema of dermal papillae
* Mast cell degranulation

features of?

A

Allergic Contact Dermatitis

*note very similar micro features of Urticaria

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8
Q

CP of Erythema Multiforme

A

Target- like papules
(consisting of red macules or papules with pale vesicular or eroded centers)

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9
Q

**

Macroscopic features:
* pathces have pale, vesicular, or eroded centers (Target-like papules)

Microscopic Findings:
* Dermal oedema
* lesions w/ degenerating (apoptotic) keratinocytes w/ lymphocytic infiltrates

A

Erythema Multiforme

*keratinocytes: the major cell type of the epidermis

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10
Q

CP of Psoriasis

A

pink to salmon-coloured palques w/ silvery scaling

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11
Q

Microscopic Findings:
* Epidermal thickening (acanthosis), w/ parakeratotic (nuclei still in stratum corneum)
* loss of the stratum granulosum and parakeratotic scale (due to lack of maturation)
* Regular elongation of the rete ridges
* Thinning of the epidermal cell layer overlying the tips of dermal papillae

Features of?

A

Psoriasis

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12
Q

patho of Linchen PLanus

* chronic inflammatory skin disorder

A

CD8+ T cell-mediated cytotoxic immune response against antigens in the basal cell layer and the dermo-epidermal junction

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13
Q

**

CP of Lichen Planus

A

6 P’s
1) Pruritic, purple, polygonal, planar papules, and plaques of skin and squamous mucosa
2) Mucosal involvement –> Wickham striae

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14
Q

**

Microscopic Findings:
* The lymphocytes are intimately associated with basal keratinocytes, which often atrophy or become necrotic
* “zig-zag” contour/”saw-tooth” infiltrate of lymphocytes at Dermo-epidermal interface (junction)
* Presence of anucleate, necrotic basal cells (colloid bodies or Civatte bodies)

features of?

A

Lichen Planus

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15
Q

cause of Lichen simplex Chronicus

A

Response to local repetitive trauma, such as continual rubbing or scratching

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16
Q

CP of Lichen Simplex Chronicus

A

Raised, erythematous, and scaly lesions

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17
Q

Microscopic Findings:
* Acanthosis (epi thickening)
* Hyperkeratosis
* Hypergranulosis ( ↑ thickness of the stratum granulosum)
* Solar elastosis
* Elongation of the rete ridges
* Fibrosis of the papillary dermis
* Dermal chronic inflammatory infiltrate

features of?

A

Linchen Simplex Chronicus

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18
Q

cause of Impetigo

* superficial bacterial infection

A

Staphylococcus aureus, Streptococcus pyogenes

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19
Q

CP of Impetigo

A

lesions w/ Honey-coloured crusting

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20
Q

Microscopic Findings:
* Accumulation of neutrophils beneath the stratum corneum that often produces a sub-corneal pustule
* Superficial dermal inflammation accompany these findings
* Bacterial cocci in the superficial epidermis (demonstrated by Gram stain)

features of?

A

impetigo

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21
Q

obv+ skin condition

A

Skin condition: Superficial dermal fungal infection caused by Candida albicans
Obv: Satelite lesions

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22
Q

Microscopic Findings:
*Neutrophilic infiltrate in the epidermis
*Psoriasiform hyperplasia

A

Candidiasis of the Skin

Psoriasiform hyperplasia-> Candida

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23
Q

Stain used for Candida causing superfical Dermal fungal infection

A

PAS

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24
Q

Obv+ skin disorder

A

Condition: Deep dermal fungal infection caused by Apergillus
Obv: A- Erythematous subcutaneous nodule
B- Focally haemorrhagic lesion

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25
Q

Histochemistry for Deep Dermal fungal infection caused by Aspergillus

A

1) PAS- Periodic Acid-Schiff
2) Gomori methenamine silver stains

*identify fungal organisms

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26
Q

cause of Verrucae (Warts)

* viral infection

A

Human Papilloma Virus (HPV)

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27
Q

Microscopic Findings:
* Epidermal hyperplasia
* Cytoplasmic vacuolisation [koilocytosis] (preferentially of the more superficial epidermal layers) –> Halos of pallor surrounding infected nuclei
* Infected cells with prominent kerato-hyalin granules and jagged eosinophilic intracytoplasmic protein aggregates (result of impaired maturation)

features of?

A

Verrucae (Warts)

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28
Q

the 4 types of Verrucae (Wrats)

A
  1. Verruca Vulgaris
  2. Verruca Plana (Flat Wart)
  3. Verruca Plantaris/Palmaris
  4. Condyloma Acuminatum (Venereal Wart)
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29
Q

most common type of Verrucae (Wrats)

A

Verruca Vulgaris

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30
Q

loc of Verruca Vulgaris

A

dorsum of the hand

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31
Q

Verucca Vulgaris presents w/ Rough, ————–to ————— skin coloured papule/plaque Macroscopically

A

hyperkeratotic to papillomatous

Hyperkeratotic –> thickening of the outer layer of the skin

32
Q

Macroscopic features:
- Rough, hyperkeratotic to papillomatous skin coloured papule/plaque

microscopic features :
- Papillomatous hyperplasia
- Prominent granular layer
- Inward bending of rete
- Koilocytosis

features of ?

A

Veruuca Vulgaris

33
Q

**

what type of Verruca (Wrats) has the following microscopic features:
- Multiple “bird’s eye” nuclei in the granular cell layer

A

Verruca Plana

34
Q

Macroscopic features:
- Warty cauliflower-like lesion w/ papillary or polypoid fronds

Microscopic features :
- Papillomatous mammillated epithelial hyperplasia
- Koilocytic changes
- Hyperkeratosis

features of?

A

Condyloma Acuminatum (Venereal Wart)

35
Q

patho of Pemphigus

A
  • Antibody-mediated (type II) hypersensitivity reactions
  • IgG auto-antibodies that bind to intercellular desmosomal proteins (Desmoglein types 1 and 3) of skin and mucous membranes
36
Q

Microscopic Findings:
* Acantholysis: Lysis of the intercellular adhesive junctions between neighbouring squamous epithelial cells that results in the rounding up of detached cells
* Superficial dermal infiltrates comprised of lymphocytes, macrophages, and eosinophils

features of?

A

Pemphigus

37
Q

Direct Immuno-Fluorescence of Pemphigus

A

Fishnet-like pattern of intercellular IgG deposits

38
Q
  • Acantholysis selectively involves the layer of cells immediately above the basal cell layer, giving rise to a supra-basal acantholytic blister

what type of Pemphigus is this?

A

Pemphigus Vulgaris

39
Q

**

microscopic features;
- Acantholysis in the granular cell layer with “missing” stratum corneum
- Neutrophils in the granular cell layer
- Separation of the corneum from the rest of the epidermis

features of?

A

Pemphigus Foliaceus

40
Q

Microscopic Findings:
* Perivascular infiltrate of lymphocytes and variable numbers of eosinophils, occasional neutrophils
* Superficial dermal oedema
* Associated basal cell layer vacuolisation; The vacuolated basal cell layer eventually gives rise to a fluid-filled sub-epidermal non-acantholytic blister

features of?

A

Bullous Pemphigoid

41
Q

Direct Immuno-Fluorescence of Bullous Pemphigoid

A

Linear deposition of IgG antibodies and complement in the epidermal basement membrane

42
Q

Epi of Dermatitis Herpetiformis

A
  • Males
  • 80% occurs is ass. w/ Coeliac disease
43
Q

patho of Dermatiis Herpetiformis

A

Genetically predisposed persons develop:
* IgA antibodies to dietary Gluten (derived from the wheat protein Gliadin) and
*IgA auto-antibodies that cross-react with epidermal transglutaminase , expressed by keratinocytes

44
Q

**

CP of Dermatitis Herpetiformis

A

Pruritic urticaria and grouped vesicles

45
Q

**

Microscopic Findings:
* Neutrophils accumulate selectively at the tips of dermal papillae, forming small micro-abscesses- “Papillary Abscess”
* The basal cells overlying these micro-abscesses show vacuolisation and focal dermo-epidermal separation that ultimately coalesce to form subepidermal blisters

features of?

A

Dermatitis Herpetiformis

46
Q

**

CF of Seborrhoeic Keratosis

A
  • Round, exophytic, coin-like plaques
  • “Stuck-on” appearance
  • Tan to dark brown colour
47
Q

**

Microscopic Findings:
* Monotonous sheets of small cells that resemble the basal cells of the normal epidermis
* Variable melanin pigmentation is present within these basaloid cells
* Hyperkeratosis at the surface
* Presence of small keratin-filled cysts (Horn cysts)
* Down-growth of keratin into the main tumour mass (Pseudo-Horn cysts)

features of?

A

Seborrhoeic Keratosis

48
Q

Patho of Acitinic Keratosis

A

TP53 mutations caused by UV light-induced DNA damage

49
Q

**

Clinical presentation of Acitinic Keratosis

A

Small (<1cm), Rough, erythmatous(red) or brownish papules

  • rough –> sandpaper- like on touch
50
Q

**

Macro features:
- red, scaly lesions w/ rough texture
Microscopic findings:
* Cytologic atypia in the lower portions of the epidermis
* Accompanying hyperplasia of basal cells or atrophy and diffuse thinning of the epidermal surface
* Thickened, blue-gray elastic fibers in the dermis (dermal solar elastosis)
* Thickened stratum corneum, with retained nuclei (parakeratosis)

features of?

A

Actinic Keratosis

* rough texture –> sand paper like

51
Q

Acitinic Keratosis is asso. w/ an increased risk of developing?

A

SCC- Squamous Cell Carcinoma

52
Q

Risk factors of SCC?

A
  • Chronic exposure to sunlight (e.g. Acitinic Keratosis)
  • Industrial carcinogens (tars and oils)
  • Chronic ulcers
  • Old burn scars
  • Ingestion of arsenicals
  • Ionising radiation
53
Q

Patho of SCC

A
  • TP53 mutations caused by UV light-induced DNA damage
  • Mutations in HRAS
  • Loss-of-function mutations in Notch receptors,
54
Q

Clinical presentation of SCC in situ

A

Sharply defined, red, scaling plaques

55
Q

Clinical presentation of invasive SCC

A

Nodular, with variable scale and ulceration

56
Q

**

What skin cancer presents w/ Keratin pearls on Histology?

A

Squamous Cell Carcinoma (Well-diffrentaited form)

57
Q

Epi of Basal Cell Carcinoma

A

Older people

58
Q

Microscopic Findings:
* Tumour cells resemble the normal epidermal basal cell layer
* Palisading (aligned) nuclei
* Separation of the peripheral border from the stroma (reduced stroma), with a creation of a characteristic cleft

features of?

A

Basal Cell Carcinoma

59
Q

Patho of Melanocytic Naevus

A

Activating mutation in BRAF

60
Q

Clinical presentation of Melanocytic Naevus

A
  • Small papules; Size: ≤5 mm
  • Tan-to-brown, uniformly pigmented
  • Well-defined, rounded borders
61
Q

the 3 types of Melanocytic Naevus

A

1) Compound
2) Junctional
3) intradermal naevus

62
Q

What is the diffrence (Microscopically) btw Compound and Junctional Melanocytic Naevus ?

A

Junctional –> Nest of Mealnocytes grow along the dermo-epidermal junctions
Compound –> Melanocytes grow within the Dermis only

63
Q

how do junctional / compound Melanocytic Naevus look like?

A

Compound–> well-defined, Brown nodule w/ rounded borders
Junctional –> Flat uniform bronw macule

64
Q

Microscopic Findings:
* Junctional component
* Stromal component
* Nevomelanocytes extend into the reticular dermis
* Patterns of dermal involvement: i. Diffuse, ii. Interstitial or iii. Perivascular
* Commonly, adnexal involvement
* Possible involvement of nerves

features of?

A

Congenital Naevus

65
Q

patho of Dysplastic naevus

A

Activating mutation in BRAF

66
Q

**

CP of Dysplastic naevus

A
  • Larger than acquired naevi (>5 mm)
  • Numerous (in Familial Dysplastic Naevus Syndrome)
  • Flat macules to slightly raised plaques, with a “pebbly” surface
  • variable pigmentation (variegation) * Irregular borders
67
Q

Macroscopic features:
- Uneven colour with dark brown centers and lighter, uneven edges
- Large and irregular in shape

Microscopic features:
- irregular nuclear contours & hyperchromasia
- Nevus cell nests within the epidermis may be enlarged and exhibit abnormal fusion or coalescence with adjacent nests (bridging)
- Melanin pigment that is phago- cytosed by dermal macrophages
- Subepidermal lamellar sclerosis (‘lamellar fibroplasia’)

features of?

A

Dysplastic Naevus

68
Q

patho of melanoma

A
  • Somatic activating mutations in the proto-oncogenes BRAF or NRAS
  • Activating mutations in the c-KIT receptor tyrosine kinase
69
Q

who is at most risk of Melanoma

A

Fair-skinned individuals

70
Q

Clincial presentaitons of melanoma

A
  • Rapid enlargement of a pre-existing naevus
  • Itching or pain
  • Development of a new pigmented lesion, during adult life
  • Irregularity of the borders of a pigmented lesion
  • Variegation of colour within a pigmented lesion
71
Q

**

THE ABCDE of melanoma

A
72
Q

the 4 types of melanoma

A

1) Superficial spreading melanoma
2) Lentigo maligna
3) Nodular melanoma
4) Acral melanoma

73
Q

**

Microscopic Findings:
* Malignant cells grow as poorly formed nests or as individual cells at all levels of the epidermis (pagetoid spread) and in expansile dermal nodules (radial and vertical growth phases)
* large nuclei with irregular contours
* Chromatin is characteristically clumped at the periphery of the nuclear membrane
* Prominent “cherry red” eosinophilic
nucleoli

features of?

A

Melanoma

74
Q

**

tumour marker used to detect melanoma

A

1) S-100
2) MART-2/ Melan-A
3) HMB45
4) AE1/AE3
5) Vimentin

75
Q

**

Prognosis of Melanoma

A

Depth of tumor (Breslow thickness) correlates w/ risk of metastasis

patho II (29 decks)

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