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1
Q

What is an Ephelis? What is the histology?

A

Ephelis

  • Freckle
  • Histo
    • Normal density of melanocytes
    • Increased melanin pigment in basal keratinocytes
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2
Q

What are the differences between an ephelis and a cafe au lait spot?

A
  • Ephelis (freckle)
    • Vary with sun exposure
    • Normal density melanocytes
    • Increased melanin in basal keratinocytes
  • Cafe au lait
    • Larger
    • Independent of sun exposure
    • Increased melanocytes
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3
Q

What disease process is pictured below?

A

Lentigo

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4
Q

Lentigo

  • Location
  • Gross appearance
  • Microscopic appearance
A
  • Location
    • Hands
    • Face
    • Mucous membranes
  • Gross appearance
    • Macules or patches
    • independent of sun
  • Microscopic appearance
    • Hyperplasia of melanocytes in basal layer (linear)
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5
Q

Junctional Nevus

  • Gross appearance
  • Microscopic appearance
A
  • Gross appearance
    • Usually flat
  • Microscopic appearance
    • Nests of melanocytes
    • Epidermal - dermal junction
    • Little or no mitosis
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6
Q

Compound Nevus

  • Gross appearance
  • Microscopic appearance
A
  • Gross appearance
    • Raised
  • Microscopic appearance
    • Nests of melanocytes:
      • At dermal - epidermal junction
      • Deeper in dermis
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7
Q

Intradermal Nevus

  • Gross appearance
  • Microscopic appearance
A
  • Gross appearance
    • Raised
  • Microscopic appearance
    • Cluster of dermal melanocytes
    • No nest nature
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8
Q

Mature Nevus

  • Gross appearance
  • Microscopic appearance
A
  • Gross appearance
    • Raised??
  • Microscopic appearance
    • Deeper melanocytes have fusiform shape
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9
Q

Maturation of nondysplastic nevi

A

Maturation sequence of nondysplastic melanocytic nevi.

  • A, Normal skin shows only scattered dendritic melanocytes within the epidermal basal cell layer.
  • B, Junctional nevus.
  • C, Compound nevus.
  • D, Dermal nevus.
  • E, Dermal nevus with neurotization (extreme maturation). Nevi may exist at any stage in this sequence for variable periods of time, although many are believed to progress through this sequence.
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10
Q

What increases cancer risk in congenital nevi?

A

Size

Large = increased melanoma risk

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11
Q

Blue Nevus

  • Gross appearance
  • Microscopic appearance
A
  • Gross appearance
    • heavily pigmented
  • Microscopic appearance
    • non nested dermal infiltrates
    • dermal fibrosis
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12
Q

What percent of people with Dysplastic Nevus Syndrome have melanoma by age 60?

A

50%

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13
Q

What are the microscopic characteristics of Dysplastic Nevi?

A
  • Lentiguous hyperplasia
    • melanocytes begin to replace basal layer
  • Cytologic / nuclear atypia
  • Melanin incontinence
    • released by dead melanocytes
    • Linear / lamellar fibrosis in dermis
      • surrounding rete pegs
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14
Q

What are the first and second stages of growth in melanomas?

A
  1. Radial growth
    • Horizontal spread
    • Unable to metastasize
  2. Vertical growth
    • Nodular appearance
    • Metastatic potential
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15
Q

What disease process is pictured below?

A

Seborrheic keratosis

dark keratin-filled surface plugs (inset)

benign basaloid cells

prominent keratin-filled “horn” cysts, some of which communicate with the surface (pseudo-horn cysts).

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16
Q

What disease process is pictured below?

A

Acanthosis Nigricans

  • Micro
    • •Hyperkeratosis
    • •Papillomatosis
      • •undulating enlarged dermal papilla
    • •Slight basal cell hyperpigmentation
    • •No melanocytic hyperplasia
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17
Q

What disease process is pictured below?

A

Fibroepithelial polyp

  • Gross:
    • Flesh colored
    • Pedunculated
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18
Q

What may be associated with fibroepithelial polyps?

A
  • Diabetes
  • Obesity
  • Intestinal polyposis
  • Increased in pregnancy
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19
Q

What is the makeup of an Inclusion Epidermal Cyst?

A
  • Wall
    • Normal epidermal epithelium
  • Filled with
    • Laminated keratin
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20
Q

What is the makeup of a Pilar / Tricholemmal Epidermal Cyst?

A
  • Wall
    • Hair follicular epithelium
  • Filled with
    • Homogenous keratin
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21
Q

What is the makeup of a Dermoid Epidermal Cyst?

A
  • Wall
    • normal epidermal epithelium
    • Small hair follicles budding out from wall
  • Filled with
    • laminated keratin

(just like inclusion but with hair follicles)

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22
Q

What is the makeup of a Steatoma Simplex Epidermal Cyst?

A

Sebeceous cyst

  • Wall
    • Similar to sebaceous duct
    • Lobules budding from wall
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23
Q

What is the mutation and inheritance pattern resulting in Steatocystoma multiplex Epidermal Cyst?

A

Mutation in keratin 17

AD

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24
Q

What disease process is pictured below?

A

Cylindroma

“Turban Tumor”

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25
Cylindroma * Gross appearance * Microscopic appearance * Mutation
* Gross appearance * Papules or nodules * Turban tumor * along forehead and scalp * Microscopic appearance * Cells in islands * Surrounded by fibrous dermal matrix * Mutation * In CYLD * tumor suppressor
26
What disease process is pictured below?
Syringoma * Location * Eyelids * Lwr face * Gross * Tan / White papules * Micro * Eccrine differentiation of cords * Cords with "tadpole" appearance
27
What disease process is pictured below?
Trichoepithelioma * Location * Face * Scalp * Neck * Gross * Dome shaped * Flesh colored * Micro * baseloid cells attempting to form primitive hair follicles
28
Sebaceous adenoma * Histology * Associated condition * Mutations
* Histology * Prolif of sebocytes * Central cells filled with lipid * Associated condition * HNPCC * Mutations * DNA mismatch repair (same as HNPCC) * WNT pathway
29
What disease process is pictured below?
Pilomatrixoma * Histo * basaloid cells with hairlike differentiation * similar to germinal region of normal bulb * Mature cells = anucleate "ghost cells" * Mutation * activation of beta-catenin
30
What disease process is pictured below?
Apocrine Carcinoma * Apocrine ductal differentiation * Apocrine secretions * pinching off at apex
31
What disease process is pictured below?
Actinic Keratosis * Location * sun exposed areas * Gross * Scaly patch * sandpaper consistancy * Micro * Atypia in basal layers * Hyperkeratosis and parakeratosis common
32
What skin disease is characterized by erythematous scaly patches with a sandpaper consistancy in sun exposed areas?
Actinic keratosis Premalignant
33
What is actinic keratosis of the lip called?
Actinic cheilitis
34
What mutations cause Actinic Keratosis? What can this transform into?
TP53 mutations (Increase RAS signaling) Can become SCC (premalignant)
35
What population is most susceptible to Actinic Keratosis?
Caucasians
36
What disease process is pictured below?
Bowen's Disease aka SCC in situ * Gross * Irregular erythematous plaque * Scale * Location * Trunk * Extremities
37
What is Bowen's Disease?
SCC in situ * Gross * Irregular erythematous plaque * Scale * Location * Trunk * Extremities
38
What disease process is pictured below?
SCC
39
What disease process is pictured below?
Keratoacanthoma
40
Keratoacanthoma * Gross appearance * Course
* Gross appearance * Fleshy nodule * central hyperkeratic crater * Course * Reaches max size in 6-8 wks * Then regresses
41
What disease process is pictured below?
Basal Cell Carcinoma * Gross * Pearly, pink/tan macule, papule, or nodule * Telangectasia * Micro * Stromal clefting * differentiates from trichoepithelioma * Palisading pattern
42
Nevoid Basal Cell Carcinoma Syndrome (NBCCS) * Symptoms * Inheritance * Gene mutation
* Symptoms * Tumors before age 20 * Basal Cell Carcinoma * Inheritance * AD * Gene mutation * PTCH (patch) gene * codes SHH receptor * Overexpression of GLI1
43
What gene mutation accounts for Xeroderma pigmentosa?
PTCH and p53 DNA repair problem
44
What genes are associated with sporadic Basal Cell Carcinoma?
* PTCH * p53
45
What signs are of concern for development of malignant melanoma?
* Small lesions growing to \> 6mm * New onset pain or itching
46
What is the most common subtype of malignant melanoma?
Superficial Spreading Malignant Melanoma
47
Lentigo Maligna Melanoma * Onset * Population * Location
* Onset * decades * Population * elderly men * Location * head and neck
48
Superficial Spreading Malignant Melanoma * Population * Risk factor * Frequency
* Population * Mostly adults * Risk factor * Sun exposure * Frequency * 60% of malignant melanoma
49
Acral Lentiginous Malignant Melanoma * Population * Location
* Population * dark skinned races * Location * Palms * Soles * Nails * Genitalia * Not related to sun exposure
50
Nodular Malignant Melanoma * Growth phase of malignant melanoma * Special features
* Growth phase of malignant melanoma * Vertical * Special features * may be amelanotic * may ulceratie
51
Explain Clarks Levels I-V for Malignant Melanoma
* I: in situ * II: invade papillary dermis * III: fill papillary dermis * IV: invade reticular dermis * V: invade subcutaneous fat
52
Describe the Breslow Classification for Melanoma Prognosis
Measurement of depth Stratum Granulosum to max depth
53
S100 and HMB-45 are used as markers in which type of cancer?
malignant melanoma
54
Factor XIIIa is used as a marker for which type of cancer?
Benign Fibrous Histiocytoma (Dermatofibroma) Stains dermal dendritic cells
55
What disease process is pictured below?
Benign Fibrous Histiocytoma | (Dermatofibroma)
56
Benign Fibrous Histiocytoma (Dermatofibroma) * Macroscopic * Microscopic * Prognosis
* Macroscopic * dimples inward on lateral compression * Microscopic * Mid-dermis * Tumor of fibroblasts, histiocytes, collagen * histiocytes: factor XIIIa positive * Hyperplasia with hyperpigmented rete ridges * Prognosis * Benign
57
Dermatofibrosarcoma Protruberans * Macroscopic * Microscopic * Location * Course
* Macroscopic * Large mass * Microscopic * fibroblasts in storiform (pinwheel) pattern * thin epidermis * extension into fat * Location * Trunk * Course * Locally aggressive * Rarely metastasizes
58
What mutation is present in Dermatofibrosarcoma Protruberans?
Balanced translocation between collagen 1A1 and PDGF-ß increases PDGF production
59
What disease process is shown below?
Pemphigus Vulgaris
60
This histology is present in which blistering disease?
Pemphigus Folliaceus Anti-desmoglein 1 Subcorneal blister
61
This histology is present in which blistering disease?
Pemphigus vulgaris Anti-desmoglein 3 Suprabasalar blister
62
Name the forms of pemphigus
* L: Vulgaris * R: Folliaceus
63
What disease process is pictured below?
Bullous pemphigoid Anti-BPAG (hemi-desmosome protein) Separation at dermal-epidermal border (lamina lucida)
64
What disease process is pictured below?
Dermatitis Herpetiformis IgA to gliadin Cross-rxn with reticulin of fibrils Accumulates at the dermal papilla
65
Simplex type Epidermolysis * Defect * Blister location * Skin layer * On body
* Defect: Hemidesmosomes * in keratin 14 or 5 * forms keratin fibrils * Blister location: * Skin layer * Basal layer * (degeneration of basal cell layer) * On body * Sites of friction or pressure
66
Junctional Type Epidermolysis Bullosa * Defect * Blister location * Skin level * On body
* Defect: hemidesmosomes * integrins * laminin * collagen XVII * BPAG2 mutation * Blister location: * Skin level * Lamina lucida layer * On body * sites of friction or pressure
67
Dystrophic Type Epidermolysis Bullosa * Defect * Blister location * Skin level * On body
* Defect * Mutation in collagen VII * Forms anchoring fibrils * Blister location * Skin level: beneath lamina densa * On body: sites of friction or pressure
68
What blistering disease process is pictured below?
Porphyria
69
What bacteria is important in the pathogenesis of acne? What is the mechanism of pathogenesis?
* Bacteria * Propionibacterium acnes * Mechanism * Lipases liberate proinflammatory fatty acids from sebum
70
What disease process is pictured below?
Acne Vulgaris L: closed comedon R: open comedon
71
What form of panniculitis is pictured below?
Erythema Nodosum Located on front of legs Inflamm of CT septa in the hypodermis
72
What form of panniculitis is pictured below?
Erythema Induratum Lesions of back of leg (calf) Ulcerations can become atrophic scars Inflamm of fat lobules
73
What is the pathogenesis of Erythema Induratum?
* Cause: Primary vasculitis (supply vessels of fat lobules) * granulomatous * Fat necrosis * Inflamm and Ulceration * Atrophic scars and hyperpigmentation
74
What population is most commonly affected by Erythema Induratum?
Adolescents Pregnant women
75
Erythema Nodosum vs Erythema Induratum
76
What are the causes of factitial Panniculitis?
* Self-inflicted trauma * Injection of foreign material * Silicone * Leakage of breast implants * Injection of toxic material
77
What causes Verrucae?
HPV Transmitted by direct contact
78
Location of the following verrucae: * Vulgaris * Plana * Condyloma Accuminatum
* Vulgaris * Anywhere, esp dorsal hands and periungual * pebble-like * Plana * Face, dorsal hands * Flat and smooth * Condyloma Accuminatum * Anogenital region * cauliflower-like masses
79
Verrucae: Location, Appearance, and HPV types * Vulgaris * Plana * Plantaris / Palmaris * Condyloma Accuminatum
80
Molluscum contagiosum * Cause * Spread * Location * Micro
* Cause * Pox virus * Spread * Direct contact * Location * Trunk * Anogenital * Micro * Molluscum bodies * Cytoplasmic inclusion * Forms curd-like umbilication * Stratum granulosum and corneum
81
Impetigo * Cause * Clinical progression * Micro
* Cause * Staph aureus (most common * beta hemolytic strep * Toxin cleaves desmoglein 1 molecule * Clinical progression * Macule to pustule to erosion with **_Honey colored crusts_** * Micro * Subcorneal pustule * due to location of desmoglein 1
82
What are the causes of erythema multiforme?
Infection Drugs Malignancy Collagen Vascular Disease
83
Erythema multiforme * Micro * What cells are responsible for the center vesicle? * For the erythematous periphery?
* Micro * dermoepidermal junction * degenerating basal keratinocytes * What cells are responsible for the center vesicle? * CLA + CD8+ T cells * migration into epidermis * For the erythematous periphery? * CD4+ T helper cells * Langerhans cells
84
What complication may occur in Stevens-Johnson syndrome?
Secondary infection leading to sepsis
85
Psoriasis * Clinical presentation * Micro * Pathogenesis * Genetic association
* Clinical presentation * Salmon plaques * Loose scales * Extensor regions * Auspitz sign: small bleed points when scale lifted * Micro * Taller dermal papilla * Pathogenesis * CD4+ cells, Ch17 cells, activated CD8+ cells * keratinocyte proliferation * Genetic association * HLA-Cw\*0602
86
What is the Koebner phenomenon?
Local trauma can create a self - perpetuating inflammatory response Present in psoriasis
87
Seborrheic Dermatits * Change in skin * Location * Pathogenesis
* Change in skin * flaking (like dandruff) * Location * regions of high density sebaceous glands * Pathogenesis * yeast Malassezia furfur + sebum
88
What are the 6 P's of Lichen Planus?
1. Pruritic 2. Purple 3. Polygonal 4. Planar 5. Papules and 6. Plaques
89
Lichen Planus * Clinical Appearance * Micro
* Clinical Appearance * Violaceous * Flat topped * Wickham Striae = lacy pattern * Micro * Infiltrate at dermal epidermal junction * Saw - toothing of junction * Civatte bodies * (necrotic basal cells in papillary dermis)
90
What cell type is pictured below? In what disease is it present?
Sezary-Lutzner cell CD4+ Th cell Found in Mycosis Fungoides NEED PICS!!
91
What disease process is pictured below?
Sezary Syndrome Metastasis of cells in Mycosis Fungoides NEED PIC!!!
92
What disease process is pictured below?
Mastocytosis NEED PIC!!!
93
Which form of Mastocytosis is pictured below?
Urticaria pigmentosa Multiple lesions NEED PIC!!
94
What form of mastocytosis is pictured below?
Mastocytoma Single lesion NEED PIC!
95
Mastocytosis * Clinical symptoms * Mutation * Microscopic appearance * Staining techniques
* Clinical symptoms: histamine / heparin effects * Flushing * Pruritis * Rhinorrhea * Dermatographism * hive-like formation in normal skin after stroked by a pointed object * Mutation * Activating * c-KIT receptor tyrosine kinas * Microscopic appearance * Mast cell aggregates * Staining techniques * Toluidine blue * Geimsa
96
What disease process is pictured below?
Ichthyosis Increased stratum corneum Excessive build-up of keratin NEED PIC
97
Ichthyosis * Clinical appearance * Microscopic
* Clinical appearance * Build-up of keratin gives "fish scale" look to skin * Microscopic * Incerased stratum corneum * defective desquamation * Loss of normal basket weave appearance * No inflammation
98
Ichthyosis Vulgaris * Inheritance pattern * Age of onset * Associated with what complications?
* Inheritance pattern * AD * can be acquired * Age of onset * infancy / childhood * Associated with what complications? * lymphoid malignancy * visceral malignancy
99
Lamellar Ichthyosis * Inheritance pattern * Age of onset * Appearance
* Inheritance pattern * AR * Age of onset * Birth * Appearance * Palms and soles involved * Thickened epidermis can act as band
100
Urticaria * Macroscopic appearance * Microscopic
* Macroscopic appearance * Wheals * "Hives" * Microscopic * Superficial dermal edema * widened spaces between collagen * mast cells * cause vascular hyperpermeability
101
What induces the following types of Urticaria? * Mast cell dependent; IgE dependent * Mast cell dependent; IgE independent * Mast cell independent; IgE independent
* Mast cell dependent; IgE dependent * Ag induced * Mast cell dependent; IgE independent * Direct stimulation of mast cells * Medications, radiocontrast * Mast cell independent; IgE independent * Vascular changes stimulated directly * Aspirin: inhibits COX * Deficiency of C1
102
What disease process is pictured below?
Eczematous dermatitis * Macroscopic * red papulovescicular * oozing, crusting * Micro * intercellular edema w/i epidermis * Types * Atopic * Allergic contact

Pathology (27 decks)

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