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Pathology > Skin > Flashcards

Skin Flashcards

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
Q

Cylindroma

  • Gross appearance
  • Microscopic appearance
  • Mutation
A
  • 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
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26
Q

What disease process is pictured below?

A

Syringoma

  • Location
    • Eyelids
    • Lwr face
  • Gross
    • Tan / White papules
  • Micro
    • Eccrine differentiation of cords
    • Cords with “tadpole” appearance
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27
Q

What disease process is pictured below?

A

Trichoepithelioma

  • Location
    • Face
    • Scalp
    • Neck
  • Gross
    • Dome shaped
    • Flesh colored
  • Micro
    • baseloid cells attempting to form primitive hair follicles
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28
Q

Sebaceous adenoma

  • Histology
  • Associated condition
  • Mutations
A
  • Histology
    • Prolif of sebocytes
    • Central cells filled with lipid
  • Associated condition
    • HNPCC
  • Mutations
    • DNA mismatch repair (same as HNPCC)
    • WNT pathway
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29
Q

What disease process is pictured below?

A

Pilomatrixoma

  • Histo
    • basaloid cells with hairlike differentiation
      • similar to germinal region of normal bulb
    • Mature cells = anucleate “ghost cells”
  • Mutation
    • activation of beta-catenin
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30
Q

What disease process is pictured below?

A

Apocrine Carcinoma

  • Apocrine ductal differentiation
  • Apocrine secretions
    • pinching off at apex
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31
Q

What disease process is pictured below?

A

Actinic Keratosis

  • Location
    • sun exposed areas
  • Gross
    • Scaly patch
    • sandpaper consistancy
  • Micro
    • Atypia in basal layers
    • Hyperkeratosis and parakeratosis common
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32
Q

What skin disease is characterized by erythematous scaly patches with a sandpaper consistancy in sun exposed areas?

A

Actinic keratosis

Premalignant

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33
Q

What is actinic keratosis of the lip called?

A

Actinic cheilitis

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34
Q

What mutations cause Actinic Keratosis? What can this transform into?

A

TP53 mutations (Increase RAS signaling)

Can become SCC (premalignant)

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35
Q

What population is most susceptible to Actinic Keratosis?

A

Caucasians

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36
Q

What disease process is pictured below?

A

Bowen’s Disease

aka SCC in situ

  • Gross
    • Irregular erythematous plaque
    • Scale
  • Location
    • Trunk
    • Extremities
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37
Q

What is Bowen’s Disease?

A

SCC in situ

  • Gross
    • Irregular erythematous plaque
    • Scale
  • Location
    • Trunk
    • Extremities
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38
Q

What disease process is pictured below?

A

SCC

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39
Q

What disease process is pictured below?

A

Keratoacanthoma

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40
Q

Keratoacanthoma

  • Gross appearance
  • Course
A
  • Gross appearance
    • Fleshy nodule
    • central hyperkeratic crater
  • Course
    • Reaches max size in 6-8 wks
    • Then regresses
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41
Q

What disease process is pictured below?

A

Basal Cell Carcinoma

  • Gross
    • Pearly, pink/tan macule, papule, or nodule
    • Telangectasia
  • Micro
    • Stromal clefting
      • differentiates from trichoepithelioma
    • Palisading pattern
42
Q

Nevoid Basal Cell Carcinoma Syndrome (NBCCS)

  • Symptoms
  • Inheritance
  • Gene mutation
A
  • Symptoms
    • Tumors before age 20
    • Basal Cell Carcinoma
  • Inheritance
    • AD
  • Gene mutation
    • PTCH (patch) gene
      • codes SHH receptor
    • Overexpression of GLI1
43
Q

What gene mutation accounts for Xeroderma pigmentosa?

A

PTCH and p53

DNA repair problem

44
Q

What genes are associated with sporadic Basal Cell Carcinoma?

A
  • PTCH
  • p53
45
Q

What signs are of concern for development of malignant melanoma?

A
  • Small lesions growing to > 6mm
  • New onset pain or itching
46
Q

What is the most common subtype of malignant melanoma?

A

Superficial Spreading Malignant Melanoma

47
Q

Lentigo Maligna Melanoma

  • Onset
  • Population
  • Location
A
  • Onset
    • decades
  • Population
    • elderly men
  • Location
    • head and neck
48
Q

Superficial Spreading Malignant Melanoma

  • Population
  • Risk factor
  • Frequency
A
  • Population
    • Mostly adults
  • Risk factor
    • Sun exposure
  • Frequency
    • 60% of malignant melanoma
49
Q

Acral Lentiginous Malignant Melanoma

  • Population
  • Location
A
  • Population
    • dark skinned races
  • Location
    • Palms
    • Soles
    • Nails
    • Genitalia
  • Not related to sun exposure
50
Q

Nodular Malignant Melanoma

  • Growth phase of malignant melanoma
  • Special features
A
  • Growth phase of malignant melanoma
    • Vertical
  • Special features
    • may be amelanotic
    • may ulceratie
51
Q

Explain Clarks Levels I-V for Malignant Melanoma

A
  • I: in situ
  • II: invade papillary dermis
  • III: fill papillary dermis
  • IV: invade reticular dermis
  • V: invade subcutaneous fat
52
Q

Describe the Breslow Classification for Melanoma Prognosis

A

Measurement of depth

Stratum Granulosum to max depth

53
Q

S100 and HMB-45 are used as markers in which type of cancer?

A

malignant melanoma

54
Q

Factor XIIIa is used as a marker for which type of cancer?

A

Benign Fibrous Histiocytoma

(Dermatofibroma)

Stains dermal dendritic cells

55
Q

What disease process is pictured below?

A

Benign Fibrous Histiocytoma

(Dermatofibroma)

56
Q

Benign Fibrous Histiocytoma (Dermatofibroma)

  • Macroscopic
  • Microscopic
  • Prognosis
A
  • 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
Q

Dermatofibrosarcoma Protruberans

  • Macroscopic
  • Microscopic
  • Location
  • Course
A
  • Macroscopic
    • Large mass
  • Microscopic
    • fibroblasts in storiform (pinwheel) pattern
    • thin epidermis
    • extension into fat
  • Location
    • Trunk
  • Course
    • Locally aggressive
    • Rarely metastasizes
58
Q

What mutation is present in Dermatofibrosarcoma Protruberans?

A

Balanced translocation between collagen 1A1 and PDGF-ß

increases PDGF production

59
Q

What disease process is shown below?

A

Pemphigus Vulgaris

60
Q

This histology is present in which blistering disease?

A

Pemphigus Folliaceus

Anti-desmoglein 1

Subcorneal blister

61
Q

This histology is present in which blistering disease?

A

Pemphigus vulgaris

Anti-desmoglein 3

Suprabasalar blister

62
Q

Name the forms of pemphigus

A
  • L: Vulgaris
  • R: Folliaceus
63
Q

What disease process is pictured below?

A

Bullous pemphigoid

Anti-BPAG (hemi-desmosome protein)

Separation at dermal-epidermal border (lamina lucida)

64
Q

What disease process is pictured below?

A

Dermatitis Herpetiformis

IgA to gliadin

Cross-rxn with reticulin of fibrils

Accumulates at the dermal papilla

65
Q

Simplex type Epidermolysis

  • Defect
  • Blister location
    • Skin layer
    • On body
A
  • 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
Q

Junctional Type Epidermolysis Bullosa

  • Defect
  • Blister location
    • Skin level
    • On body
A
  • Defect: hemidesmosomes
    • integrins
    • laminin
    • collagen XVII
      • BPAG2 mutation
  • Blister location:
    • Skin level
      • Lamina lucida layer
    • On body
      • sites of friction or pressure
67
Q

Dystrophic Type Epidermolysis Bullosa

  • Defect
  • Blister location
    • Skin level
    • On body
A
  • Defect
    • Mutation in collagen VII
    • Forms anchoring fibrils
  • Blister location
    • Skin level: beneath lamina densa
    • On body: sites of friction or pressure
68
Q

What blistering disease process is pictured below?

A

Porphyria

69
Q

What bacteria is important in the pathogenesis of acne? What is the mechanism of pathogenesis?

A
  • Bacteria
    • Propionibacterium acnes
  • Mechanism
    • Lipases liberate proinflammatory fatty acids from sebum
70
Q

What disease process is pictured below?

A

Acne Vulgaris

L: closed comedon

R: open comedon

71
Q

What form of panniculitis is pictured below?

A

Erythema Nodosum

Located on front of legs

Inflamm of CT septa in the hypodermis

72
Q

What form of panniculitis is pictured below?

A

Erythema Induratum

Lesions of back of leg (calf)

Ulcerations can become atrophic scars

Inflamm of fat lobules

73
Q

What is the pathogenesis of Erythema Induratum?

A
  • Cause: Primary vasculitis (supply vessels of fat lobules)
    • granulomatous
  • Fat necrosis
  • Inflamm and Ulceration
  • Atrophic scars and hyperpigmentation
74
Q

What population is most commonly affected by Erythema Induratum?

A

Adolescents

Pregnant women

75
Q

Erythema Nodosum vs Erythema Induratum

A
76
Q

What are the causes of factitial Panniculitis?

A
  • Self-inflicted trauma
  • Injection of foreign material
    • Silicone
    • Leakage of breast implants
  • Injection of toxic material
77
Q

What causes Verrucae?

A

HPV

Transmitted by direct contact

78
Q

Location of the following verrucae:

  • Vulgaris
  • Plana
  • Condyloma Accuminatum
A
  • Vulgaris
    • Anywhere, esp dorsal hands and periungual
    • pebble-like
  • Plana
    • Face, dorsal hands
    • Flat and smooth
  • Condyloma Accuminatum
    • Anogenital region
    • cauliflower-like masses
79
Q

Verrucae: Location, Appearance, and HPV types

  • Vulgaris
  • Plana
  • Plantaris / Palmaris
    • Condyloma Accuminatum
A
80
Q

Molluscum contagiosum

  • Cause
  • Spread
  • Location
  • Micro
A
  • Cause
    • Pox virus
  • Spread
    • Direct contact
  • Location
    • Trunk
    • Anogenital
  • Micro
    • Molluscum bodies
      • Cytoplasmic inclusion
      • Forms curd-like umbilication
      • Stratum granulosum and corneum
81
Q

Impetigo

  • Cause
  • Clinical progression
  • Micro
A
  • 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
Q

What are the causes of erythema multiforme?

A

Infection

Drugs

Malignancy

Collagen Vascular Disease

83
Q

Erythema multiforme

  • Micro
  • What cells are responsible for the center vesicle?
  • For the erythematous periphery?
A
  • 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
Q

What complication may occur in Stevens-Johnson syndrome?

A

Secondary infection leading to sepsis

85
Q

Psoriasis

  • Clinical presentation
  • Micro
  • Pathogenesis
  • Genetic association
A
  • 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
Q

What is the Koebner phenomenon?

A

Local trauma can create a self - perpetuating inflammatory response

Present in psoriasis

87
Q

Seborrheic Dermatits

  • Change in skin
  • Location
  • Pathogenesis
A
  • Change in skin
    • flaking (like dandruff)
  • Location
    • regions of high density sebaceous glands
  • Pathogenesis
    • yeast Malassezia furfur + sebum
88
Q

What are the 6 P’s of Lichen Planus?

A
  1. Pruritic
  2. Purple
  3. Polygonal
  4. Planar
  5. Papules and
  6. Plaques
89
Q

Lichen Planus

  • Clinical Appearance
  • Micro
A
  • 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
Q

What cell type is pictured below? In what disease is it present?

A

Sezary-Lutzner cell

CD4+ Th cell

Found in Mycosis Fungoides

NEED PICS!!

91
Q

What disease process is pictured below?

A

Sezary Syndrome

Metastasis of cells in Mycosis Fungoides

NEED PIC!!!

92
Q

What disease process is pictured below?

A

Mastocytosis

NEED PIC!!!

93
Q

Which form of Mastocytosis is pictured below?

A

Urticaria pigmentosa

Multiple lesions

NEED PIC!!

94
Q

What form of mastocytosis is pictured below?

A

Mastocytoma

Single lesion

NEED PIC!

95
Q

Mastocytosis

  • Clinical symptoms
  • Mutation
  • Microscopic appearance
  • Staining techniques
A
  • 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
Q

What disease process is pictured below?

A

Ichthyosis

Increased stratum corneum

Excessive build-up of keratin

NEED PIC

97
Q

Ichthyosis

  • Clinical appearance
  • Microscopic
A
  • 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
Q

Ichthyosis Vulgaris

  • Inheritance pattern
  • Age of onset
  • Associated with what complications?
A
  • Inheritance pattern
    • AD
    • can be acquired
  • Age of onset
    • infancy / childhood
  • Associated with what complications?
    • lymphoid malignancy
    • visceral malignancy
99
Q

Lamellar Ichthyosis

  • Inheritance pattern
  • Age of onset
  • Appearance
A
  • Inheritance pattern
    • AR
  • Age of onset
    • Birth
  • Appearance
    • Palms and soles involved
    • Thickened epidermis can act as band
100
Q

Urticaria

  • Macroscopic appearance
  • Microscopic
A
  • Macroscopic appearance
    • Wheals
    • “Hives”
  • Microscopic
    • Superficial dermal edema
      • widened spaces between collagen
    • mast cells
      • cause vascular hyperpermeability
101
Q

What induces the following types of Urticaria?

  • Mast cell dependent; IgE dependent
  • Mast cell dependent; IgE independent
  • Mast cell independent; IgE independent
A
  • 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
Q

What disease process is pictured below?

A

Eczematous dermatitis

  • Macroscopic
    • red papulovescicular
    • oozing, crusting
  • Micro
    • intercellular edema w/i epidermis
  • Types
    • Atopic
    • Allergic contact

Pathology (27 decks)

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