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Patho Phys Exam 1 > Skin Continued... Malignant Epidermal Tumors > Flashcards

Skin Continued... Malignant Epidermal Tumors Flashcards

1
Q
  1. Explain and compare the pathology of malignant epidermal tumors – squamous cell carcinoma (SCC) and basal cell carcinoma (BCC).
    a. Involvement of UV radiation or sun damage
A

SCC is sun related

as is BCC

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2
Q
  1. Explain and compare the pathology of malignant epidermal tumors – squamous cell carcinoma (SCC) and basal cell carcinoma (BCC)
    b. Association with a mutation in either tumor protein p53 (TP53) gene, HRAS or proteins that cause dysregulation of the Hedgehog pathway.
A

Squamous cell-TP53 in both, involves HRAS (onco-gene)

Basal Cell: TP53

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3
Q

Explain and compare the pathology of benign and premalignant epithelial lesions – seborrheic keratosis and actinic keratosis.

a. Involvement of UV radiation or sun damage

A

Actinic=solar keratosis
-balding scalp, lateral neck, distal upper and lower extremities

Seborrheic is not sun related- age related with unknown cause

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4
Q

Explain and compare the pathology of benign and premalignant epithelial lesions –

seborrheic keratosis

and actinic keratosis.

b. The cause or risk factors

A

Actinic-sun exposure (UV) which causes DNA damage

Seborrheic- age related with unknown cause –> somatic mutation in fibroblast gene FGFR3

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5
Q

Explain and compare the pathology of benign and premalignant epithelial lesions –

seborrheic keratosis

and actinic keratosis.

c. Association with a mutation in either the gene for fibroblast growth factor receptor 3 or tumor protein p53 (TP53).
i) How does that affect the protein produced (e.g. constitutively active or non-functional)?

A

Actinic–> UV –> TP53 mutation (tumor supressor) –> proliferation of basal cells –> intraepithelial dysplasia

Seborrheic keratosis –> age-related but a somatic gene mutation occurs with unknown cause to fibroblast growth receptor gene FGFR3 mutating it and making it CONSTITUTIVELY ACTIVE –> increased proliferation of epithelial cells –> excess keratin production

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6
Q

Explain and compare the pathology of benign and premalignant epithelial lesions –

seborrheic keratosis

and actinic keratosis.

iii) Which causes dysplasia?

A

Actinic causes proliferation of basal cells which leads to intraepithelial dysplasia

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7
Q

Explain and compare the pathology of benign and premalignant epithelial lesions –

seborrheic keratosis (3)

and actinic keratosis (4)

d. Characteristic histological features – why and how these occur.

A

Seborrheic keratosis Histological Features

  1. Acanthosis-epidermal thickening
  2. HORN CYSTS-filled with keratin
  3. No Rete Ridges

Actinic Keratosis

  1. Partial Thickness dysplasia on bottom half of epidermis
  2. Hyperchromasia (dark nuclei)
  3. Varied nuclei and cell shape with loss of orientation (pleomorphism)
  4. Hyperkeratosis and parakertosis
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8
Q

Explain and compare the pathology of benign and premalignant epithelial lesions –

seborrheic keratosis

and actinic keratosis.

e. Appearance and type of skin lesion (gross level) – why and how these occur.

A

Seborrheic Keratosis

  1. Tan/Brown (melanin)
  2. STUCK ON appearance
  3. Waxy-loss of keratin
  4. plaque-raised
  5. scaly

Occurs on trunk, extremities, neck, and head

Actinic Keratosis

  1. Zone of Redness (erythematous macule or patch)
  2. Scaly (hyperkeratotic)

Balding head, neck, distal extremities

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9
Q

Explain and compare the pathology of benign and premalignant epithelial lesions –

seborrheic keratosis

and actinic keratosis.

f. Progression to skin cancer?

A

Actinic can either persist, or progress to in situ SCC (and then maybe invasive-hopefully not) which is full thickness dysplasia (this makes sense, it goes from just half dysplasia to full)

Seborrheic does not

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10
Q
  1. Explain and compare the pathology of malignant epidermal tumors –

squamous cell carcinoma (SCC) and basal cell carcinoma (BCC)

a. Involvement of UV radiation or sun damage
b. Association with a mutation in either tumor protein p53 (TP53) gene, HRAS or proteins that cause dysregulation of the Hedgehog pathway.

A

Both sun exposed…

Squamous cell= TP53 and HRAS (oncogene)

Basal Cell= P53 mutation and deregulation of the Hedgehog pathway

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11
Q
  1. Explain and compare the pathology of malignant epidermal tumors –

squamous cell carcinoma (SCC)

basal cell carcinoma (BCC).

b. Association with a mutation in either tumor protein p53 (TP53) gene, HRAS or proteins that cause dysregulation of the Hedgehog pathway.
i) How does that affect the protein produced (e.g. constitutively active or non-functional)?
ii) What affect does this have on basal cells/keratinocytes?

A

Squamous cell= TP53 and HRAS (oncogene)

Basal Cell= P53 mutation and deregulation of the Hedgehog pathway

Basal Cell:
This can cause destruction of tissue..

SCC: overexpression of keratinocytes

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12
Q
  1. Explain and compare the pathology of malignant epidermal tumors –

squamous cell carcinoma (SCC)

basal cell carcinoma (BCC).

c. Likelihood of metastasis or local invasion.

A

Invasive SCC; penetrates all epidermis and through the BM-CAN METASTASIZE

Basal Cell: RARELY METASTASIZE

BOTH SCC AND BCC ARE LOCALLY INVASIVE

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13
Q
  1. Explain and compare the pathology of malignant epidermal tumors –

squamous cell carcinoma (SCC) -3 things

basal cell carcinoma (BCC) - 3 things

d. Characteristic histological features – why and how these occur.

A

Squamous cell:
Histological features
1. Full thickness dysplasia
2. Carcinoma invaded dermis (when should be mainly collagen) –> nuclear crowding and disorganization
3. Keratin pearls: cells that make arrangements of keratin into
swirls

Basal cell:

Histological features
1. Nests of uniform basaloid cells in dermis-RING LIKE?
2. Very blue staining cells with hyperchromatic, oval nuclei
3. Palisade arrangement of cells (resembles the basal layer of the
epidermis)

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14
Q
  1. Explain and compare the pathology of malignant epidermal tumors –

squamous cell carcinoma (SCC)-5

basal cell carcinoma (BCC)-4

e. Appearance and type of skin lesion (gross level)

Flat or elevated?
Scaley??
Blood vessels??
Surrounding tissue?

A

Gross features:
1. Nodule (elevated lesion)
2. Prominent keratinization (scales)
3. Central ulceration – no blood supply, necrotic center
4.Hyperpigmentation
5. Often lesion is tender, ulcerated or rapidly growing, prominent
keratinization (scales)

Gross features

  1. PEARLY PAPULE –> NOT SCALY
  2. Dilated subepidermal blood vessels
  3. No scales or hyperkeratosis
  4. Ulceration and destruction of the surrounding tissue
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15
Q
  1. Explain and compare the pathology of malignant epidermal tumors –
    g. What are the main differences between cutaneous squamous cell carcinoma and oral squamous cell carcinoma?
    - 3 things (serous? where? appearance?)

also

i) Causes or risk factors-Not sure about this one
h. Progression from actinic keratosis

A

Oral squamous cell carcinoma
1. Much more aggressive than cutaneous SCC

  1. Commonly found on floor of mouth and lateral or ventral
    tongue-does not arise from actinic keratosis
  2. May arise in sites of erythroplakia (premalignant persistent
    red patches) or leukoplakia (persistent white plaques)
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16
Q
  1. Explain and compare the pathology of malignant epidermal tumors –

squamous cell carcinoma (SCC)

basal cell carcinoma (BCC).

f. Involvement of the oral mucosa or mucous membranes.

A

SCC in oral mucosa

BCC NOT

17
Q
  1. Explain and compare the pathology of malignant epidermal tumors –

squamous cell carcinoma (SCC)

basal cell carcinoma (BCC).

h. Progression from actinic keratosis

A

SCC arises from actinic

BCC-it is unknown

18
Q

A 60-year-old female presented to her dermatologist with a rough, scaly, erythematous papule on her cheek. She has no other health issues. A biopsy of the lesion most likely showed:
A. Acanthosis with horn or keratin filled
cysts in the epidermis
B. Full thickness dysplasia of the epidermis
with hyperkeratosis and parakeratosis
C. Groups or nests of uniform basaloid cells
in the dermis
D. Parakeratosis and acanthosis with
downward extension of the rete ridges
E. Superficial dermal edema

A

SCC-B. Full thickness dysplasia of the epidermis
with hyperkeratosis and parakeratosis

Explanations for others
A. seborrehic
C. Basal cell carcinoma
D. Psoriasis
E. uticaria
19
Q 
A 35-year-old male presents to his primary care physician with a complaint of red, scaly plaques on his elbows.  When he pulls off the scale, the skin looks smooth, red, and glossy with tiny punctate bleeding.  He has hayfever, but is otherwise healthy and has not come in contact with ‘anything new’ in the last few weeks. He is most likely diagnosed with:
A. Acute eczematous dermatitis 
B. Bullous Pemphigoid C. Lichen planus 
D. Psoriasis 
E. Urticaria
A

D. Psoriasis

this shit is gross

20
Q 
A pathologist examines a biopsy from the esophagus of a 45-year-old male with longstanding GERD.  He notes columnar epithelial cells with goblet (mucus producing) cells instead of the normal stratified squamous epithelium. The specimen show no cellular atypia.  He most likely has:
A. Atrophy 
B. Dysplasia 
C. Hyperplasia 
D. Metaplasia 
E. Necrosis
A

Metaplasia

21
Q

A raised, brown, stuck on looking thing is what

A

seborrheic keratosis

22
Q

Red erythematous macule which is rough/scaly/keratotic

A

Actinic keratosis

Patho Phys Exam 1 (14 decks)

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