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MSK II > Skin pathology > Flashcards

Skin pathology Flashcards

1
Q

Excoriation

A

Lesion disrupting epidermis that causes a raw linear area

Often self-induced

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2
Q

Lichenification

A

Thickened, roughened skin with prominent markings

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3
Q

Usually the result of repeated rubbing

A

Lichenification
Hypergranulosis

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4
Q

Macule or patch

A

Circumscribed flat lesion distinguished form surrounding skin color

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5
Q

Onycholysis

A

Separation of nail from nail bed

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6
Q

Papule or nodule

A

Elevated, dome shaped or flat topped lesion

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7
Q

Plaque

A

Elevated, flat-topped lesion

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8
Q

Wheal

A

Itchy, transient, elevated lesion

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9
Q

Pustule

A

Discrete, pus-filled, raised lesion

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10
Q

Scale

A

Dry, horny, platelike excrescence

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11
Q

Usually the result of imperfect cornification

A

Scale

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12
Q

Acanthosis

A

Diffuse epidermal hyperplasia

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13
Q

Characteristic features of acanthosis

A

Epidermal thickening
Variable degree of hyperkeratosis

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14
Q

Acantholysis

A

Intracellular detachment

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15
Q

Dyskeratosis

A

Abnormal, premature keratinization with cells below stratum granulosum

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16
Q

Erosion

A

Discontinuity of skin, showing incomplete loss of epidermis

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17
Q

Exocytosis of skin

A

Infiltration of epidermis by inflammatory cells

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18
Q

Hydropic swelling/ballooning

A

IC edema of keratinocytes

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19
Q

Hypergranulosis

A

Thickening of stratum granulosum

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20
Q

Hyperkeratosis

A

Thickening of stratum corneum

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21
Q

Lentiginous

A

Linear pattern of melanocyte proliferation within the epidermal basal layer

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22
Q
A
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23
Q

Papillomatosis

A

Surface enlargement caused by hyperplasia and enlargement of contiguous dermal papillae

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24
Q

Parakeratosis

A

Keratinization with retained nucleus in the stratum corneum

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25
Q

Where parakeratosis is normal

A

Mucous membranes

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26
Q

Spongiosis

A

IC edema of the epidermis causes separation of epithelial cells, particularly in prickle cell layer

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27
Q

Ulcerations

A

Discontinuity of skin marked by complete loss of the epidermis, revealing dermis or subq

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28
Q

Vacuolization of skin

A

Formation of vacuoles within or adjacent to cells

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29
Q

General characteristics of acute inflammatory dermatoses

A

Inflammatory infiltrates
Edema
Variable degree of epidermal, vascular, or subq injury

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30
Q

Urticaria

A

Dilation of vascular structure in the superficial dermis

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31
Q

Cause of urticaria

A

Localized mast cell degranulation with dermal microvascular hyperpermeability

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32
Q

Pathogenesis of urticaria

A

Antigen-induced release of vasoactive mediators

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33
Q

Defect in hereditary angioneurotic edema

A

Inherited deficiency of C1 inhibitor results in excessive activation of early components of the complement system

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34
Q

Microscopic features of urticaria

A

Superficial dermal edema –> spaces between collagen bundles

Dilated lymphatics and vasculature

Normal epithelium

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35
Q

General characteristics of dermatitis

A

Erythematous, papulovesicular, weeping lesions

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36
Q

Pathogenesis of allergic contact dermatitis

A

T-cell mediated inflammatory reactions –> type IV hypersensitivity

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37
Q

Pathogenesis of atopic dermatitis

A

Skin barrier dysfunction due to mutation in filaggrin, an epidermal barrier protein

Inflammation from invading T cells

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38
Q

Lab findings in atopic dermatitis

A

Increased IgE
Eosinophilia

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39
Q

Pathophysiology of irritant contact dermatitis

A

Nonimmunologic response to chemicals or physical agents

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40
Q

Common symptoms for all types of dermatitis

A

Pruritus
Red, papulovesicular, oozing, crusted lesions

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41
Q

Self-limited type IV hypersensitivity

A

Erythema multiforme

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42
Q

Characteristic lesions in erythema multiforme

A

Targetoid

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43
Q

Pathogenesis of erythema multiforme

A

Keratinocyte injury mediated by CD8+ T cells

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44
Q

Variants of erythema multiforme

A

Stevens-Johnson syndrome
Toxic epidermal necrolysis
Overlap

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45
Q

Important inciting agent of Stevens-Johnson syndrome

A

Medications, including sulfonamides

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46
Q

Lesions in Stevens-Johnson syndrome

A

Erosions and hemorrhagic crusts around the lips and oral mucosa and in the perineal area

Cover <10% of body surface area

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47
Q

Possible consequence of secondary infection in Stevens-Johnson syndrome

A

Sepsis

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48
Q

Most common cause of toxic epidermal necrolysis

A

Drug-induced

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49
Q

Possible consequences of toxic epidermal necrolysis

A

Sepsis or death

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50
Q

Lesions in toxic epidermal necrolysis

A

Widespread erythema and necrosis – >30% body surface

bullous detachment of the epidermis and mucous membrane with exfoliation

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51
Q

Koebner phenomenom

A

Lesions can be induced in susceptible individuals with local trauma

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52
Q

Microscopy in psoriasis

A

Acanthosis
Downward elongation of rete ridges
Parakerotic scale
Thin or absent stratum granulosum
Suprapapillary plates
Auspitz sign
Small aggregates of neutrophils

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53
Q

Two types of small neutrophil aggregates seen in psoriasis

A

Munro microabscesses
spongiform pustules

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54
Q

Munro microabscesses

A

Neutrophils that form small aggregates within the parakeratotic stratum corneum in psoriasis

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55
Q

Spongiform pustules

A

Neutrophils form small aggregates within the superficial epidermis

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56
Q

Six P’s of lichen planus

A

Pruritic
Purple
Polygonal
Planar
Papules
Plaques

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57
Q

Description of lesions in lichen planus

A

Itchy, violaceous, flat-topped, popules that coalesce focally and form plaques

Wickham striae

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58
Q

Pathogenesis of lichen planus

A

Expression of altered antigens in the basal epidermal cells or DE junction elicits CTL response

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59
Q

Skin lesion associated with HCV

A

Lichen planus

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60
Q

Histological features of lichen planus

A

Interface dermatitis
Saw-toothing
Civatte/colloid bodies
Hypergranulosis
Hyperkeratosis

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61
Q

Rare progression of lichen planus in oral mucosa

A

Squamous cell carcinoma

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62
Q

Caused by colonization of the skin by certain fungal species of genus Malassezia in response to increased sebum production

A

Seborrheic dermatitis

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63
Q

Gross appearance of seborrheic dermatitis

A

Moist/greasy macules and papules on erythematous, yellow, often greasy base associated with scaling and crusting

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64
Q

Herald patch in pityriasis rosea

A

Well-demarcated, thin, oval to round plaque that is usually pink and erythematous

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65
Q

Collarette scale in pityriasis rosea

A

Ring of tissue-like scale that remains attached within the border of the plaque

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66
Q

AN inflammatory reaction in the subq adipose tissue

A

Panniculitis

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67
Q

Two forms of panniculitis

A

Erythema nodusum
Erythema induratum

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68
Q

Clinical presentation in panniculitis

A

Poorly defined, exquisitely tender, symmetric, erythematous plaques and nodules

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69
Q

Pathogenesis of panniculitis

A

Type IV hypersensitivity to microbial or drug-related antigens

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70
Q

Microscopy in early septal panniculitis

A

Edema, fibrin, and neutrophils in CT septae

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71
Q

Microscopy in later septal panniculitis

A

Lymphocytes, macrophages, and multinucleated giant cells in CT septae

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72
Q

Skin disorders with IgG autoantibodies against Dsg1

A

Pemphigus foliaceus
Impetigo
Scalded skin syndrome

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73
Q

Skin disorder with IgG autoantibodies against Dsg1 and Dsg3

A

Pemphigus vulgaris

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74
Q

Skin disorder with autoantibodies against BPAG2

A

Bullous pemphigoid

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75
Q

Skin disorder with IgA autoantibodies to fibrils

A

Dermatitis herpetiformis

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76
Q

Hallmark of pemphigus

A

Acantholysis

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77
Q

Characteristics suprabasal acantholytic blister

A

Pemphigus vulgaris

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78
Q

Reticular pattern in immunofluorescence staining

A

Deposition of immunoglobulin along plasma membranes of keratinocytes in pemphigus

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79
Q

Subepidermal non-acantholytic blisters on microscopy

A

Bullous pemphigoid

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80
Q

On microscopy, fibrin and neutrophils accumulate selectively at tips of dermal papillae

A

Dermatitis herpetiformis

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80
Q

Skin lesions associated with celiac disease

A

Dermatitis herpetiformis

80
Q

Continuous and linear deposition of IgG and complement in epidermal basement membrane on immunofluorescence

A

Bullous pemphigoid

81
Q

Characteristic presence of grouped vesicles

A

Dermatitis herpetiformis

82
Q

Gross appearance of dermatitis herpetiformis

A

Bilateral, symmetrical, and grouped

Vesicles and plaques that are extremely pruritic

83
Q

Discontinuous, granular deposits of IgA at tips of dermal papillae on immunofluorescence

A

Dermatitis herpetiformis

84
Q

Pathogenesis of dermatitis herpetiformis

A

IgA autoantibodies against gliadin in celiac disease cross react with reticular fibers of dermis

85
Q

Types of epidermolysis bullosa

A

Simplex/epidermolytic
Junctional
Scarring dystrophic
Mixed

86
Q

Disease caused by inherited defects in structural proteins that lend mechanical stability to the skin

A

Epidermolysis bullosa

87
Q

Non-inflammatory blistering disorders

A

Epidermolysis bullosa
Porphyria

88
Q

Epidermolysis bullosa type where cleavage occurs in the epidermis

A

Simplex/epidermolytic

89
Q

Disease caused by mutation in genes for keratins 5 and 14 of basal epithelial cells

A

Simplex type of epidermolysis bullosa

90
Q

Epidermolysis bullosa type where cleavage occurs in the lamina lucida of the dermis

A

Junctional type

91
Q

Mutation in junctional type of epidermolysis bullosa

A

Genes encoding for laminin usually, or for BPAG2

92
Q

Epidermolysis bullosa type where cleavage occurs within the sub-lamina densa

A

Scarring dystrophic

93
Q

Mutation causing scarring dystrophic type of epidermolysis bullosa

A

Gene for collagen type VII

94
Q

Pigments normally present in hemoglobin, myoglobin, and cytochromes

A

Porphyrins

95
Q

Five major types of porphyria

A

Congenital erythropoietic
Erythrohepatic protoporphyria
Acute intermittent
Porphyria cutanea tarda
Mixed

96
Q

Most common porphyria

A

Porphyria cutanea tarda

97
Q

Deficiency in porphyria cutanea tarda

A

Hepatic uroporphyrinogen decarboxylase activity

98
Q

Cutaneous manifestations in porphyria cutanea tarda

A

Blistering skin lesions, often on hands
Photosensitization

99
Q

Microscopy in lentigo

A

Linear, non-nested, melanocytic hyperplasia, restricted to basal cell layer

100
Q

Diffuse light to dark brown area of pigmentation of the central face

A

Melasma

101
Q

Acquired disease of progressive melanocyte loss due to T cell mediated destruction

A

Vitiligo

102
Q

Fluoresce when illuminated by Wood lamp examination

A

Patches seen in vitiligo

103
Q

Inheritance pattern of oculocutaneous albinism

A

Autosomal recessive

104
Q

Pathogenesis of albinism

A

Normal melanocytes and melanosomes

Reduced or absent melanin due to abnormal synthesis because of tyrosinase deficiency

105
Q

Location of tyrosinase gene

A

Chromosome 11q14:3

106
Q

Condition associated with albinism

A

Chediak-Higashi syndrome

107
Q

Pathogenesis of nevus

A

Acquired activating mutations in components of RAS signaling pathway

108
Q

Nest of nevus cells that grow along the dermo-epidermal junction

A

Junctional nevi

109
Q

Nuclei in junctional nevi

A

Uniform and rounded
Inconspicuous nucleoli
Little to no mitotic activity

110
Q

Nests of nevus cells that grow into the underlying dermis with both dermal and epidermal components

A

Compound nevi

111
Q

Nevus cells in the dermis, epidermal nests may be lost entirely

A

Intradermal/dermal nevi

112
Q

Gross appearance of dysplastic nevus

A

Larger, >5 mm
Variegated pigmentation
Irregular borders

113
Q

Microscopy of dysplastic nevus

A

Nuclear enlargement
Irregular, angulated nuclear contours
Hyperchromasia

114
Q

Embryonic origin of melanocytes

A

Neural crest

115
Q

Non-sun-exposed skin areas where melanoma can occur

A

Oral and anogenital mucosa
Esophagus
Meninges
Uvea

116
Q

Syndrome caused by defect in nucleotide excision repair that is precursor to melanoma

A

Xeroderma pigmentosum

117
Q

Two general pathogenesis of melanoma

A

Mutations that disrupt cell cycle control genes

Mutations that activate pro-growth signaling pathways

118
Q

Mutation that disrupt cell cycle control genes that can lead to melanoma

A

CDKN2A gene mutation

119
Q

Encodes for P15, P16, and ARF tumor suppressors

A

CDKN2A

120
Q

Mutations that activate pro-growth signaling pathways that can lead to melanoma

A

Aberrant increases in RAS and PI3K/AKT

Activation mutations in BRAF

Mutations that activate telomerase

121
Q

Serine/threonine kinase downstream of RAS that can be mutated in melanoma

A

BRAF

122
Q

Most consistent clinical signs of melanoma

A

> 10 mm
Color change and variations
Irregular and notched borders

123
Q

Warning signs of melanoma (ABCDEs)

A

Asymmetry
Borders, irregular
Color, variegated
Diameter, increasing
Evolution

124
Q

Macular area correlates with what phase of melanoma

A

Radial growth

125
Q

Raised areas corresponding to nodular aggregates of malignant cells correlates with what phase of melanoma

A

Vertical

126
Q

Clinicopathological classes of the radial phase of melanoma

A

Lentigo maligna
Superficial spreading
Acral/mucosal lentiginous

127
Q

Melanoma unrelated to sun exposure

A

Acral/mucosal lentiginous

128
Q

Microscopy in radial phase of melanoma

A

Nests of malignant cells in epidermis only

129
Q

Heralds vertical growth phase of melanoma

A

Appearance of nodule that correlates with emergence of tumor subclone with metastatic potential

130
Q

Most important prognostic indicator predicting melanoma metastasis

A

Breslow thickness

131
Q

Distance from superficial epidermal granular layer to site of deepest intradermal tumor cells

A

Breslow thickness

132
Q

Melanoma cell histology

A

Large nuclei with irregular contours and prominent red/eosinophilic nucleoli

133
Q

Melanocyte markers

A

HMB-45
S-100

134
Q

Fontana-Masson silver stain in melanoma

A

Fine black dusting of melanin pigment within the cytoplasm of neoplastic cells

135
Q

Tumor depth in melanoma associated with favorable prognosis

A

<1.7 mm

136
Q

Round, flat, coin-like, waxy plaque with dark keratin-filled surface plugs

A

Seborrheic keratosis

137
Q

Pathogenesis of seborrheic keratosis

A

Activating mutations of FGFR3, a receptor tyrosine kinase

138
Q

Characteristic histological features of seborrheic keratosis

A

Horn cysts
Invagination cysts

139
Q

Invagination cysts in seborrheic keratosis

A

Invaginations of keratin into the
main mass

140
Q

Horn cysts in seborrheic keratosis

A

Small keratin filled cysts

141
Q

Skin presentation associated with Leser-Trelat

A

Seborrheric keratosis

142
Q

Cancer associated with Leser-Trelat

A

Carcinomas of GI tract –> stomach

143
Q

Cutaneous sign of underlying benign and malignant conditions

A

Acanthosis nigricans

144
Q

Thickened, hyperpigmented skin with a velvet-like texture, usually in flexural areas

A

Acanthosis nigricans

145
Q

Benign type of acanthosis nigricans is associated with these conditions

A

Obesity
Insulin resistance
Endocrine abnormalities –> diabetes, pineal tumor, pituitary tumor

146
Q

Malignant type of acanothsis nigricans is associated with these conditions

A

Underlying cancers –> GIT adenocarcinomas

147
Q

Pathogenesis of acanthosis nigricans

A

Increased growth factor receptor signaling in skin

148
Q

Histology of fibroepithelial polyp

A

Fibrovascular cores by benign squamous epithelium

149
Q

Skin condition that may be associated with diabetes, obesity, and intestinal polyposis

A

Fibroepithelial polyps

150
Q

Premalignant conditions associated with SCC

A

Xeroderma pigmentosum
Actinic keratosis

151
Q

In situ lesion of sharpy defined, red, scaling plaques

A

SCC

152
Q

Invasive lesion that is usually nodular with hyperkeratotic scale that may ulcerate

A

SCC

153
Q

Invasion of dermis by sheets and islands of neoplastic epidermal cells with variable degrees of differentiation with keratin pearls

A

SCC

154
Q

Characteristics of invasive tumor cells in SCC

A

Enlarged nuclei with angulated contours and prominent nucleoli

155
Q

What test may be needed to confirm diagnosis of poorly differentiated SCC

A

Immunohistochemical stains for keratin

156
Q

Syndromic associations of BCC

A

Gorlin syndrome
Nevoid BCC syndrome

157
Q

Germline mutation in PTCH gene

A

Gorlin syndrome

158
Q

Pathogenesis of BCC

A

Mutations leading to uncontrolled hedgehog signaling pathway

159
Q

Pearly nodules with telangiectasis

A

BCC

160
Q

Rodent ulcers in BCC

A

Extensive local invasion after years of neglect or if unusually aggressive

161
Q

Histology of multifocal superficial pattern of BCC

A

Multifocal growths originate from epidermis and extend over skin surface

162
Q

Histology of nodular lesion pattern of BCC

A

Grow downwards and extend into the dermis as cords and islands of atypical basophilic cells with hyperchromatic nuclei

163
Q

Palisading of peripheral tumor cells and separation artifacts are seen in what skin cancer

A

BCC

164
Q

Hyperkeratotic lesions, <1cm, with sandpaper like consistency

A

Actinic keratosis

165
Q

Cytological atypia in the lowermost layers of the epidermis

A

Actinic keratosis

166
Q

Histological findings in dermis in actinic keratosis

A

Superficial dermis contains thickened, pale, blue-gray elastic fibers

167
Q

Lymphoma of skin homing CD4+ T cells

A

Mycosis fungoides

168
Q

Scaly red-brown patches, raised scaling plaques, and fungating nodules

A

Mycosis fungoides

169
Q

Pautrier microabscesses

A

T cell invades the epidermis as single cells in small clusters in mycosis fungoides

170
Q

Spectrum of disorders characterized by increased numbers of mast cells in the skin and other organs

A

Mastocytosis

171
Q

Urticaria pigmentosa

A

Cutaneous form of mastocytosis that primarily affects children

172
Q

Darier sign

A

Localized area of dermal edema and erythema (wheal) when lesional skin is rubbed

173
Q

Dermatographism

A

Area of dermal edema, resembling a hive, resulting from localized stroking of normal skin

174
Q

Mutations causing mastocytosis

A

KIT mostly
PDGFR-alpha receptor tyrosine kinases

175
Q

Giemsa staining in mastocytosis

A

Purple metachromatic granules within the cytoplasm of mast cells

176
Q

Histology of macrocytosis

A

Numerous ovoid cells with uniform, centrally located nuclei in dermis

177
Q

Site of damage in alopecia areata

A

Bulb region of anagen hair follicles, resulting in shortened anagen cycle

178
Q

Most common type of hair loss

A

Androgenetic alopecia or male pattern baldness

179
Q

Nonscarring progressive miniatruization of the hair follicle

A

Androgenetic alopecia

180
Q

Androgen chiefly responsible for the follicular pathology

A

DHT

181
Q

Treatment for androgenetic alopecia

A

Minozidil
finasteride

182
Q

Chronic and debilitating inflammatory disorder of the hair follicles

A

Hidradenitis suppurativa

183
Q

Characteristics of lesions in hidradenitis suppurativa

A

Inflammatory nodules, subq abscesses, and sinus tracts

184
Q

Primary pathogenesis of hidradenitis suppurativa

A

Hyperkeratotic plugging of the terminal hair follicle resulting in follicular duct rupture

185
Q

Clinical hallmark of noninflammatory acne vulgaris

A

Comedone

186
Q

Follicular papules contain a central black keratin plug due to the oxidation of melanin pigments

A

Open noninflammatory acne vulgaris

187
Q

Follicular papules without visible central keratin plug, as it is trapped beneth the epidermal surface

A

Closed noninflammatory acne vulgaris

188
Q

Inflammatory acne vulgaris

A

Papules
Pustules
Nodules

189
Q

Four factors of pathogenesis of acne vulgaris

A

Hyperkeratinization
Hypertrophy of sebaceous glands
Lipase synthesizing bacteria
Secondary inflammation

190
Q

Lipase synthesizing bacteria in acne vulgaris

A

Cutibacterium acnes
Propionibacterium acnes

191
Q

4 stages of rosacea

A

-Flushing episodes
-Persistent erythema and telangiectasia
-Pustules and papules
-Rhinophyma

192
Q

Permanent thickening of the nasal skin by confluent erythematous papules and prominent follicles due to hypertrophy of sebaceous glands and follicular plugging by keratotic debris

A

Rhinophyma stage of rosacea

193
Q

Associated with chronic hyperkeratosis leading to fish-like scales

A

Ichthyosis

194
Q

Pathogenesis of ichthyosis

A

Degective keratinocyte desquamation leading to retention of an abnormally formed scale

195
Q

Mutation in ichthyosis

A

Loss of function mutations in the filaggrin gene

196
Q

Acquired non-inherited variant of ichthyosis

A

Ichthyosis vulgaris

197
Q

Possible associations of ichthyosis vulgaris

A

Lymphoid and visceral malignancies

198
Q

Inheritance of xeroderma pigmentosum

A

Autosomal recessive with 100% penetrance

199
Q

Eye changes in xeroderma pigmentosum

A

-Conjunctival injection with photophobia and melanosis
-Corneal scarring
-Pterygium
-Cancer of the eyelid

MSK II (16 decks)

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