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SBL Block 1 > Skin Pathology > Flashcards

Skin Pathology Flashcards

1
Q

Epidermis Structure
Layers (5)
Cells with Function: Keratinocytes, Melanocytes, Dendritic, Merkel

A 
Stratum Corneum
Stratum Lucidum
Stratum Granulosum
Stratum Spinosum
Stratum Basale

Keratinocytes: Connected by desmosomes to form physical barrier, stratified squamous epithelium

Melanocytes: Produce melanin for UV protection

Dendritic (Langerhans): migrate to lymph nodes to activate T cells

Merkel: afferent nerve fibers

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2
Q

Dermis Structure

Components (4) Adnexa Description and Components (4)

A

Connective tissue
Blood vessels
Nerves
Adnexa

Adnexa: adjacent structures derived from the skin
Includes hair follicles, sebaceous glands, sweat glands, nails

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3
Q

Freckle (Ephelis)

Description (4)

A

Most common pigmented lesion

Hyperpigmentation from increased melanin in basal keratinocytes
Normal melanocytes
Darken when exposed to light

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4
Q

Lentigo

Description (2) and Histology

A

Local hyperplasia of melanocytes
In cell layer immediately above basement membrane

Linear (non-nested) melanocytic hyperplasia

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5
Q

Melanocytic Nevi

Mutations (2) Progression (3) Distinguishing Features from Melanoma (2)

A

Activating mutations of:
NRAS
BRAF

Junctional Nevi
Compound Nevi
Intradermal Nevi

Loss of tyrosinase activity
Acquired cholinesterase activity

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6
Q

Dysplastic Nevi

Prognosis, Mutations (4) Morphology (3) Dermal Changes (3)

A

Possible progression to melanoma

Activation of : NRAS, BRAF
Loss of: CDKN2A
CDK4 mutations

> 5cm
Enlarged nevus cell nests that may coalesce
Cytologic Atypia

Lentiginous hyperplasia
Melanin incontinence
Linear Fibrosis

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7
Q

Melanoma
Most Common Form, Mutations (5)
Radial Growth Classes (3)
Vertical Growth Phase Characteristics (2)

A

Most deadly skin cancer

Sporadic: caused by UV radiation

CDKN2A: loss of p16INK4a
RAS and PI3K/AKT pathway activation
BRAF activation
PTEN loss
TERT: telomerase activation

Radial Growth Classes:
Lentigo maligna
Superficial spreading (most common)
Acral/Mucosal Lentiginous Melanoma

Vertical Growth Phase:
Appearance of a nodule
Metastatic potential

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8
Q 
Melanoma
Prognostic Factors (5) Clinical Features (5)
A 
Tumor Depth (Breslow thickness)
Number of mitoses
Ulceration of skin
Tumor infiltrating lymphocytes
Sentinel node metastases
"ABCDEs"
Asymmetry
Borders - irregular
Color - variable
Diameter - increasing
Evolution (change) over time
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9
Q

Seborrheic Keratoses

Pathogenesis (2) Morphology (4) Histology (4)

A

FGFR3 mutation
Paraneoplastic: Leser-Trelat sign

Superficial, round, flat, waxy plaques

Exophytic
Sharply demarcated
Invagination cysts
Horn cysts

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10
Q

Acanthosis Nigricans

Morphology (2) Disease Associations (3) Pathogenesis (4)

A

Thickened, hyperpigmented skin
Velvety texture to skin

Diabetes
Obesity
GI adenocarcinomas (paraneoplastic)

Increased growth factor signaling to skin
FGFR3 mutation
IGFR1 excess
TGF-alpha excess (increased EGFR)

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11
Q 
Fibroepithelial Polyp (Acrochordon)
Morphology, Histology (2) Associated Syndrome (2)
A

Soft, flesh colored bag like tumor with slender stalk

Fibrovascular core
Covered by squamous epithelium

Birt-Hogg-Dube Syndrome: skin tags with perifollicular mesenchymal tumors

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12
Q

Eccrine Poromas Locations (2)

A

Palms and Soles where sweat glands are numerous

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13
Q

Cylindromas

Locations (2) Mutation, Origin, Morphology, Associated syndromes (2)

A

Forehead and Scalp

CYLD inactivation

Ductal differentiation (eccrine/apocrine)

Islands of normal cells resembling normal appearing basaloid cells

Mutliple Familial Trichoepithelioma
Brooke-Spiegler syndrome

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14
Q

Syringomas

Morphology, Origin

A

Multiple small, tan papules near eyelid

Eccrine differentiation

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15
Q

Sebaceous Adenoma

Associated Syndrome, Mutations, Morphology

A

Muir-Torre syndrome (colorectal carcinoma)

Deficits in DNA mismatch repair proteins

Frothy or bubbly cytoplasm

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16
Q

Pilomatricomas

Mutation, Origin

A

Activation of CTNNB1

Basaloid cells showing hairlike differentiation

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17
Q

Actinic Keratosis

Triggers (3) Mutation, Progression, Morphology (3)

A

Ionizing radiation
Industrial hydrocarbons
Arsenicals

TP53 mutations

May progress to cutaneous squamous cell carcinoma

Actinic cheilitis (if lip involved)
Elastosis of superficial dermis
Parakeratosis of stratum corneum

18
Q

Squamous Cell Carcinoma

Pathogenesis (4) Associated Conditions with Mutations (2) Morphology (4)

A

Correlated with lifetime sun exposure
Progression from actinic keratosis
Chronic immunosuppression: increased HPV 5/8 infections

Ataxia-Telangiectasia: ATM defect
Xeroderma Pigmentosum: XPA defect

Red scaling plaques
Variable keratin production
Ulceration
Variable differentiation

19
Q

Basal Cell Carcinoma

Associated Condition with Mutation, Pathogenesis (3) Growth Patterns (2) Morphology (3)

A

*Most common malignancy worldwide but rearely mestastasizes

Nevoid Basal Cell Carcinoma Syndrome: PTCH defect

Increased SHH signaling:
PTCH defect causes
Constitutive activation of SMO/GL1 (tumor growth)

Multifocal growth: outward
Nodular Lesions: downward

Pearly papules with telangiectasias
Ulceration (on sinuses causes Rodent Ulcer)
Peripheral palisading

20
Q

Benign Fibrous Histiocytoma (Dermatofibroma)

Histology (3)

A

Benign spindle shaped cells

Nonencapsulated mass in mid-dermis

Pseudoepitheliomatous hyperplasia: downward elongation of rete ridges

21
Q

Dermatofibrosarcoma Protuberans

Mutation, Morphology (3)

A

COL1A1-PDGFB translocation

Storiform closely packed fibroblasts
Honeycomb pattern of extension into subcutaneous fat
Protuberant firm nodule

22
Q 
Mycosis Fungoides (Cutaneous T cell Lymphoma)
Lesion Progressions (3) Prognostic Factors (2) Histology (3) Cell Type Involved, Severe Complication
A

Scaly, red-brown patches
Raised, scaling plaques
Fungating nodules

% of body covered
Progression through to nodules

Bandlike aggregates of Sezary-Lutzner cells
Infolded nuclear membranes
Pautrier microabscesses in epidermis

CD4+ Th cells

Sezary Syndrome: erythroderma (whole body covered in scaling lesions)

23
Q

Mastocytosis

Pathogenesis (2) Cutaneous Form, Clinical Signs with Descriptions (2)

A

KIT mutations
Increased mast cells in skin

Urticaria Pigmentosa

Darier sign: edema and erythema when lesion rubbed
Dermatographism: hives from rubbing normal skin

24
Q

Ichthyosis

Pathogenesis (2) Morphology

A

Defective desquamation
Hyperkeratosis causes fishlike scaly skin

Buildup of compacted stratum corneum

25
Q

Urticaria (Hives)

Pathogenesis, Types (3) Morphology (2)

A

Microvacular hyperpermeability

Types:
IgE mediated mast cell degranulation
Mast cell degranulation via direct substance stimulation
Direct Vasodilation: Aspirin induced, Hereditary Angioneurotic edema (C1 inh defect)

Pruritic edematous plaques
Contained to dermis

26
Q

Eczematous Dermatitis

Pathogenesis (4) Morphology (6) Histology

A

T cell mediated Type IV hypersensitivity reactions:
Reactive chemicals are haptens
Haptens taken up by Langerhans cells
Presented to Th cells, memory cells cause strong second reaction

Red, Papulovesicular, Oozing, Crusted Lesions
Can develop reactive acanthosis and hyperkeratosis

Spongiotic Dermatitis: Edema in epidermis and dermis

27
Q

Erythema Multiforme

Pathogenesis, Morphology (5) Complications (2)

A

CD8+ CTL-mediated damage to Keratinocytes

Targetoid lesions**
Perivascular lymphocytic infiltrate
Interface dermatitis: dermoepidermal junction

Stevens Johnson Syndrome: fever and mucosal lesions
Toxic Epidermal Necrolysis: epidermal sloughing

28
Q

Psoriasis

Associated HLA, Pathogenesis (3) Presentation (2) Morphology (3)

A

HLA-Cw*0602 association

CD8+ CTL’s, Th1 and Th17 cell mediated inflammation
TNF highly involved
Can be trauma induced: Koebner phenomenon

Pink-salmon colored plaques covered by white scale
Nail discoloration and pitting
Auspitz Sign: multiple small bleeds in plaque

Thin/Absent Stratum Granulosum
Spongiform Pustules in superficial epidermis
Munro microabscesses in corneum

29
Q

Seborrheic Dermatitis

Pathogenesis (2) Correlations (2) Presentation (2) Morphology (4)

A

Increased sebum from androgen exposure
Fungal colonization

HIV
Parkinsons

Fissures behind ears
Dandruff

Follicular lipping: Mounds of parakeratosis at ostia of hair follicle
Lymphocyte and Neutrophil mediated perivascular inflammation

30
Q

Lichen Planus

Presentation (6) Morphology (3)

A 
Pruritic
Purple
Polygonal
Planar
Papules and
Plaques

Wickham striae (white dots along plaques)
Interface dermatitis
Civatte bodies: necrotic basal cells in dermis

31
Q

Pemphigus

Variants (5) Pathogenesis, Histology, Presentation

A 
Vulgaris (most common)
Vegetans
Foliaceus
Erythematosus
Paraneoplastic

IgG auto-Abs against desmogleins

Acantholysis: loss of squamous intercellular bridges

Suprabasal acantholytic blister

32
Q

Bullous Pemphigoid

Pathogenesis and Presentation (2)

A

Autoantibodies to basal keratinocyte hemidesmosomes

Cutaneous and oral subepidermal, nonacantholytic blisters

33
Q

Dermatitis Herpetiformis

Pathogenesis, Disease Association, Morphology (3)

A

IgA antibodies to gluten cross react with reticulin

Celiac’s Disease

Pruritic subepidermal blisters
Fibrin and neutrophil at tips of dermal papillae
Granular IgA deposits

34
Q

Epidermolysis Bullosa
Pathogenesis, Presentation (2)
Types with Descriptions
Simplex (3) Junctional (2) Dystrophic (2)

A

Defect in skin structural proteins

Blisters at sites of pressure/rubbing/trauma
Show up at birth

Simplex: most common
Keratins 14 and 5 affected
Basal cell layer blisters

Junctional:
Laminin defects (AR)
Blisters at lamina lucida

Dystrophic:
COL7A1 defects
Blisters beneath lamina densa

35
Q

Porphyria

Pathogenesis, Presentation (3) Types (5)

A

Porphyrin defects

Urticaria and subepidermal vesicles exacerbated by sunlight
Causes scarring

Congenital erythropoietic
Erythrohepatic protoporphyria
Acute intermittent porphyria
Porphyria cutanea tarda
Mixed
36
Q

Acne Vulgaris

Pathogenesis (4) Morphology (2) Severe Variant

A

Keratin plug formation
Sebaceous gland hypertrophy
Lipase synthesizing bacteria (Propionbacterium acnes)
Secondary inflammation of follicle

Open comedones
Closed comedones

Acne conglobata

37
Q

Rosacea

Pathogenesis (3) Morphology, Stages (4)

A

Elevated kallikrein 5 (stimulated by TLR2)
Causes increased antimicrobial cathelicidin

Perifollicular infiltrate

Flushing episodes (pre-rosacea)
Persistent erythema and telangiectasia
Pustules and papules
Rhinopyma

38
Q

Erythema Nodosum

Classification, Pathogenesis, Histology (2) Presentation (3)

A

Panniculitis

Delayed hypersensitivity to drug/microbial antigens

Early lesions: widened septae in connective tissue
Late Lesions: Septal Fibrosis

Poorly defined, tender, erythematous plaques
Fever
Malaise

39
Q

Erythema Induratum

Classification, Pathogenesis (2) Histology (3) Presentation (2)

A

Panniculitis

Primary vasculitis of vessels supplying fat lobules
Fat necrosis

Granulomatous inflammation
Caseous necrosis
Necrotizing vasculitis

Erythematous, slightly tender nodule
Ulceration of nodule

40
Q

Verrucae

Etiologies (2) Types (4) Common Histology

A

HPV 6 and 11

Verruca vulgaris (most common)
Verruca Plana (flat wart)
Verrucae Plantaris/Palmaris
Condyloma accuminatum (genital)

Verrucous epidermal hyperplasia

41
Q

Impetigo

Pathogenesis (3) Morphology and Histology

A

Bacterial infection causes epidermal damage
Scale crust (scab) forms
Blister caused by desmoglein 1 cleavage by toxin

Honey-colored crust to blisters

Accumulation of neutrophils under stratum corneum

42
Q

Pneumonic for Painful Skin Lesions (6)

A

“GLENDAB”

Glomus Tumor
Leimyoma
Eccrine Spiradenoma
Neurofibroma
Dermatofibroma
Angiolipoma
Blue Rubber Bleb Nevus

SBL Block 1 (6 decks)

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