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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
Urticaria (Hives) | Pathogenesis, Types (3) Morphology (2)
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
Eczematous Dermatitis | Pathogenesis (4) Morphology (6) Histology
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
Erythema Multiforme | Pathogenesis, Morphology (5) Complications (2)
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
Psoriasis | Associated HLA, Pathogenesis (3) Presentation (2) Morphology (3)
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
Seborrheic Dermatitis | Pathogenesis (2) Correlations (2) Presentation (2) Morphology (4)
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
Lichen Planus | Presentation (6) Morphology (3)
``` Pruritic Purple Polygonal Planar Papules and Plaques ``` Wickham striae (white dots along plaques) Interface dermatitis Civatte bodies: necrotic basal cells in dermis
31
Pemphigus | Variants (5) Pathogenesis, Histology, Presentation
``` Vulgaris (most common) Vegetans Foliaceus Erythematosus Paraneoplastic ``` IgG auto-Abs against desmogleins Acantholysis: loss of squamous intercellular bridges Suprabasal acantholytic blister
32
Bullous Pemphigoid | Pathogenesis and Presentation (2)
Autoantibodies to basal keratinocyte hemidesmosomes Cutaneous and oral subepidermal, nonacantholytic blisters
33
Dermatitis Herpetiformis | Pathogenesis, Disease Association, Morphology (3)
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
Epidermolysis Bullosa Pathogenesis, Presentation (2) Types with Descriptions Simplex (3) Junctional (2) Dystrophic (2)
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
Porphyria | Pathogenesis, Presentation (3) Types (5)
Porphyrin defects Urticaria and subepidermal vesicles exacerbated by sunlight Causes scarring ``` Congenital erythropoietic Erythrohepatic protoporphyria Acute intermittent porphyria Porphyria cutanea tarda Mixed ```
36
Acne Vulgaris | Pathogenesis (4) Morphology (2) Severe Variant
Keratin plug formation Sebaceous gland hypertrophy Lipase synthesizing bacteria (Propionbacterium acnes) Secondary inflammation of follicle Open comedones Closed comedones Acne conglobata
37
Rosacea | Pathogenesis (3) Morphology, Stages (4)
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
Erythema Nodosum | Classification, Pathogenesis, Histology (2) Presentation (3)
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
Erythema Induratum | Classification, Pathogenesis (2) Histology (3) Presentation (2)
Panniculitis Primary vasculitis of vessels supplying fat lobules Fat necrosis Granulomatous inflammation Caseous necrosis Necrotizing vasculitis Erythematous, slightly tender nodule Ulceration of nodule
40
Verrucae | Etiologies (2) Types (4) Common Histology
HPV 6 and 11 ``` Verruca vulgaris (most common) Verruca Plana (flat wart) Verrucae Plantaris/Palmaris Condyloma accuminatum (genital) ``` Verrucous epidermal hyperplasia
41
Impetigo | Pathogenesis (3) Morphology and Histology
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
Pneumonic for Painful Skin Lesions (6)
"GLENDAB" ``` Glomus Tumor Leimyoma Eccrine Spiradenoma Neurofibroma Dermatofibroma Angiolipoma Blue Rubber Bleb Nevus ```

SBL Block 1 (6 decks)

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