TUMORS KODACHROMES Flashcards
BCC
Cherry angioma
Trichofolliculoma. In the dermis, there is a keratin-filled cyst lined by squamous epithelium with associated follicular structures.
Radiating from the wall of these cysts are many small, yet well-differentiated hair follicles (Fig. 30-3). Well-developed secondary hair follicles often show a hair papilla (Fig. 30-3). These follicles usually have an outer and an inner root sheath, the latter of which may contain eosinophilic trichohyaline granules and a central small hair shaft (Fig. 30-3). These small, fine hairs are visualized best where the secondary hair follicles appear in cross-sections. Small groups of sebaceous gland cells may be embedded in the walls of the secondary hair follicles
Trichofolliculoma. Emanating from the cyst wall are numerous small “secondary” hair follicles, some of which show, in addition to a hair and an outer root sheath, an inner root sheath with trichohyaline granules.
Dilated pore of Winer. An irregular cystic cavity containing keratin is present in the dermis.
Pilar sheath acanthoma. Lobulated masses of cells extend from the cystic cavity into the surrounding dermis.
Trichoepithelioma. A dermal tumor with a prominent stroma, horn cysts of varying sizes, and basaloid epithelial formations.
Identify. Where is this seen?
Papillary mesenchimal Body
Seen in Trichoepithelioma. Some of the basophilic islands form papillary mesenchymal bodies resembling follicular papillae.
Trichoblastoma. Large islands of basaloid tumor cells are present in the dermis exhibiting peripheral palisading associated with a fibrous stroma.
Pilomatricoma. The tumor is often well-circumscribed and composed of epithelial islands embedded in a cellular stroma. Two types of cells comprise the islands: basophilic cells and shadow cells. The basophilic cells resemble hair matrix cells. The shadow cells show a central unstained shadow at the site of the lost nucleus. In the center of the field, one can see transformation of the basophilic cells into shadow cells.
Trichilemmoma. The tumor shows verrucous hyperplasia with lobular formations extending into the superficial dermis. As a result of their differentiation toward outer root sheath cells, many cells appear clear.
Nevus sebaceus. There is epidermal hyperplasia and papillomatosis. Dilated apocrine glands are present in the dermis, and anagen follicles are lacking.
Sebaceous hyperplasia. The lesion consists of an enlarged sebaceous gland lying in close proximity to the epidermis.
Sebaceous adenoma. In the lobules, two types of mature cells can be recognized: basaloid and sebaceous cells. However, sebaceous cells predominate. Cytologic atypia is not seen.
Sebaceous adenoma. The tumor is composed of enlarged sebaceous lobules of varying size and shape.
Apocrine hidrocystoma. The dermis contains a multiloculated cystic lesion lined by epithelial cells with occasional papillary projections.
Apocrine hidrocystoma (cystadenoma). The cyst is lined by a single row of columnar cells showing decapitation secretion. Peripheral to the row of secretory cells are elongated myoepithelial cells.
Hidradenoma papilliferum. The tumor consists of a wellcircumscribed dermal nodule with scattered cystic and branching spaces.
Hidradenoma papilliferum. Numerous papillary projections are seen within the lesion. The papillary folds are lined by one layer of high cylindrical cells, which show evidence of active “decapitation” secretion like that seen in apocrine glands. A basal layer of small cuboidal cells is also present.
Syringocystadenoma papilliferum. The lesion exhibits a cystic invagination extending into the dermis, with numerous papillary projections.
Syringocystadenoma papilliferum. The papillary projections are lined by two rows of cells. The luminal row of cells consists of columnar cells with evidence of active “decapitation” secretion. The outer row of cells consists of small cuboidal cells. Plasma cells are usually seen in the papillary core.
Cylindroma. The tumor is composed of irregularly shaped islands that fit together like pieces of a jigsaw puzzle. The islands are surrounded by a hyaline sheath.
Cylindroma. Two types of epithelial cells constitute the islands: cells with small dark nuclei representing undifferentiated cells, and cells with large pale nuclei representing cells with a certain degree of differentiation toward ductal or secretory cells. Droplets of hyaline material are seen in the islands.
Syringoma. In the dermis, numerous tubular structures are embedded in a dense, collagenous stroma.
Syringoma. The walls of the ducts are predominantly lined by two rows of epithelial cells. Some ducts are lined by an eosinophilic cuticle, whereas others have comma-like tails. Granular eosinophilic material is seen in some ducts.
Eccrine poroma. The tumor consists of broad, anastomosing bands emanating from the epidermis.
Eccrine spiradenoma. Well-circumscribed aggregates of blue tumor cells are seen in the dermis.
Eccrine poroma. The cells comprising the tumor have a uniformly small cuboidal appearance and are connected by intercellular bridges.
Dermatofibroma (fibrous histiocytoma). A: Gross specimen. A poorly circumscribed dermal lesion is present with overlying increased epidermal pigmentation and acanthosis. The tumor has a yellow cut surface with focal hemorrhage present centrally. B: The epidermis is hyperplastic and separated by a narrow clear zone from a moderately cellular spindle cell tumor extending into the deep dermis. C: The tumor is composed of variably-sized spindle cells with pale eosinophilic cytoplasm in a collagenous stroma. D: This dermatofibroma shows prominent hyalinization and pigmentation. E: Hemosiderin and multinucleated giant cells dominate in this zone of another dermatofibroma.
Dermatofibrosarcoma protuberans (DFSP).
A: Gross specimen of a myxoid variant of DFSP. The lesion is better circumscribed than the more typical form of DFSP and forms a central nodule extending into subcutis, with lateral extension in the dermis showing a component of firmer white tissue. B: Densely packed spindle cells are present, arranged in a storiform pattern extending around fat cells. C: Strands of bland spindle cells infiltrate subcutis, producing a honeycomb-like pattern. D: This DFSP exhibits an area with a prominent fibrosarcoma-like pattern. This feature is now thought to be of adverse prognostic significance (see text).
Keloid scar. A: Nodules of spindle cells with abundant collagen are present in the dermis with prominent hyalinization. B: Glassy eosinophilic and hyalinized collagen fibers are interspersed with swathes of fibroblasts.
Nevus sebaceus
Identify the circular whorls.
Where is this usually seen?
SQUAMOUS EDDIES: Circular whorls composed of eosinophilic, flattened squamous cells arranged in an onion-peel fashion (irritated seb ker);
May be seen in irritated seborrheic keratosis (inverted follicular keratosis)
- horn/keratin pearl- Trapped keratin within cystic nests; dense/parakeratin (not loose flaky keratin) and 2. Located in dermis (not epidermis); (eosinophilic parakeratotic keratinization); well or moderately differentiated; WITH DENSE PINK KERATIN; IN THE MIDDLE OF ISLANDS OF ATYPICAL KERATINOCYTES; A LOT OF NUCLEI; IN THE DERMIS; YUNG KERATIN PARANG NATTRAP INSIDE THE NEST OF TUMOR; ENTRAPPED PARAKERATOSIS
- horn cyst - foci of orthokeratosis within the substance of the lesion, loose keratin; In the EPIDERMIS; representfoci of abrupt complete keratinization(with only a very thin surrounding granular cell layer and without retained nuclei); Seb ker; NASA EPIDERMIS TAPOS LOOSE YUNG KERATIN; ORTHOKERATIN (WALANG NUCLEI)
- pseudohorn cyst - Keratin-filled cystic structure that is the result of cutting through invaginations of the stratum corneum; with connection on the surface; in the epidermis; seb ker; OPEN UP TO THE SURFACE
- horn/keratin pearl- Trapped keratin within cystic nests; dense/parakeratin (not loose flaky keratin) and 2. Located in dermis (not epidermis); (eosinophilic parakeratotic keratinization); well or moderately differentiated; WITH DENSE PINK KERATIN; IN THE MIDDLE OF ISLANDS OF ATYPICAL KERATINOCYTES; A LOT OF NUCLEI; IN THE DERMIS; YUNG KERATIN PARANG NATTRAP INSIDE THE NEST OF TUMOR; ENTRAPPED PARAKERATOSIS
Identify the circular whorls.
Where is this seen?
horn/keratin pearl- Trapped keratin within cystic nests; dense/parakeratin (not loose flaky keratin) and 2. Located in dermis (not epidermis); (eosinophilic parakeratotic keratinization); well or moderately differentiated; WITH DENSE PINK KERATIN; IN THE MIDDLE OF ISLANDS OF ATYPICAL KERATINOCYTES; A LOT OF NUCLEI; IN THE DERMIS; YUNG KERATIN PARANG NATTRAP INSIDE THE NEST OF TUMOR; ENTRAPPED PARAKERATOSIS
Seen in Well-differentiated or moderately differentiated SCC
- squamous eddies- Circular whorls composed of eosinophilic, flattened squamous cells arranged in an onion-peel fashion (irritated seb ker); irritated seborrheic keratosis (inverted follicular keratosis) - horn cyst - foci of orthokeratosis within the substance of the lesion, loose keratin; In the EPIDERMIS; representfoci of abrupt complete keratinization(with only a very thin surrounding granular cell layer and without retained nuclei); Seb ker; NASA EPIDERMIS TAPOS LOOSE YUNG KERATIN; ORTHOKERATIN (WALANG NUCLEI) - pseudohorn cyst - Keratin-filled cystic structure that is the result of cutting through invaginations of the stratum corneum; with connection on the surface; in the epidermis; seb ker; OPEN UP TO THE SURFACE
ANGIOKERATOMA
PYOGENIC GRANULOMA
KERATOACANTHOMA
ACTINIC KERATOSIS
ACTINIC KERATOSIS
*shows sparing of adnexal structure (acrosyringium) - that’s why the SC immediately above the adnexal structures have orthokeratosis; tapos yung affected areas sa taas parakeratotic. kaya sila alternating hence the FLAG SIGN
STEATOCYSTOMA
DERMOID CYST with attached mature skin appendages
DDX:
- Epidermal inclusion cyst / epidermoid cyst:
Smooth, dome shaped firm, skin colored nodule that is freely movable on palpation and sometimes has a small, dilated punctum
Lined only by stratified squamous epithelium; no adnexal structures identified
Lumen contains abundant keratin flakes
- Vellus hair cyst:
Multiple, small, smooth, skin colored, reddish, bluish, yellowish, brown, violaceous or grayish papules
Mid dermal cyst containing laminated keratin and many vellus hairs
Epithelial lining consists of several layers of squamous epithelium, often with a granular cell layer - Steatocystoma:
Skin colored to yellowish dermal cystic papules or nodules
Cyst lined by stratified squamous epithelium without a granular layer with attached sebaceous gland
Diagnostic, corrugated eosinophilic layer lining luminal surface - Pilar / trichilemmal cyst:
Firm and well circumscribed nodule on palpation
Lined by stratified squamous epithelium, which lacks granular layer
Contains dense eosinophilic keratin
DERMOID CYST with attached mature skin appendages
Syringoma
Syringocystadenoma papilliferum
Fibrous cores of papillae contain numerous plasma cells and are lined by a double layer of cuboidal columnar epithelium
Intradermal nevus
Intradermal Nevus
Small nests of melanocytes in upper dermis, often around pilosebaceous units, with variable pigmentation and cellularity
May have multinucleated melanocytes; deeper portion is usually less pigmented and less cellular and may have Wagner-Meissner corpuscles (representing neural portion of nevus)
Mucin in 3% of stroma and within nests of nevus cells (Am J Dermatopathol 2008;30:236)
Rarely nevus giant cells, balloon cells, infiltration by fat cells or osseous metaplasia
No junctional component
Can also be classified as Unna’s pattern (purely adventitial lesion confined to expanded papillary dermis and often to perifollicular dermis, usually neck, trunk or limbs) or Miescher’s pattern (melanocytes diffusely infiltrate adventitial and reticular dermis in wedge shaped pattern, usually on face) (Am J Dermatopathol 2007;29:141)
Slit-like pseudovascular spaces may be seen through artifact of processing and biopsy procedure
Spitz Nevus
Symmetrical, well circumscribed tumor composed of large epithelioid and spindled melanocytes. The epidermis is hyperplastic.
Spitz Nevus
The melanocytic nests extend from the epidermis into the reticular dermis. At the base, the nests break up into single cells. Maturation of cells with depth is noted.
Spitz Nevus
An eosinophilic hyaline globule (Kamino body) is found intraepidermally. Retraction artifacts (clefting) surrounding the melanocytic nests and separating them from the epidermis are typically present.
Conventional Spitz nevi are well circumscribed, symmetrical and show an overall wedge shaped silhouette
Consist of large junctional and dermal melanocytic nests formed by spindled or epitheliod cells
Melanocytes are large, spindled or epitheliod, contain abundant pale or ground glass cytoplasm and finely dispersed pigment (if present)
Mild nuclear pleomorphism may occur, mitoses are rare or absent
Melanocytic nests may show maturation with depth and break up into single melanocytes at the dermal base of the lesion
Junctional nests often show separation artifacts (clefting) to the surrounding epidermis and are oriented perpendicularly to the epidermis
Mild pagetoid scatter of single melanocytes may be a feature but is usually confined to the lower half of the epidermis and found only in the center of the lesion
Transepidermal elimination of melanocytic nests may occur
A typical finding of classic Spitz nevi are PAS+, eosinophilic, hyaline globules, so called Kamino bodies, located at the dermoepidermal junction
Perivascular lymphocytic infiltrates are variably present
Identify the pointed structure
Papillary Mesenchymal Body
Seen in trichoepithelioma or trichoblastoma
