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Pathology by week > W9 - Skin pathology > Flashcards

W9 - Skin pathology Flashcards

1
Q

Describe what H&E staining stands for?

A

hematoxylin and eosin stain

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2
Q

What does each component of H&E stain and what colour does each give?

A

Haematoxylin => nuclei => BLUE

Eosin => cytoplasm => PINK

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3
Q

Describe the layers (3) of the skin

A
  1. Epidermis

BM

  1. Dermis
  2. Subcutaneous fat
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4
Q

Describe the layers (5) of the epidermis

A
  1. Stratum basale (deepest)
  2. stratum spinosum (thickest)
  3. Stratum granulosum
  4. Stratum lucidum
  5. Stratum corneum (outermost)
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5
Q

What type of epithelia is the epidermis?

A

Squamous cell epithelia - highly keratinised!

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6
Q

Which layer of the epidermis stains more blue on H&E - basale or corneum?

A

Basale - because the cells are stem cells, which are rapidly dividing and have more nuclei than the superficial cells

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7
Q

What does the spinosum in the stratum spinosum signifiy?

A

The cells here have spines that connect the keratinocytes together, forming intercellular bridges.

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8
Q

Which is the thickest layer of the epidermis?

A

Stratum spinosum, also known as the squamous cell layer

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9
Q

How long does it take cells to reach the stratum corneum from the stratum basale?

A

roughly 28 days

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10
Q

Where are the melanocytes usually seen?

A

within the stratum basale

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11
Q

Name 5 structures seen within the dermis layer

A
  1. Sweat glands
  2. Sebacous glands
  3. Hair follicles
  4. Blood vessels
  5. Nerve endings
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12
Q

Inflammatory skin reactions have been divided into 3 groups based on their patterns - name them.

A

Epidermis

Dermis

Subcutis

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13
Q

Name the 4 morphological patterns of inflammatory reactions affecting the EPIDERMIS

A
  1. Spongiotic
  2. Lichenoid
  3. Psorasiform
  4. Vesicuobullous
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14
Q

Name the most common examples (2) of spongiotic reactions

A

Eczema, dermatitis

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15
Q

Histological features (4) of spongiotic reactions?

A
  1. Spongiosis (intraepidermal oedema)
  2. Exocytosis of lymphocytes (T cells) into the epidermis
  3. Superficial perivascular lymphocytic infiltration (dermis)
  4. Vesicles containing APCs such as Langerhan cells and T cells
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16
Q

Name the most common example of lichenoid inflammation

A

Lichen planus

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17
Q

What sort of disease is lichen planus?

A

Autoimmune disorder causing raised purple-red flat blotches on your skin, white patches in your mouth and bald patches on your scalp

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18
Q

Histological features (5) of lichenoid inflammation

A
  1. Irregularly thickened epidermis
  2. Degenerative skin cells
  3. Liquefaction degeneration of basal layer of epidermis
  4. Band of lymphocytes at the epidermal/dermal border
  5. Melanin pigments beneath the epidermis
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19
Q

What are the typical skin lesions in psoriasis?

A

Red patches/plaques with silvery top, usually well-deamrcated and on extensor surfaces (knees, elbows)

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20
Q

Does the skin cycle change in psoriasis?

A

Yes - from 28 days to go through the layers and shed off, in psoriasis we have fast proliferation ( sometimes even a 7 day turnover)

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21
Q

Describe the most common cause of psoriasiform reaction?

A

Psoriasis

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22
Q

Histological features (3) of psoriasiform reactions

A
  1. Acanthosis = thickening of epidermal layer

*due to rapid turnover and accumulation fo thick scale over site of irritation

  1. Parakeratosis = abnormal retention of nuclei in the stratum corneum as the keratinocytes dont have time to lose their nuclei in rapid turnover
  2. Hypogranulosis = little to no granular layer
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23
Q

Name the common causes of vesiculobullous reactions

A
  1. Pemphigoid
  2. Pemphigus
24
Q

What is usually the underlying pathophysiology leading to vesiculobullous disorders?

A

Autoimmune - antibodies attacking the epidermis

25
Q

Describe histological (3) and immunofluorescence (1) features of bullous pemphigoid

A

Histological:

  1. Epidermal BM destroyed by autoantibodies
  2. Eosinophl infiltrated
  3. Blisters just BENEATH the epidermis

Immunofluorescence:

  1. Linear IgG along the BM
26
Q

What are the 2 types of pemphigus?

A

Pemphigus foliaceus - SUPERFICIAL

Pemphigus Vulgaris - DEEP

27
Q

Describe histological (2) and IF (1) features of pemphigus vulgaris

A

Histological:

  1. Acantholysis = loss of coherence between epidermal cells due to the breakdown of intercellular bridges
  2. Deep intraepidermal/suprabasal blisters

IF:

  1. Chicken wire pattern = Intercellular deposits of IgG
28
Q

Describe what the abs attack in Bullous pemphigoid and pemphigus vulgaris

A

Bullous Pemphigoid = BM

Pemphigus Vulgaris = Intercellular bridges

29
Q

What is seborrheic keratosis?

A

common noncancerous growths

usually pigmented

well defined borders

stuck on appearance

30
Q

Histoloigcal features (2) of seborrheic keratosis

A
  1. Acanthosis
  2. Horn pseudocysts
31
Q

Most common form of skin cancer is

A

Basal Cell Carcinoma

32
Q

Rodent ulcer refers to

A

BCC

33
Q

BCC - comment on: aggressive/slow growing, metastasis, any associated mutations

A
  1. Locally aggressive
  2. Hardly ever metastasise
  3. PTCH mutation - especially implicated in Gorlin’s syndrome (predisposes young individuals to BCCs)
34
Q

What does a BCC lesion look like?

A

Red, pearly lesion, telangiectatic blood vessels. If ulcerated = rodent ulcer.

35
Q

What is actinic keratosis?

A

Precancerous lesion on chronically sune exposed skin, which can transform to SCC

36
Q

BCC - histological features (4)

A
  1. basaloid (arising from the basal layer) epithelial tumour arising from the epidermis
  2. clefting = white artefact around each tumour nodule
  3. Mitotic activity
  4. Peripheral palisading = basophilic, large nuclated cells that appear to form a basal layer by forming an orderly line around the periphery of tumor nests in the dermis
37
Q

Histological features (3) of actinic keratosis

A
  1. Atypia of epidermis-basal => dysplasic cells near in basal layer near BM due to high proliferation
  2. BM is NOT LOST
  3. Parakeratosis = nucleic keratinocytes in stratum corneum
38
Q

What is Bowen’s disease?

What are its histological features (3)

A

Bowen’s disease = SCC in situ

  1. Full thickness atypia
  2. BM intact
  3. Increased mitotic activity
39
Q

Squamous cell carcinoma - what does it normally appear like?

A

An irregular, keratinous nodule or a firm erythematous plaque

  • frequently ulcerates
40
Q

Describe histological features (5) of SCC

A
  1. Irregular agrgegates of PINK cells, tumour often PINK
  2. Infiltrate the dermis
  3. Increased mitotic activity
  4. Keratin pearls
  5. Perineural invasion
41
Q

Histological features (3) of benign neivi

A
  1. Well organised neivi
  2. Melanocytes are small
  3. As we move down into dermis, melanocytes become small and have LESS mitotic activity
42
Q

Malignant melanoma - histological features (4)

A
  1. Cellular atypia = melanocytes much bigger, angry looking
  2. Assymetry
  3. Pagetoid spread = melanocytes left the nest and are moving UPWARDS
  4. Uniform tissue - all melanocytes look the same
43
Q

2 main prognostic indicators for melanoma

A
  1. Breslow thickness - MOST important (histological thickness)
  2. Ulceration
44
Q

When do we check for BRAF V600E mutation in melanomas? and why?

A

BRAF mutation = in the thicker melanomas, we then check to see if the patient has a BRAF mutation because it can determine whether BRAF inhibitory therapy is useful

45
Q

What do you see?

What does it signify?

A

Spongiotic reaction

likely eczema

46
Q

What do you see?

What does it signifiy?

A

Lichenoid inflammation

Likely lichen planus

47
Q

What do you see?

What does it signify?

A

Psoriasiform reaction

psoarisis

48
Q

What do you see?

What does it signify?

A

vesiculobullous reaction

Bullous pemphigus

49
Q

What does it show?

What does it signifiy?

A

Vesiculobullous reaction

Pemphigus vulgaris

50
Q

What does this show? What does it signify?

A

BCC - blue tumour

51
Q

What do you see? What does it signifiy?

A

Actinic keratosis (solar keratosis)

52
Q

What do you see? What does it signify?

A

Bowen’s disease (SCC in situ)

53
Q

What do you see? What does it signifiy?

A

SCC

54
Q

What do you see? What does it signifiy?

A

SCC

55
Q

What do you see? what does it signifiy?

A

Benign neivi

  • well organised
  • small melanocytes
  • As they go down into the dermis, they are smaller and you don’t get mitotic activity in the dermis
56
Q

What do you see? What does it signify?

A

melanoma

57
Q

What do you see? What does it signify?

A

Uniform sheet of malignant melanocytes (all big + active) => melanoma

Pathology by week (70 decks)

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