XXII - The Skin

Question 1

This term is the accumulation of edema fluid within the epidermis. Characterizes all forms of eczamatous dermatitis.

Answer 1

Spongiosis(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 839

Question 2

An uncommon, usually self-limited disorder that seems to be a hypersensitivity response to certain infections and drugs. Patients present with an array of “multiform” lesions, including macules, papules, vesicles, and bullae, as well as the characteristic targetoid lesion consisting of a red macule or papule with a pale vesicular or eroded center.

Answer 2

Erythema Multiforme (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 840

Question 3

In this skin disorder, there is marked epidermal thickening (acanthosis), and loss of the stratum granulosum with extensive overlying parakeratotic scale. The most typical lesion is a well-demarcated, pink to salmon-colored plaque covered by loosely adherent silver-white scale.

Answer 3

Psoriasis(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841

Question 4

This sign is described as bleeding upon removal of scales from the lesions of psoriasis.

Answer 4

Auspitz sign(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841

Question 5

Small aggregates of neutrophils within the parakeratotic stratum corneum in psoriasis.

Answer 5

Munro microabscesses(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841

Question 6

Small aggregates of neutrophils within the spongiotic superficial epidermis in psoriasis.

Answer 6

Pustules of Kogoj(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841

Question 7

Layer of the skin which is affected in psoriasis.

Answer 7

S. granulosum(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841

Question 8

“Pruritic, purple, polygonal, planar papules, and plaques” describes this disorder of the skin and mucosa. The pattern of inflammation of this disorder is characterized by angulated, zigzag contour (“sawtoothing”) of the dermoepidermal junction.

Answer 8

Lichen Planus (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841

Question 9

Anucleate, necrotic basal cells seen in the inflamed papillary dermis of patients with lichen planus are called?

Answer 9

Colloid bodies or Civatte bodies(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841

Question 10

Presents as roughening of the skin that takes on an appearance reminiscent of “lichen on a tree”. It is a response to local repetitive trauma such as continual rubbing or scratching.

Answer 10

Lichen Simplex Chronicus (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 842

Question 11

Common lesions of children and adolescents, caused by human papillomavirus (HPV). Histologic features include epidermal hyperplasia that is often undulant in character, and cytoplasmic vacuolization (koilocytosis).

Answer 11

Verrucae (warts)(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 843

Question 12

The most common type of wart. Occurs anywhere but are found most frequently on the hands, particularly on the dorsal surfaces and periungual areas, where they appear as gray-white to tan, flat to convex, 0.1- to 1-cm papules with a rough, pebble-like surface.

Answer 12

Verruca vulgaris(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 844

Question 13

These warts are common on the face or dorsal surfaces of the hands. These warts are flat, smooth, tan macules.

Answer 13

Verruca plana/flat wart(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 844

Question 14

These warts occur on the soles and palms. Described as rough, scaly lesions that may reach 1 to 2 cm in diameter, coalesce, and be confused with ordinary calluses.

Answer 14

Verruca plantaris and verruca palmaris(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 844

Question 15

These warts occurs on the penis, female genitalia, urethra, and perianal areas.

Answer 15

Condyloma acuminatum (venereal wart) (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 844

Question 16

A rare autoimmune blistering disorder resulting from loss of integrity of normal intercellular attachments within the epidermis and mucosal epithelium. Caused by a type II hypersensitivity reaction

Answer 16

Pemphigus (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 845

Question 17

Common histologic denominator in all forms of pemphigus, described as the lysis of the intercellular adhesion sites.

Answer 17

Acantholysis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 845

Question 18

In this variant of pemphigus, acantholysis selectively involves the layer of cells immediately above the basal cell layer, giving rise to a suprabasal acantholytic blister. There is uniform deposition of immunoglobulin and complement along the cell membranes of keratinocytes, producing a characteristic “fishnet” appearance.

Answer 18

Pemphigus vulgaris(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 845

Question 19

In this variant of pemphigus, acantholysis selectively involves the superficial epidermis at the level of the stratum granulosum.

Answer 19

Pemphigus foliaceus(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 845

Question 20

An autoimmune disease in which the characteristic finding is linear deposition of IgG antibodies and complement in the basement membrane zone. Characterized by a subepidermal, nonacantholytic full-thickness epidermal fluid-filled blister.

Answer 20

Bullous pemphigoid (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 846

Question 21

A rare disorder characterized by urticaria and grouped vesicles. Fibrin and neutrophils accumulate selectively at the tips of dermal papillae, forming small microabscesses, which coalesce to form a subepidermal blister. On immunofluorescence, granular deposits of IgA are localized at the tips of dermal papillae.

Answer 21

Dermatitis herpetiformis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 846

Question 22

These common epidermal tumors occur most frequently in middle-aged or older individuals. The lesions consist of an orderly proliferation of uniform, benign basaloid keratinocytes with a tendency to form keratin microcysts (horn cysts), which has a “stuck-on” appearance on the skin.

Answer 22

Seborrheic keratosis(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 849

Question 23

These are rare tumors that primarily occur in the head and neck region of older individuals. They usually present as flesh-colored papules and can be a marker for an internal malignancy.

Answer 23

Sebaceous Adenoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 849

Question 24

These lesion is usually the result of chronic exposure to sunlight and is associated with hyperkeratosis. The dermis contains thickened, blue-gray elastic fibers or “solar elastosis” which is the result of chronic sun damage.

Answer 24

Actinic keratoses(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 850

Question 25

Acronym for remembering the histologic features of actinic keratoses.

Answer 25

“Sunny” SPAINS S - solar elastoses (dermal sun damage)P - parakeratosisA - atypia (keratinocytic)I - inflammationN - not full thickness atypia(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 850

Question 26

A common tumor arising on sun-exposed sites in older people, with higher incidence in women. Arise from prior actinic keratoses. Characterized by highly anaplastic, rounded cells with foci of necrosis and only abortive, single-cell keratinization (dyskeratosis).

Answer 26

Squamous cell carcinoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 851

Question 27

This is the most common human cancer, which is a slow-growing tumor that rarely metastasizes. Tends to occur at sites subject to chronic sun exposure and in lightly pigmented people. h

Answer 27

Basal cell carcinoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 852

Question 28

These tumors present as pearly, smooth-surfaced papules, often containing prominent, dilated subepidermal blood vessels (telangiectasia). The cells have scant cytoplasm, small hyperchromatic nuclei, and a peripheral palisade with clefting from the stroma.

Answer 28

Basal cell carcinoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 852

Question 29

This refers to any benign congenital or acquired neoplasm of melanocytes.

Answer 29

Melanocytic nevus(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 853

Question 30

These are large nevi and may occur as hundreds of lesions on the body surface. They are flat macules to slightly raised plaques, with a “pebbly” surface. Considered as a marker of melanoma risk.

Answer 30

Dysplastic nevi(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 854

Question 31

This cancer of the skin may develop from a dysplastic nevus, and results from excessive sun exposure. Malignant cells have large nuclei with irregular contours having chromatin characteristically clumped at the periphery of the nuclear membrane and prominent eosinophilic nucleoli often described as “cherry red”. Has both radial and vertical growth phases.

Answer 31

Melanoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 855

Question 32

This determines the biologic behavior of melanomas.

Answer 32

Nature and extent of the vertical growth phase (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 857

Question 33

What is the most common type of all autoimmune blistering disordering of the skin (pemphigus)?

Answer 33

Pemphigus Vulgaris(TOPNOTCH)

Question 34

Histologically, what is the most common denominator in all forms of pemphigus?

Answer 34

Acantholysis (TOPNOTCH)

Question 35

Morphology: Subepidermal nonacantholytic blisters

Answer 35

Bullous Pemphigoid (TOPNOTCH)

Question 36

Morphology: Suprabasal acantholytic blister

Answer 36

Pemphigus Vulgaris (TOPNOTCH)

Question 37

Morphology: Characteristically, fibrin and neutrophils accumulate selectively at the tips of the dermal papillae forming small microabscesses

Answer 37

Dermatitis Herpetiformis (Seen in Celiac Disease) (TOPNOTCH)

Question 38

Morphology: accumulation of neutrophils beneath the stratum corneum

Answer 38

Impetigo (TOPNOTCH)

Question 39

Munro microabscesses is classically seen in?

Answer 39

Psoriasis (TOPNOTCH)

Question 40

Auspitz sign is associated with what condition?

Answer 40

Psoriasis (TOPNOTCH)

Question 41

Pearly papules often containing prominent, dilated subepidermal blood vessels (telangiectasias)

Answer 41

Basal Cell Carcinoma (TOPNOTCH)

Question 42

What is the most commonly accepted exogenous cause of squamous cel carcinoma of the skin?

Answer 42

Exposure to UV light (TOPNOTCH)

Question 43

Cutaneous horns are seen in what condition?

Answer 43

Actinic Keratosis (TOPNOTCH)

Question 44

Morphology: characterized by loss of melanocytes

Answer 44

Albinism (TOPNOTCH)

Question 45

In albinism, melanocytes are present but melanin pigment is not produced due to what enzyme deficiency or defect?

Answer 45

Tyrosinase (TOPNOTCH)

Question 46

Q: + for melanocyte-associated proteins such as tyrosinase or Melan-A or S

Answer 46

Vitiligo (TOPNOTCH)

Question 47

The early developmental stage in melanocytic nevi is called?

Answer 47

Junctional nevi (TOPNOTCH)

Question 48

Most junctional nevi grow into the underlying dermis as nests or cords of cells and are calle

Answer 48

Compound nevi (TOPNOTCH)

Question 49

When all the epidermal nests of compound nevi are lost entirely they form what

Answer 49

intradermal nevi (TOPNOTCH)

Question 50

Appears to play an important role in the development of skin malignant melanoma

Answer 50

Sunlight (TOPNOTCH)

Question 51

What are the 5 clinical warning signs of melanoma?

Answer 51

1. enlargement of a pre-existing mle2. itching or pain in pre-existing mole3. development of a new pigment lesion during adult life4. irregularity of the borders of a pigment lesion5. variegation of color within a pigmented lesion (TOPNOTCH)

Question 52

Appears clinically as flesh-colored, dome shaped nodules with central, keratin filled plug, imparting a crater like topography

Answer 52

Keratoacanthoma (TOPNOTCH)

Question 53

Morphology: Central, keratin filled crater surrounded by proliferating epitheal cells that extend upward in a lip-like fashion over the sides of the crater and downward into the dermis as irregular tongues

Answer 53

keratoacanthoma (TOPNOTCH)

Question 54

The most important clinical sign of malignant melanoma

Answer 54

change in color, size, or shape in a pigmented lesion (TOPNOTCH)

Question 55

In Malignant Melanoma, what type of growth indicated the tendency of a melanoma to grow horizontally within the epidermal and superficial dermal layers, often for a prolonged period of time?

Answer 55

Radial growth (TOPNOTCH)

Question 56

In Malignant Melanoma, what are the determinants of a more favorable prognosis?

Answer 56

1. Tumor depth of less than 1.7 mm2. Absence or low numbers of mitoses3. Presence of a brisk TIL response (Tumor Infiltrating Leukocytes)4. Absence of regression 5. Female gender6. Location on extremity skin (TOPNOTCH)

Question 57

A 20 y/o male, previously known case of peanut allergy inadvertently took biscuits containing peanuts. Within a short time, he developed pink wheals on his extremities and trunk that are pruritic. Histologic findings in his lesion will include:

Answer 57

Sparse superficial perivenular infiltrate of mononuclear cells and eosinophils. (TOPNOTCH) Robbins Pathologic Basis of Disease, 9th ed., p. 1162

Question 58

Most important cause of cutaneous squamous cell carcoma

Answer 58

DNA damage induced by UV light exposure(TOPNOTCH)Robbins Basic Pathology 9th ed., 122

Question 59

Usually present as pearly papules contaning prominent dilated subepidermal blood vessles(telangiectasia), which may ulcerate and locally invade bone or facial sinuses; cells at the periphery of tumor cell islands tend to be arranged radially with long axes in parallel alignment(palisading)

Answer 59

Basal cell carcinoma(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1157

Question 60

Actinic keratosis may lead to what type of skin cancer?

Answer 60

Cutaneous squamous cell carcinoma(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1157

Question 61

Histologic hallmark of Cutaneous T-cell Lymphoma

Answer 61

Presence of Sezary-Lutzner cells(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1160

Question 62

Presents with small, pruritic papules to large edematous plaques, which may coalesce to form annular, linear, or arcform configurations. There is usually superficial perivenular infiltrate consisting of mononuclear cells, rare neutrophils, and eosinophils

Answer 62

Urticaria(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1162

Question 63

Febrile form of erythema multiforme associated with extensive involvement of skin, lips and oral mucosa, conjunctiva, urethra, and genital and perianal areas, often seen in children.

Answer 63

Steven-Johnson syndrome(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1164

Question 64

It is characterized by kertinocyte injury mediated by skin-homing CD8+ band cytotoxic T lymphocytes; presenting with diverse array of lesions.

Answer 64

Erythema Multiforme (TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1164

Question 65

Process by which local trauma induce psoriatic lesions in susceptible individuals

Answer 65

Koebner phenomenon(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1165

Question 66

Presents with macules and papules on an erythematous-yellow, often greasy base, in association with extensive scaling and crusting. Histologically, mounds of parakeratosis containing neutrophils and serum are present at the ostia of hair follicles(Follicular lipping)

Answer 66

Seborrheic dermatitis(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1166

Question 67

Group of disorders caused by inherited defects in structural proteins that lend mechanical stability to the skin; common feature is a proclivity to form blisters at sites of pressure, rubbing, or trauma, at or soon after birth

Answer 67

Epidermolysis bullosa(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1171

Question 68

Presents with urticaria and vesicles associated with scarring that are exacerbated by exposure to sunlight. The vesicles are subepidermal in location and dermis contains vessels with walls that are thickened by glassy deposits of serum proteins.

Answer 68

Porphyria(TOPNOTCH)Robbins Basic Pathology, 9th ed., p 1172

Question 69

Presents with stages of flushing, then persistent erythema and telangiectasia, followed by pustules and papules, and lastly by permanent thickening of the nasal skin by confluent erythematous papules and prominent follicles(rhinophyma)

Answer 69

Rosacea(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1174

Question 70

Presents with multiple lesions on the skin and mucus membranes, with predilection for the trunk and anogenital areas. Lesions are firm, often pruritic, pink to skin-colored umbilicated papules, with curd-like material which can be expressed from the central umbilication

Answer 70

Molluscum contagiosum(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1176

Question 71

The pathogenesis of blister formation in this condition is related to bacterial production of a toxin that cleaves desmoglein 1, the protein responsible for cell-to-cell adhesion within the uppermost epidermal layers.

Answer 71

Impetigo(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1177

Question 72

Presents as an erythematous macule and multiple pustules. As pustules break, shallow erosions from, covered with drying serum, giving the characteristic honey-colored crust

Answer 72

Impetigo(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1177

Question 73

It has the characteristic microscopic feature of accumulation of neutrophils beneath the stratum corneum often producing a subcorneal pustule containing serum proteins and inflammatory cells.

Answer 73

Impetigo(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1177

Question 74

A 25 year old male presents with well-demarcated pink plaques on his elbows, scalp, and knees that have a silvery scale. A biopsy showed acanthosis, elongated rete ridges, loss of stratum granulosum with an overlying parakeratotic scale, thinning of the epidermis overlying the dermal papillae, and neutrophil aggregates in the parakeratotic stratum corneum. The dermatologist removes one of the scales, and a pinpoint bleeding is observed. This phenomenon is due to (A) the acanthosis (B) thinning of the epidermis overlying the dermal papillae (C) neutrophil aggregates (D) elongated rete ridges

Answer 74

thinning of the epidermis overlying the dermal papillae (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841

Question 75

A 62 year old woman has a coin-like, dark brown plaque on her chest that appears stuck-on. She has it excised, and histopathology showed an orderly proliferation of basaloid cells, with keratin microcysts. Some of the basaloid cells have melanin. Her lesion (A) is a tumor of malignant melanocytes (B) is common in her age group (C) will exhibit a fishnet appearance if subjected to immunofluorescence (D) is a melanocytic nevus

Answer 75

is common in her age group (seborrheic keratosis) (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 845848-849

Question 76

A 33 year old female has multiple flesh-colored papules on her face, neck, trunk, and limbs. One of the papules is excised, which showed a lobular proliferation of sebocytes, some with vacuolated cytoplasm, others more basaloid in appearance. Her lesions may be a sign of underlying (A) colorectal carcinoma (B) nonHodgkin lymphoma (C) aplastic anemia (D) thalassemia

Answer 76

colorectal carcinoma (sebaceous adenoma and Muir-Torre syndrome) (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 849

Question 77

A 45 year old male has a pearly papule with prominent vessels on his eyelid. He has it excised, and the lesion showed multiple nodules of basaloid cells with scant cytoplasm and peripheral palisading. The nodules appear separated from the stroma. His lesion (A) frequently metastasizes to distant sites (B) is correlated to sun exposure (C) is associated with HPV infection (D) may arise on mucosal surfaces

Answer 77

is correlated with sun exposure (basal cell carcinoma) (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 852