Dermpath

Front 1

Patient with demarcarted scaly plaques, affects nails scalp extremities

Micro: parakeratosis, hypogranulosis, psoriasiform epidermal hyperplasia. Polys in stratum corneum, spongiosis

Back 1

Psoriasis

Front 2

Patient with a rash

Micro: mounding parakeratosis, variable epidermal hyperplasia and spogiosis, chronic inflammation

Back 2

Eczematous dermatitis

Front 3

Buzzwords:
"herald patch"
"christmas tree distribution"

Micro: parakeratosis, spngiosis, papillary dermal microhemorrhage

Small plaques with collarette of scale

Back 3

Pitiriasis rosea

Front 4

Irregularly irregular epidermal hyperplasia

Back 4

Prurigo nodularis "picker's nodule"

Front 5

Patient with puritic purple, polygonal flat papules, may have lacy white, reticulated hyperkeratosis (Wickham's striae), on the scalp, nails, buccal mucosa

Micro: hyperkeratosis, acanthosis, "saw tooth" elongation of rete, lichenoid infiltrate, colloid bodies

1. what if you see eos? MC cause?

2. what if you see parakeratosis?

3. What if on penis? more nodular areas of inflammation?

Back 5

Lichen planus

1. Lichenoid drug eruption, caused MC by gold

2. Benign lichenoid keratosis

3. Lichen niditus

Front 6

younger woman with scaly papules and plaques, follicular plugging, scarring alopecia. Heal with hypopigmentation, especially at sun-exposed sites

Micro: hyperkeratosis, vacular interface dermatitis, superficial AND deep infiltrate

1. percent that develop systemic disease?

Back 6

Chronic cutaneous lupus erythematosus (Discoid lupus)

1. 5-10%

Front 7

patient with mucocutaneous eruption, iris and targetoid lesions, bilateral, h/o sulfonimide use

Micro:inflammation at dermal/epidermal junction, vacuolar interface, necrotic keratinocytes, rare eos, later full thickness necrosis and subepidermal bullae

1.what other etiologies?

2. what are other manifestations of this disease?

Back 7

Erythema multiforme

1.anticonvulsants, herpes infection

2. Toxic epidermal necrosis/ stephens-johnson syndrome

Front 8

middle aged patient with flacid blisters and erosions with mucus membrane involvement

Micro: suprabasilar acatholysis, intraepidermal bullae, "tombstone row" of basal later, sparse infiltrate

IF- IgG and C3 show "chicken wire" pattern

1.what if patient is elderly and the bullae is formed at the stratum corneum/loss of corneum?

2. What if bullae is subepidermal and contains eos and polys, and is usually intact?

3. what if subepidermal bullae but puritic vescicles on elbows, assc. with gluten-sensitive enteropathy, and bullae are filled with polys that also form microabscesses in the dermis?

Back 8

Pemphigus vulgaris

1. pemphigus foliaceus

2. bullous pemphigoid (caused by anti-BM antibodies)

3. dermatitis herpetiformis

Front 9

young patient with dome-shaped pink papule (1cm) on the face or lower extremities

Micro: symmetrical lesion that is well circumscribed with hyperplastic epidermis and kamino bodies, oval melanocytic nests in a "streaming down" pattern. May have focal pagetoid spread, and maturation. Cells are large, spindled and epithelioid with eosinophilic cytoplasm and basophilic nuclei. occasional superficial mitoses are OK. Cleft retraction is classic.

Back 9

Spitz nevus

Front 10

30 YO woman with well circumscribed dark papule with recent onset on the thigh

Micro: symmetric lesion with fascicles, horizontally streaming (raining down) growth. Cells are uniform, fusiform. interspersed with pigmented melanophages. Only at dermal/epidermal junction

Back 10

Pigmented spindle cell nevus

Front 11

Patient with well circumscribed blue/black papule/nodule, 1-2 cm on the butt or scalp

Micro: biphasic growth, with plexiform growth of dendritic melanocytes in sclerotic stroma and fascicles of fusiform melanocytes, ? no junctional component

IHC: s100, HMB-45 +

Back 11

Cellular blue nevus

Front 12

h/o previous nevus, new lesion within 1 year

Micro: atypical junctional component, dermal scar, b9 residual nevus at the base

Back 12

recurrent nevus

Front 13

melanoma

1. MC cancer in what age group?
2. what is the ABCD rule?
3.MC genetic abnormalities?
4.how do you measure breslow thickness?
5. prognostic indicators

6. variant with dermal fusiform component/ sarcomatoid looking (or may look low grade with mucin) and lymphocytes

Back 13

Melanoma

1. 25-29
2. asymmetry, border (irregular), color (varied), diameter (larger than 6mm)
3. del 9p, 10q, gain 7
4. from granular cell later to deepest extension (in mm)
5. Ulceration, mitotic rate, LVS invasion
6. desmoplastic

Front 14

elderly patient with flat pigmented macule on sun-exposed site that has been slowly growing.

Micro: Confluent dermal/epidermal junction with atypical melanocytes as single units

1. what if microinvasion in the dermis is found?

2. associated with hat other malignant skin lesion?

Back 14

Lentigo maligna

1. lentigo maligna melanoma

2. desmoplastic melanoma

Front 15

Basal cell CA

1. variants

Back 15

basal cell CA

1. sclerosing, morpheaform (retraction, aggresive growth, fibroblastic stroma

Front 16

patient with flesh colored firm papules on the face around the eyes, after puberty

Micro: small/circumscribed dermal proliferations in "tadpole/ comma" form with central lumen

1. derived form what tissue?

Back 16

Syringoma

1. eccrine gland duct

Front 17

patient with flesh-colored pauples on the face around nose, family history

Micro: basaloid tumor islands in the dermis that are interanastimosing "frond-like", with fibroblastic stroma and papilary mesenchymal bodies. may see primitive hair formation

1. variant with horned cysts?

Back 17

trichoepithelioma

1. desmoplastic trichoepithelioma

Front 18

patient with flesh colored nodules on the head, neck, and scalp, multiple

Micro: basaloid tumor islands that have a "jigsaw" pattern with dense BM around islands and hyaline droplets within. 2 cell types: outer round cells, inner polygonal cells.

Back 18

cylindroma

Front 19

what is the best (most sensitive and specific) immunostain for merkle cell?

Back 19

CK20- dot like pattern. Yes, also neuroendocrine.

Front 20

small nodule on neck or head of elderly patient

Micro: lesion c/o pleomorphic population of hyperchromatic stellate to spindled cells, mixed with epithelioid cells. Arrangement is RANDOM. atypical mitoses, background shows solar elastosis

IHC: vimentin, CD68, CD10

DX of exlcusion

1. how is this not MFH/pleomorphic undifferentiated sarcomas?

Back 20

atypical fibroxanthoma

1. anatomical distinction, AFX ONLY in dermis- no invasion- no subcutis

Front 21

flesh-brown colored papule on the head and neck of elderly person with hyperkeratosis

Micro: circumscribed, cup-shaped invagination of squamous epithelium, filled with keratin debris. Is ENDOPHYTIC.

Back 21

Warty diskeratosis

Front 22

Desmoplastic melanoma

Unique features:

1.
2.
3.

4. why commonly misdiagnosed?

Back 22

1. Presents like keloid in head/neck- is flesh colored
2. less likely to metastesize
3. more likely to locally recur

4. fusiform spindled cells without atypia- mistaken for dermal scar. Also may be HMB-45 -, should stain for S-100

Front 23

4mm or greater nevus with a "fuzzy" border

Micro: architectural disorder and cytologic atypia, also dermal fibrosis. However, both are mild, and there is NO pagetoid spread, and NO distruction of rete.

Back 23

dysplastic melanocytic nevus

Front 24

older man with stuck-on lesion on the trunk or head/neck


Gross: Exophytic, sharply demarcated, pigmented lesions that protrude above surface of skin, appear to be stuck to skin. Single or multiple, soft, tan-black, “greasy” surface

Micro: Acanthotic – most common, rounded verrucous surface; thick layer of basal cells mixed with horn cysts (contain keratin) and pseudohorn cysts (downgrowth of keratin into tumor mass); no prominent granular layer; some cells contain melanin due to transfer from neighboring melanocytes

Back 24

Seborrheic karatosis

Front 25

Skin changes in GVHD

A. Early
1.
2.
B. Late
1.
2.

Back 25

Skin changes in GVHD

A. Early
1. basal vacuolization
2. chronic inflammation
3. spongiosis and ancatholysis
4. follicular involvement
B. Late
1. acanthosis, hyperkaratosis, hypergranulosis
2. atrophy in chronic stage- like scleroderma

Front 26

Classic aunt-minnie

peripheral grooved ridge to see classic features
● Keratin-filled epidermal invagination with an angulated, parakeratotic tier (cornoid lamella)
● Epithelium deep to the tier is vacuolated and devoid of a granular cell layer
● Adjacent epithelium towards the center is either atrophic, normal thickness or acanthotic
● Dyskeratotic cells may be seen

Back 26

porokaratosis

Front 27

plaque and h/o scratching

Gross: Thick, scaly plaques with erythema, well demarcated from surrounding skin

Micro:
● Marked hyperkeratosis associated with foci of parakeratosis
● Prominent granular cell layer
● The epidermal rete are elongated and irregularly thickened
● Mild spongiosis
● Perivascular and interstitial inflammation with histiocytes, lymphocytes and occasional eosinophils in superficial dermis

Back 27

Lichen simplex chronicus

Front 28

Exophytic growth with marked hyperkeratosis, focal parakeratosis, papillomatosis resembling church spires
Prominent granular layer, koilocytosis, dilated vessels within papillary dermis

Back 28

verruca vulgaris

Front 29

raised annular lesion associated with morphea, chronic hepatitis C infection, autoimmune thyroiditis, secondary hyperparathyroidism, resolves spontaneously

Micro: Mid dermal necrobiotic collagen center surrounded by palisading histiocytes, as well as fibroblasts and lymphocytes

2. similar in deeper location, associated with adult and juvenile rheumatoid arthritis and rheumatic fever

Back 29

Granuloma annulare

2. rheumatoid nodule

Front 30

What is morphea?

Back 30

Localized scleroderma- thickening of dermal collagen pushing down subcutis, epidermal atrophy

Front 31

Tan-brown, red or skin colored, circumscribed lesions, sandpaper texture. May have cutaneous horn.

Micro:
Basal cell and squamous layer atypia and disorderly maturation, hyperkeratosis, parakeratosis. Usually no granular layer except at follicular orifices. Elastosis and often chronic inflammation of dermis. Follicular apparatus and intraepidermal sweat duct are spared. May have coexisting melanocytic atypia

Back 31

Actinic keratosis

Front 32

Pink to brown, flat or slightly raised plaque or nodule. Peripheral collarette of scale

Micro: Bland, intraepithelial tumor of clear keratinocytes with dermal inflammation and abrupt transition to normal epidermis. May have melanocytic proliferation, psoriasiform acanthosis, parakeratosis

Back 32

clear cell acanthoma

Front 33

Child with pink/brown papule on the trunk with a white clearing around it.

Micro:
non-pigmented melanocytic lesion in the dermis. Cells look atypical. Infiltrated by lymphocytes and macs. No fibrosis.

Back 33

Halo nevus