Greenfield 4-17-08 Dermatopath Part 2

Front 1

3 Blistering Diseases

Back 1

Pemphigus Vulgaris
Bullous Pemphigoid
Dermatitis Herpetiformis

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Pemphigus Vulgaris histiologic hallmark

Back 2

Tombstoning of basal cells

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Points about pemphigus vulgaris

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blister that is within the epidermis
Spongiosis (may be eosinophils) in lower epidermis
Acantholysis ( loss of cohesion of epidermal cells) leads to formation of clefts, then blisters in suprabasal location
Basal keratinocytes remain attached to dermis like a “row of tombstones” but are separated from one another

Front 4

Characs of Bullous Pemphigoid

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Subepidermal cleft formation
Clefts do not contain
fluid
Multiple eosinophils in cleft
Separation of D-E junction

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clusters of urticarial papules, papulovesicles, and vesicles that are so intensely pruritic that they soon are scratched away, leaving in the wake erosions, ulcers, hemorrhagic crusts, and eventually pigmented macules and scars.

Back 5

Dermatitis Herpetiformis

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histo characs of Dermatitis Herpetiformis

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Collections of neutrophils and eosinophils in dermal papillae and in a subepidermal space
Microabsesses form with separation between the
papillae tips and the epidermis

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How is dermatitis herpetiformis dif from herpes

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itchiness

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2 dermal disorders

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Scleroderma
Erythema nodosum

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Hardening of the skin by virtue of thickening of bundles of collagen in the dermis and subcutis. May be localized or widespread.

Back 9

Scleroderma

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En Coup de Sabre

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type of linear scleroderma that presents on the frontal or frontoparietal scalp

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Points about scleroderma

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Thickening and sclerosis of the entire reticular dermis and dermal expansion.
Diminution of adnexal structures with only one eccrine unit being identified.
A cellular proliferation is not noted, nor is a significant inflammatory component present.
Epidermis is relatively unremarkable.

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Inflammatory process in sub Q fat aka. panniculitis

inflammation from septa into fat lobules

septa widen by granulomatous and fibrosing inflammation

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Erythema nodosum

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An inflammatory process, i.e., a panniculitis, marked by tender erythematous plaques, nodules, or tumors (or combinations thereof) that usually affect the anterior aspect of the legs and, less often, the arms.

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Erythema nodosum

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3 Viral Infections

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Verruca
Herpes
Molluscum Contagiosum

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Multinucleated giant cells. think what?

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Herpes

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profound degeneration of keratinocytes

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Acantholysis-

part of herpes lesion

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Ballooning degeneration-

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swelling of epidermal cells

part of herpes lesion

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what is Smear for herpes - See acantholytic balloon cells

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Tzanck Smear

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Molluscum contagiosum is caused by a ___ virus that has a predilection for infundibular epithelium. Nearly all of the cells involved contain large packets of virus called molluscum bodies. Those bodies are evidences histopathologically of millions of virions that have proliferated in the cytoplasm of affected epithelial cells. By microscopy it is apparent that only epithelium is infected by the virus of molluscum contagiosum. It is rare for molluscum contagiosum to appear on non-hair-bearing skin, such as a palm or sole.

Back 19

Molluscum contagiosum is caused by a pox virus that has a predilection for infundibular epithelium. Nearly all of the cells involved contain large packets of virus called molluscum bodies. Those bodies are evidences histopathologically of millions of virions that have proliferated in the cytoplasm of affected epithelial cells. By microscopy it is apparent that only epithelium is infected by the virus of molluscum contagiosum. It is rare for molluscum contagiosum to appear on non-hair-bearing skin, such as a palm or sole.

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Benign and Malignant Neoplasms

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Melanoma
Basal cell carcinoma
Squamous cell carcinoma
Seborrheic keratosis
Metastatic breast carcinoma
Paget’s disease of the breast

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Shiney, rolled border, sometimes telangectasia,

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basal cell carcinoma

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Histological description of squamous cell carcinoma

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Irregular masses of epidermal
Cells that proliferate downward
into the dermis

Number of atypical cells is
Higher in the more poorly
differentiated tumors

Atypical cells appear to originate from the basal layer and grow downward
as irregular cystic spaces

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Histological description of basal cell carcinoma

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Nodular masses of basaloid cells in the dermis

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Histological description of Metastatic Breast Cancer

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Invasion of dermis by groups and cords of tumor cells
Indian Filing is noted: tumor cells lie singly, or may form small groups or rows between fibrotic and thickened collagen bundles

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Histological description of Paget's disease

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See large scattered Paget cells which contain a large nucleus and ample cytoplasm
Epidermis becomes permeated with Paget cells

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Some description of Seborrheic Keratosis

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Horny invaginations appear as pseudo-horn cysts
On cross section
Hyperkeratosis, acanthosis, papillomatosis