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67 Cards in this Set

  • Front
  • Back
Tumors of Dermis
Benign Fibrous Histiocytoma (Dermatofibroma)

-Dermatofibrosarcoma Protuberans
(DFSP)
Dermatofibroma
Benign indolent neoplasms of dermal fibroblasts and histiocytes
Usually seen in adults, typically on legs (where antecedent trauma may occur)
Tan-bown, firm papule (sometimes tender)
Lateral compression (i.e. squeezing will cause central dimpling)
Dermatofibroma Histology:
Nonencapsulated proliferation of spindle-shaped fibroblasts in dermis
May have numerous blood vessels and hemosiderin deposition (from prior trauma)
Dermatofibrosarcoma Protuberans (DSFP)
Well-differentiated slow growing fibrosarcoma that is locally aggressive but rarely metastasizes
Dermatofibrosarcoma Protuberans (DSFP) histology
Cellular neoplasm composed of radially oriented growth of fibroblasts with a storiform pattern, mitoses are present
Skin tumors derived from “cutaneous immigrants”
Mast cells -> Mastocytosis
Histiocytes--> Histiocytosis
Lymphocytes -> Lymphoma
Mastocytosis
Increase in the number of mast cells mast cell degranulation releasing histamine and heparin causing symptoms of:
a. Pruritis, flushing, rhinorrhea, dermal edema and erythema
b. Rubbing lesional skin makes a wheal (Darier’s sign), dermatographism
A form of mastocytosis that is localized to the skin with round to oval red-brown papules and plaques
Urticaria Pigmentosa
Urticaria Pigmentosa prognosis
Generally favorable prognosis occurring mainly in infants and children
- 10% of cases may proceed to systemic mastocytosis (usually adults) and has poorer prognosis
MASTOCYTOSIS Giemsa stain highlights
the granules within mast cells
Mycosis Fungoides (MF) or Cutaneous T Cell Lymphoma (CTCL)
Lymphoproliferative disorder that arises in the skin that eventually disseminates to lymph nodes and viscera
Usually affects patients >40 y/o
Mycosis Fungoides (MF) or Cutaneous T Cell Lymphoma (CTCL) lymphocytes affected become
Atypical lymphocytes with cerebriform nuclei (Sezary-Lutner cells) that are CD4 + (helper T cells)
Express T cell receptor (TCR) gene rearrangement and lose T cell antigens
Mycosis Fungoides (CTCL) has 3 stages
1. Patch stage
2. Plaque stage
3. Tumor stage
Mycosis Fungoides Patch stage:
Erythematous, scaling patches that may itch severely
-May remain at this stage for several years
Mycosis Fungoides Biopsy (Bx) for patch stage shows
lymphocytic epidermotropism (lymphocytes within epidermis) but diagnostic cells are not always present -> need to follow up with sequential bxs over time to make definitive dx (diagnosis)
Mycosis Fungoides (patch stage) common in
butt
Mycosis Fungides Lymphocytic epidermotropism
lymphocytes going upward into the epidermis
Mycosis Fungoides Pautrier’s
Microabscess
cluster of atypical lymphocytes within epidermis
Mycosis Fungoides . Tumor Stage:
Reddish brown nodules that ulcerate
Lymph node and visceral involvement occur in up to 70% of cases
Overall 5 year survival rate is less than 10%
Sezary’s Syndrome May be regarded as
leukemic form of Mycosis Fungoides
Erythroderma is generalized
Sezary cells are present in the blood
Sezary Syndrome can present in the face as
Lionine facies
Inflammatory Dermatoses
Urticaria

Eczema
Urticaria
Hives
Hereditary Angioneurotic Edema
Eczema
Atopic dermatitis
Seborrheic dermatitis
Allergic contact
Drug related
Photosensitvity
Urticaria (Hives)
Hypersensitive (IgE) response to an antigen
IgE dependent degranulation of mast cells leading to pruritic,edematous wheals
Urticaria (Hives) May be due to
antigenic exposure: pollen, foods, drugs, insect venom
May be due to nonantigenic stimulation: cold, heat, pressure, etc.
Several types of acute eczema (i.e. allergic contact, atopic, drug related, etc) that all have the same histology:
s
Fluid accumulation in epidermis-> intercellular edema or spongiosis->intraepidermal vesicles
- Dermal edema with maybe eosinophils, lymphocytes
-Overlying parakeratosis and sometimes serum crust
Types of Eczema
Allergic contact dermatitis
Atopic dermatitis
Seborrheic dermatitis
Drug-induced dermatitis
Photo-induced dermatitis
Allergic Contact Dermatitis
Delayed hypersensitivity (i.e. poison ivy, rubber, perfume, nickel jewelry etc.)
Allergic Contact Dermatitis Onset and pattern of rash distribution can be very helpful in
detecting the offending agent
Detailed history important, including :
Use of certain hygiene products,detergent,etc
Contact with certain garments and shoes
Occupational/environmental exposure
Seborrheic Dermatitis
Common, red, scaly, itchy rash
Seen in areas of oil production: scalp, sides of nose, eyebrows, behind ears, mid-chest
“Comes and goes”
May be seasonally aggravated, especially in northern climates
Erythema Multiforme (E.M.)
Self-limited hypersensitivity (cell mediated CD8 cytotoxic injury)
Erythema Multiforme (E.M.) due to:
Drugs (i.e. sulfamide, dilantin, barbituate, penecillin)
Infection (i.e.herpes, mycoplasma, )
Or idiopathic in 50% cases
Erythema Multiforme (E.M.) histological characteristic
bull’s eye targetoid, vesiculo-bullous lesions

typically involve extremeties (especially palms and soles)
E.M. Major (or Steve’s Johnson Syndrome)
Severe form of E.M. with mucous membrane involvement
Erythema Multiforme Toxic Epidermal Necrosis (TEN)
characterized by epithelial necrosis and sloughing of skin (analogous to burns)
Erthythema Multiforme E.M. Minor histology:
Focal basal keratinocyte degeneration (due to CD8 toxic injury) with eventual blistering
-Minimal perivascular lymphocytic infiltrates
T.E.N. histology:
Necrosis involving full thickness of epidermis
Panniculitis
Inflammation of subcutaneous fat
Panniculitis types
Erythema Nodosum
b.) Erythema Induratum (Nodular vasculitis
Most common form of panniculitis
Erythema Nodosum
Painful, tender nodules on lower anterior legs

3x more common on females

Age of onset ~ 15-30 y/o
Erythema Nodosum Etiologic agents
Infection (strep, herpes,fungal,etc)
Drugs (oral contraceptives, sulfonamides)
Immune associated (ulcerative colitis, sarcoidosis, etc)
Erythema Nodosum Histology:
Inflammation (occasional giant cells) and fibrotic thickening of fat septa
Chronic, pruritic skin disorder with silvery, scaling, salmon pink papules and plaques in a characteristic distribution:
Elbows, knees, lumbo-sacral area, glans penis, palms and soles
Psoriasis
psoriasis demonstrate
New lesions develop at sites of trauma (Koebner’s phenomenom=phenomenon may result from either a linear exposure or irritation)
Psoriasis Acute onset
Pustular Psoriasis
(Von Zumbusch Syndrome)
with fever, arthritis and pustular lesions
can be life threatening
Psoriasis Histology
Parakeratotic and hyperkeratosis
Acanthosis
Thinning of epidermis where it overlies dermal papilla
Stratum granulosum is thinned or absent
Psoriasis Histology shows Munro’s abscesses
- aggregates of neutrophils in epidermis
Psoriasis Auspitz sign”
removal of skin scale -> see tiny droplets of blood from the dilated blood vessels in dermal papillae
Nail changes in Psoriasis
Oil drop sign Pitting Onychodystrophy
Lichen Planus
Multiple, symmetrically distributed, Pruritic, Polygonal Papules -> Plaques
Lichen Planus Distributed on
wrist, shins, lumbar region, scalp alopecia
Lichen Planus May have mucosal involvement:
buccal mucosa, tongue, lip

Often highlighted by
a network of white lines i.e. Wickman’s striae
Serious autoimmune disease involving connective tissue and blood vessels

Exacerbated by sun (photosensitivity)

Can be drug induced
Lupus Erythematosus
Systemic - acute Lupus Erythematosus may show a
macular butterfly” rash
Discoid Lupus Erythematosus
Usually occurs in sun exposed areas

Sharply marginated scaly, atrophic, red plaques

Scalp -> patches of alopecia
Histology of Discoid Lupus Erythematosus
Lymphocytic infiltrates along D-E junction, around blood vessels and hair adnexae

Basal cell hydropic degeneration(vacuolization)

Epidermal atrophy with follicular plugging

Thickening of basement membrane
Lupus Erythematosus Pathogenesis
Immune complex mediated and cell mediated injury
Serology  circulating autoantibodies
(i.e. antiDNA), rheumatoid factor
Lupus Erythematosus Immunofluorescence
granular band of
Ig and complement along the D-E junction
(“Lupus Band” test)
Infectious Entities
Verruca (wart)
Molluscum contagiosum
Impetigo
Superficial fungal infection
Arthrpod related infections
Verruca (wart)
Benign epithelial hyperplasia manifesed by papules and plaques
Caused by Human Papilloma Virus (HPV)
Verruca (wart) Histology:
Hyperplastic, papillated epidermis with koilocytotic (viral) changes shown by :
Irregular nuclei surrounded by cytoplasmic halo
Prominent basophilc granules in cytoplasm
Molluscum Contagiosum
Discrete, umbilicated, pearly white papules may occir in neck, trunk, anogenital area, eyelids
caused by pox virus
Impetigo
Strep or Staph skin infection
Usually seen in babies, young children or sick adults
Sites: face, hands, trunk, intertriginous areas
Impetigo Histology:
Subcorneal pustules with
gram + cocci and neutrophils
Superficial Fungal Infection Dermatophytosis – Tinea
Caused by dermatophytes ( fungi that thrive only in nonviable keratinzed tissue (i.e. stratum corneum, nails, hair)
Scabies
Contagious, pruritic infection caused by sarcoptes scabei (female mite) burrows in stratum corneum  lays eggs and fecal matter
Involves interdigital skin (webs between digits), genital skin