Section 1
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cytophagic histiocyte panniculitis - lobular - beanbag cells - r/o CTCL
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Section 1
(50 cards)
cytophagic histiocyte panniculitis - lobular - beanbag cells - r/o CTCL
Oxalosis - Yellow-brown radially arranged refractile needle-shaped crystals - build up of serum oxalate can be primary or secondary (renal failure, ethylene glycol overdose)
Calcinosis Cutis - Dark, basophilic, brittle, often fractured deposits - juvenile DM
Calciphylaxis - dying fat w/ Ca deposits - irregular and diffuse - ESRD
Mast Cell - "fried egg" appearance with central round nucleus and surrounding oval bluish cytoplasm
Pancreatic panniculitis - Lobular panniculitis - Ca2++ soap outlining necrotic lipocytes - Ghost cells (shadows of fat cells)
EPP - pink, hyaline deposits around vessels in papillary dermis only - ferrochelatase (in mitochondria; normal urine porphyrins, check feces and blood)
Pretibial Myxedema - mucin with white space between collagen bundles (collagen becomes thin/attenuated) - full thickness of dermis - hyperthyroid
Fibroblast - Spindled (along collagen fibers) to stellate (star shaped-in myxoid areas) - nuclei are tapered, not blunt like smooth muscle - they are laying collagen around them
type of cells?
Histiocyte - epithelioid cell with central, round nucleus and surrounding cytoplasm
Alopecia/Follicular Mucinosa - Distorted hair follicle w/ lots of white space (check epi for atypical lymphs c/w MF) - white spaces filled with mucin and stain with Alcian blue CD3, CD4, CD7, CD8+
lichenoid drug - parakeratosis - hypogranulosis - superficial and deep PV infiltrate - eos
eos are present in the infiltrate
Subepithelial calcified nodule - acanthosis/PEH - small, localized fairly discrete calcified nodules w/in superficial dermis - may see transepidermal elimination of calcium
lichen nitidus - Claw-like down growth over dense, discrete infiltrate "ball and claw"
Scleromyxedema - upper dermis with funky/increased spindled fibroblasts - increased collagen - increased mucin - whorled - IgG lambda
colloid milia - large round pink glassy lobules w/ cracks, fissures in papillary dermis - result of extensive solar damage (will see solar elastosis) - Grenz zone
Myofibroblast - Loose interlacing fascicles of spindle cells with elongated cytoplasmic processes
type of cells?
lichen striatus - PD edema, mild spongiosis, focal parakeratosis; more colloids in epidermis than LP; w/ periadnexal inflammation
Lichen Amyloid - hyperkeratosis or acanthosis - pink amorphous material in papillary dermis surrounded by melanophages - MEN2a (Sipple), keratinocyte derived from scratching
Langerhans Cell - dendritic cells in the epidermis and dermis - nucleus is eccentric and kidney shaped
Fibroblast - Spindled (along collagen fibers) to stellate (star shaped-in myxoid areas) - nuclei are tapered, not blunt like smooth muscle - they are laying collagen around them
type of cells?
Smooth muscle cell - characterized by long, thin cigar- shaped nuclei with blunt ends - A paranuclear vacuole, represent- ing a glycogen "snack" for the muscle - Smooth muscle found as arrector pili muscles, in the walls of blood vessels, breast, and genital skin (periareolar or dartos muscle) - stains red on trichome stain along with keratin; collagen and bone are blue-green, and nuclei are black
type of cells?
gout - palisaded granuloma surrounding amorphous gray material with feathery clefts / cotton candy appearance
Subcutaneous fat necrosis of the newborn - lobular - crystals with clefting - mixed inflammatory infiltrate
lipoblast - immature fat cells that may have an eccentric nucleus (signet-ring lipoblasts) or have a central scalloped nucleus indented by lipid vacuoles (mulberry lipoblasts)
muciphage in mucocele - macrophages with engulfed mucin
Erythema Nodosum - septal panniculitis of neutrophils (acute) to histiocytes (chronic) - miescher's radial granulomas
lichen planopilaris - lichenoid infiltrate around follicle (isthmus) - follicular plugging
lipoid proteinosis - jagged DEJ - thick, finely lamellated "onionskin" around vessels, sweat glands - Eosinophilic hyaline deposits around blood vessels, sweat glands, and in thick bundles perpendicular to the surface (deeper and more extensive than EPP) - PAS+ and diastase resistent - ECM-1
Focal Cutaneous Mucinosis - focal, superficial, ill defined , papular mucin deposition - non-acral skin
Osteoma Cutis - bone formation within skin (bright, dense, pink trabeculae with nuclei, osteocytes) - primary: McCune alrbright - Secondary bone formation of a pre-existing lesion such as a pilomatricoma, chondroid syringoma, intradermal nevus (nevus of Nanta), acne scar, scleroderma, or dermatomyositis
Scleredema - very thick, pink reticular dermis - mucin in deep dermis - strep, IgG kappa, IDDM
Mucocele - Pseudocystic space containing mucin - Muciphages and granulation tissue surround the space
nephrogenic systemic fibrosis - increased fibroblasts (CD34+), collagen, and mucin; deep - exposure to gadolinium in renal failure patients
Lupus panniculitis - hyalizing fat necrosis - lymphoid follicles - ++ mucin - lobular - interface changes
Lipodermatosclerosis - deep fibrous thickening - stasis changes - pseudomembranous fat necrosis (feathery projections) of adipocytes - "arabesquing"
Neutrophil - multilobed nucleus
Scleromyxedema - upper dermis with funky/increased spindled fibroblasts - increased collagen - increased mucin - whorled - IgG lambda
necrolytic migratory erythema (glucagonoma), pellagra - pale vacuolated keratinocytes in upper epidermis with necrosis - psoriasiform hyperplasia w confluent parakeratosis
Nodular Amyloid - large pale pink fissured masses - plasma cells - AL amyloid, IgG lambda
Erythema Induratum - lobular - granulomatous panniculitis w/ Ig vessel vasculitis - caseation necrosis - MNGCs
Scrotal Calcinosis - rugose epi - smooth muscle - large calcified "rock"
nephrogenic systemic fibrosis - increased fibroblasts (CD34+), collagen, and mucin; deep - exposure to gadolinium in renal failure patients
Plasma cell - eccentric nucleus with "'clock face" - perinucleuar pale space corresponds to rough endoplasmic reticulum
Lupus panniculitis - hyalizing fat necrosis (upper arrow) - lymphoid follicles - ++ mucin - lobular (lower arrow) - interface changes
Macular Amyloid - pink fluffy deposits in the papillary dermis/dermal papillae - no Granz - MEN2a (Sipple), keratinocyte derived from scratching
Eosinophil - bilobed nucleus with granular cytoplasm
lichen planus - band like lymph infiltrate - saw tooth acanthosis - wedge shaped hypergranulosis - no parakeratosis
Lymphocyte - round dark nucleus with no visible cytoplasm
gout - palisaded granuloma surrounding amorphous gray material with feathery clefts / cotton candy appearance
Section 2
(50 cards)
pemphigus vulgaris - Row of tombstones; acantholytic cells in blister; follicular involvement; eos
LSC - Vertical streaking of collagen in PD; irregular psoriasiform hyperplasia; hypergranulosis; +/- focal parakeratosis; "hairy palm" sign = resembles acral skin but w follicles
keratin granuloma - Granulomas, giant cells, clefts with pink material inside - Giant cells surrounding this
DLE - Most infiltrate of LEs; hyperorthokeratosis including follicles w/ follicular plugging; super & deep PV & periadnexal infiltrate (unlike LPP); atrophic epidermis w BM thickening • Lymphoid aggregates within the eccrine coil • Vertical columns of lymphocytes within fibrous tract remnants - Immunofuorescence (lupus band test) reveals granular deposits of IgM, IgG, and complement at the dermal- epidermal junction.
linear IgA - PMNs lining DEJ
miliaria rubra - Spongiosis focally involving acrosyringium
erythema multiforme - Marked basal layer vacuolization w/ spongiosis, PD edema w/ subepidermal separation; satellite cell necrosis w/ colloids all the way up; obscured DEJ; zonal changes;
PCT - subepidermal, cell poor blister w/ festooning; caterpillar bodies - thick vessels
DM - epidermal atrophy with thick BMZ - abundant dermal mucin (white and whispy) - perivascular infiltrate - basal layer vacuolization
DLE - basal layer and follicular (adnexal) vacuolization - Most infiltrate of LEs; hyperorthokeratosis including follicles w/ follicular plugging; atrophic epidermis w BM thickening • Lymphoid aggregates within the eccrine coil • Vertical columns of lymphocytes within fibrous tract remnants - Immunofuorescence (lupus band test) reveals granular deposits of IgM, IgG, and complement at the dermal- epidermal junction.
Bullous Impetigo -Subcorneal bulla -Acantholysis in granular layer - Staph phage II type 71 with Exfoliative toxin A/B
PLC - Less dense, more superficial infiltrate than PLEVA
Prurigo nodularis - hyperkeratosis - hypergranulosis - inward pointing hyper plastic rete ridges - perivascular lymphocytic infiltrate - like a wart but with no koilocytes
paraneoplastic pemphigus (PV + EM) • Dermal in ltrate of lymphocytes which is often heavy and band-like ("lichenoid") • Interface reaction with necrotic keratinocytes and vacuolar change • Intraepidermal acantholysis; Subepidermal clefting is possible, though less common • periplakin and envoplakin are most common antigens (also desmoplakin, BPAG1, plectin) • NHL, CLL, Castlemans, thymoma
fixed drug eruption - Like EM, but deeper infiltrate (super & deep PV), more polymorphous infiltrate (eos); more prominent pigment incontinence - acute stratum corneum with chronic dermal changes (pigment incontinence and fibrosis)
seborrheic dermatitis - Mildly psoriasiform; shoulder parakeratosis - more spongiosis than psoriasis, affecting infundibulum
stasis dermatitis - Mild spongiosis; dermal proliferation of thick walled vessels in PD(cannon ball); abundant hemosiderin throughout dermis; thick veins in deep dermis, SQ; variable fibrosis
sarcoid - naked granulomas (few surrounding lymphocytes)
TEN - Subepidermal, cell-poor blister w/ necrotic roof
Darier's Dz corps ronds, grains, ATP2A2 Corps ronds, characterized by small pyknotic nuclei, peri- nuclear halo, and eosinophilic cytoplasm, are present in the upper epi- dermis. Grains are small, oval cells with dark elongated nuclei and scant cytoplasm located in the corneal layer.
IgA pemphigus/subcorneal pustular dermatosis of sneddon wilkinson - subcorneal w/ PMNs - IgA has DIF+ and SW has DIF- - IgA pemphigus requires SPEP
infiltrate contains PMNs
PR - Subacute spongiotic dermatitis - mounding parakeratosis at 45 degree angle to spongiosis - Erythrocyte extravasation - Transepidermal elimination of erythrocytes
geographic tongue
Darier's dz - Lots of dyskeratosis (corps ronds, grains); hyperkeratotic plugs; clefts>blisters; suprabasal acantholysis; extends down follicles - ATP2A2 gene encodes SERCA2 on chromosome 12q23
bullous SLE - subepidermal bullae with neutrophils (not lymphocytes) - antibodies to type VII collagen
allergic contact dermatitis - Spongiosis mostly in lower epidermis, +/- vesiculation; PV infiltrate w/ lymphs, mφ's, few eos
Staph Scalded Skin - superficial acantholysis - sparse inflammation - Staph phage II with Exfoliative toxin A/B
GVHD • Subacute (fairly compact) stratum corneum • Vacuolar interface dermatitis • Necrotic keratinocytes • Epithelial atypia and disorder
HH - Dilapidated brick wall; lots of pacantholysis - full thickness; no follicular involvement; multifocal - ATP2C1 gene encodes SPCA1 (golgi pump for Ca2+) on chromosome 3q21-24
nummular dermatitis - spongiosis +/- mounding parakeratosis
Zion's balanitis - lichenoid infiltrate with numerous plasma cells
LE • Interface change usually vacuolar (out of proportion to lymphocytes) • Compact hyperkeratosis, follicular hyperkeratosis • Basement membrane zone thickening • Melanin pigment incontinence (melanoderma) • Perivascular lymphoid aggregates • Dermal mucin between collagen bundles • Immunofuorescence (lupus band test) reveals granular deposits of IgM, IgG, and complement at the dermal- epidermal junction.
pemphigus foliaceous - Acantholysis high granular layer; mixed infiltrate w/ PMNs; subcorneal blister w/ dyskeratosis, esp at granular layer; "cling-ons" on blister roof
PRP - "Checkerboard" and shoulder parakeratosis; mild acanthosis, broad rete ridges, thick suprapapillary plates, hypergranulosis; +/- follicular plugging
spongiotic drug rxn - Spongiotic w/ lymphs, occas eos, rare Civatte bodies; infiltrate extends deeper (mid-dermis); may see RBCs in upper dermis
DH - PMNs stuffing the papillae
irritant contact dermatitis - Marked ballooning of kt's in upper epidermis; neutrophilic
Grover's Disease (transient acantholytic dermatosis) - Small foci of suprabasilar acantholysis (typically not as extensive as HH), but may also have foci or spongiosis or pacantholysis without dyskeraotisis (like PV) - may have dyskeratotic keratinocytes (like Darier's), although eosinophils will help differentiate - perivascular lymphocytic infiltrate - negative DIF
ILVEN • Variable acanthosis • Stratum corneum with alternating orthokeratosis and parakeratosis • Parakeratotic areas have no granular layer • Orthokeratotic areas have a granular layer
LE • Interface change usually vacuolar (out of proportion to lymphocytes) • Compact hyperkeratosis, follicular hyperkeratosis • Basement membrane zone thickening • Melanin pigment incontinence (melanoderma) • Perivascular lymphoid aggregates • Dermal mucin between collagen bundles • Immunofuorescence (lupus band test) reveals granular deposits of IgM, IgG, and complement at the dermal- epidermal junction.
AGEP - Intracorneal; super and deep PV infiltrate; more spongiotic than pustular psoriasis; often w eos
infiltrate contains some eos
pustular psoriasis - intracorneal neutrophilic pustules, mild acanthosis early
neutrophils
bullous pemphigoid - subepidermal with eos - BPAg1 and BPAg2 (230 kD and 180kD, respectively)
*there are eos
DLE - Most infiltrate of LEs; hyperorthokeratosis including follicles w/ follicular plugging; super & deep PV & periadnexal infiltrate (unlike LPP); atrophic epidermis w BM thickening • Lymphoid aggregates within the eccrine coil • Vertical columns of lymphocytes within fibrous tract remnants - Immunofuorescence (lupus band test) reveals granular deposits of IgM, IgG, and complement at the dermal- epidermal junction.
pustular psoriasis - sub corneal neutrophilic pustules, mild acanthosis early
neutrophils
psoriasis - Regular psoriasiform hyperplasia, clubbing of rete ridges, hypogranulosis, thin suprapapillary plates w/ underlying dilated capillaries; Munro microabscesses (intracorneal PMNs), spongiform pustules of Kogoj (PMNs in spinous layer); parakeratosis, mounding early, confluent later
syphilis -psoriasiform hyperplasia -Super & deep PV infiltrate; plasma cells; heavier lichenoid infiltrate than LEs
tumid lupus (indistinguishable from reticular erythematous mucinosis) - superficial and deep lymphocytic infiltrate - basal layer vacuolization (subtle to absent) - mucin - no epidermal change
PLEVA - Obscuring of DEJ; lichenoid and spongiotic w/ lymphs "walking" up through epidermis; lots of dyskeratotic cells; super & deep PV infiltrate(unlike CTCL, PR); parakeratosis, RBCs in epidermis; may see central ulceration, wedge-shaped infiltrate
DLE - Most infiltrate of LEs; hyperorthokeratosis including follicles w/ follicular plugging; super & deep PV & periadnexal infiltrate (unlike LPP); atrophic epidermis w BM thickening • Lymphoid aggregates within the eccrine coil • Vertical columns of lymphocytes within fibrous tract remnants - Immunofuorescence (lupus band test) reveals granular deposits of IgM, IgG, and complement at the dermal- epidermal junction.
Section 3
(50 cards)
pernio - Tight PV lymphoid infiltrate (super & deep); prominent PD edema; acral skin
porokeratosis - coronoid lamellae - vacuolar change below epithelial indentation
EAC (erythema annulare centrifugum) - Prototypical super & deep PV coat-sleeve infiltrate; +/- focal parakeratosis
NXG - Broad zones of necrobiosis; cholesterol clefts; foamy histios, florid giant cells, including Touton - IgGk
Reticulohistiocytoma • Sea of histiocytes in dermis • Each histiocyte often sits in a punched-out lacuna • Cytoplasm of histiocyte is two-toned with darker and lighter areas (dusty rose or ground glass cytoplasm) • Binucleate and multinucleate cells occur - solitary has no association with malignancy, multi centric has 25% association with malignant and also association with arthritis
well's syndrome - flame figures (eosinophile degranulation onto collagen)
cryoglobulinemia - vessels occluded with pink jelly substance - erythrocyte extravasation
PG (pyoderma gangrenosum) - Sea of PMNs w/ necrotic, undermined ulcer edge; tight PV infiltrate at advancing edge
PMLE - superficial and deep perivascular lymphoid inflammation - papillary dermal edema - spongiosis
NLD - tiramisu (horizontal orientation of sclerosis alternating w/ necrobiotic granulomas); super and deep PV infiltrate w/ plasmas (look where dermis meets fat); square punch bx
Rosai Dorfman • Fibrotic nodules • Sheets of lymphocytes and very large histiocytes • Emperipolesis (intact cells, especially lymphocytes and plasma cells, passing through histiocytes) • plasma cella • S100-positive, CD1a-negative, CD68+
artheromatous emboli - arteriole containing cholesterol cleft
Degos • Wedge-shaped super cial and deep perivascular lymphoid in ltrate with vascular damage • Over time, central epidermal depression and atrophy, avascular necrosis of dermal structures, and marked dermal mucinosis
granuloma annulare, perforating - transepidermal elimination of degenerated collagen and mucin through a canal in the epidermis.
Chondroma - circumscribed mass of mature hyaline cartilage - single or grouped chondrocytes in lacunae
NXG - Broad zones of necrobiosis; cholesterol clefts; foamy histios, florid giant cells, including Touton - IgGK
Tumid Lupus - perivascular lymphoid inflammation - lymphocytes in eccrine coil - dermal mucin
CDNH (chondrodermatitis nodularis helices) - Ulcer or erosion with adjacent acanthosis overlying a zone of fibrin (necrotic elastic cartilage) - Fibrin is flanked on either side by granulation tissue
Sweet's syndrome - marked papillary edema - nodular and diffuse infiltrate of neutrophils with karyorrhexis - focal LCV
ichthyosis vulgaris - compact hyperkeratosis - no granular layer - fillagrin
epidermolytic hyperkeratosis (EHK) - "church spire" hyperkeratosis - granular and vacuolar change in granular and spinous layer - K1, 10
sarcoid - naked granulomas (few surrounding lymphocytes)
Langerhans Cell Histiocystosis Polymorphous in ltrate with prominent edema and hemorrhage • Reniform (kidney bean-shaped) nuclei • Folliculotropism common in acute type • S100-positive, CD1a-positive, peanut agglutinin- positive, langerin positive
Chordoma - lobules separated by fibrous bands - sheets, cords, or individual cells in chondroid stroma - abundant pale bubbly cytoplasm (physaliphorous) - no lacunae-like chondroma or ducts like chondroid syringoma - from the notochord; S100, vimentin, and keratin+
Relapsing polychondritis - cartilage with neutrophilic infiltrate in the surrounding perichondrium - DIF: granular band of IgG/A/M and C3 (full house) in the perichondrium - anti-collagen II
granuloma annulare - necrobiotic; upper 1⁄2 of dermis, mucinous degeneration; PV infiltrate (super and mid)
LCV - superficial vessels w/ fibrinoid necrosis - PMNs w/in vessel wall - karyorrhexis (nuclear dust, leukocytoclasis) - hemorrhage
JXG • Early: sea of histiocytes in the papillary and reticular dermis • Later: wreath giant cells appear • Late: lipidized histiocytes and Touton giant cells • Secondarily in amed with lymphocytes and eosinophils • Eye and lung are common extra-cutaneous areas
+ Touton cells
acanthosis nigricans - Hyperkeratosis, papillomatosis, mild acanthosis; finger-like dermal papillae w/ thinned overlying epidermis w/ "valleys" in between
pigmented purpuric dermatosis (Schambergs) - inflammation purely lymphoid - surrounds capillaries - erythrocyte extravasation + in epidermis - hemosiderin
granulomatous rosacea - follicular plug - Lymphocytic spongiosis of epidermis w/ granulomatous inflammmations, including giant cells and plasma cells
rheumatoid neutrophilic dermatosis
Morphea - rectangular punch - closely packed hyalinized collagen in lower dermis and extending to the fat - trapped eccrine glands
atrophie blanche (livedoid vasculopathy) • Hyalinized vessel walls • Thrombi • Cannon-ball tufting of vessels often present in super cial dermis (stasis change)
Eosinophilic Fasciitis - sclerotic changes below the fat and in septae - thick eosinophilic fascia - mixed infiltrate - peripheral eosinophilia
artheromatous emboli - arteriole containing cholesterol cleft
rheumatoid nodule -"Fiery red" homogenous, necrobiotic center; most palisaded; often no skin (r/o gout, suture granuloma) - often in the deep reticular dermis (indistinguishable from deep GA)
Reticulohistiocytoma • Sea of histiocytes in dermis • Each histiocyte often sits in a punched-out lacuna • Cytoplasm of histiocyte is two-toned with darker and lighter areas (dusty rose or ground glass cytoplasm) • Binucleate and multinucleate cells occur - solitary has no association with malignancy
urticaria - Superficial dermal vessels filled with neutrophils; also interstitial neutrophils - may see eosinophils - may have dermal edema - no lCV
PMLE - superficial and deep perivascular lymphoid inflammation - papillary dermal edema - spongiosis
Rosai Dorfman • Fibrotic nodules • Sheets of lymphocytes and histiocytes • Emperipolesis (intact cells, especially lymphocytes and plasma cells, passing through histiocytes) • S100-positive, CD1a-negative, CD68+
granuloma faciale - grenze zone - LCV with eosinophils - onion skin fibrosis - no granulomas
granuloma faciale - grenze zone - LCV with eosinophils - onion skin fibrosis - no granulomas
EAC (erythema annulare centrifugum) - Prototypical super & deep PV coat-sleeve infiltrate; +/- focal parakeratosis
granuloma annulare, interstitial - interstitial macrophages - perivascular lymphocytic infiltrate - no palisading or necrobiosis
lichen aureus - normal epidermis - lichenoid lymphocytes - extravasated rbcs
EED (erythema elevatum diutinum) - LCV - onion skin fibrosis with interspersed neutrophils / extracellular cholesterolosis - IgA gammopathy, IBD, HIV
PAN - large artery involved in deep dermis - acute with neutrophilic infiltrate/chronic may be granulomatous - fat necrosis - IBD, SLE, HBV, strep
granuloma annulare - necrobiotic; upper 1⁄2 of dermis, mucinous degeneration; PV infiltrate (super and mid)
EED (erythema elevatum diutinum) - LCV - onion skin fibrosis with interspersed neutrophils / extracellular cholesterolosis - IgA gammopathy, IBD, HIV
Section 4
(50 cards)
clear cell acanthoma - discrete acanthoma with overlying parakeratosis - distinct transition between normal epidermis and clear cells in the stratum corneum - peppered with neutrophils
Trichothiodystrophy - tiger tail - PIBIDS (ERCC2)
nodular BCC - blue islands - peripheral palisading - high nuclear/cytoplasmic ratio - retraction artifact - fibromyxoid stroma
Normal scalp - at this level, through the mid-dermis near the isthmus, arrangement of pilosebaceous structures into "follicular units" is apparent.
Folliculitis Decalvans • Suppurative folliculitis • Wedge-shaped scar with elastic stain (similar to LPP)
Pseudopelade • Shrunken deep red dermis • Broad "tree trunk" fibrous tract remnants • Preserved elastic sheath • Thick elastic fibers in dermis
- terminal follicle, defined by a hair shaft diameter that is 0.06 mm or greater (top). - The vellus hair (lower right) is readily identifiable by a shaft diameter that is equal to or less than the thickness of the inner root sheath (≤0.03 mm). - An intermediate hair (lower left) has a shaft diameter that is between the other two.
LS&A (lichen sclerosis et atrophicus) - red (compact stratum corneum) - white (papillary dermal pallor) - blue (lymphoid band beneath zone of pallor) - antibody to ECM-1
Trichotillomania - Empty hair "ducts"; +/- hemorrhage; no inflamm'n; pigmented follicular hair casts in infundibulum called "trichomalacia", clefting at base of follicle - increased catagen follicles characterized by apoptotic keratinocytes
Warty Dykeratoma • Endophytic growth • Acantholytic dyskeratosis • Overlying parakeratotic crust may be present
Scar • Fibroblasts with east-west orientation • Blood vessels with north-south orientation • Loss of elastic tissue • Epidermis is often effaced
Pattern alopecia - miniaturization of follicles with variability in diameter - In vertical sections, hairs extend to variable depths, inproportion to their diameter - Decreased anagen/telogen ratio - Many fibrous tract remnants with normal diameter and vascularity
epidermolytic acanthoma - crateriform - epidermolytic hyperkeratosis
Hidradenitis Suppurativa Dermal folliculocentric abscess w/ many apocrine glands
sBCC - multifocal blue buds - distinctive fibromyxoid stroma displaces solar elastosis downward - retraction artifact
EPS (elastosis perforans serpiginosa) - Tortuous channel through an acanthotic epidermis with extrusion of altered elastic fibers - Large bulky red elastic bers - elastic tissue stains shows increased thick elastic fibers in the channel
adenoid/reticulated SK - reticular (lace like) configuration of epidermis with interspersed horn cysts
Cutis Laxa - no elastic tissue at all - fibula 5, elastin, ATP7A (FAR EAD AxelRod)
Hyperkeratotic SK - tall stacks of loose lamellar shredded wheat keratin - papillomatosis - church spire appearance
AA (alopecia areata) - lymphoid inflammation at level of hair bulb "swarm of bees" - lymphocytes within fibrous tract remnants - eosinophils within fibrous remnants - melanin within fibrous tract remnants
elastofibroma dorsi - large fibrous tumor - elastin deposits throughout tumor - beaded elastic fibers
anagen (clear inner root sheath), catagen (thick basement membrane), telogen (wrinkling of inner root sheath)
IFK (inverted follicular keratoma) - upside down SK - endophytic lesion resembling an expanded hair follicle - squamous eddies
Hypertrophic Scar - Whorled proliferation of fibroblasts and blood vessels
Acanthotic SK -broad sheets of small polygonal keratinocytes with intervening horn cysts - loose lamellar "onion skin" keratin - commonly pigmented
elastofibroma dorsi - String of pearls/ round balls in dermis; no epidermis, big bx
cystic BCC - cystic space within tumor nodules, usually due to necrosis or mucin production.
fibroepithelioma of Pinkus - pink strands, blue buds - fine net-like basaloid cells - ample fibromyxoid stroma
Kyrle's disease - plugged perforating channel - collection of neutrophils - altered connective tissue
trichorrhexis invaginata - bamboo or ball and socket - Netherton (SPINK5)
catagen follicles - eosinophilic membrane and absent hair shaft; may see apoptotic cells
Acne keloidalis - Hypertrophic scar (not keloid) - Suppurative folliculitis with hair shafts free in the dermis - Plasma cell infiltrate
Monlithrix - beads - Hb1, 6 (or K81, 86)
ILVEN (inflamm linear verrucous epidermal nevus) - acanthosis - stratum corneum with alternating ortho (have a granular layer) and parakeratosis (have no granular layer)
Trichotillomania - Empty hair "ducts"; +/- hemorrhage; no inflamm'n; pigmented follicular hair casts in infundibulum called "trichomalacia", clefting at base of follicle - increased catagen follicles characterized by apoptotic keratinocytes
clonal SK - nests of clonal, monomorphous, typical keratinocytes - no ducts to separate from hidroacanthoma simplex
PXE (pseudoxanthoma elasticum) - party in the dermis - thick purple elastic fibers scattered throughout the dermis (or black fibers on VVG stain for elastic fibers, or von Kossa) - ABCC6
neutrophilic eccrine hidradenitis - neutrophils within eccrine coil - cytarabine
EPS 2/2 penicillamine - "Bramblebush" elastic tissue (test tube cleaner)
micronodular BCC - small basaloid nodules
Trichorrhexis nodosa - thick weak areas - trauma, argininosuccinic aciduria, Menkes' kinky hair syndrome, Netherton's syndrome, hypothyroidism, or trichothiodystrophy
PXE (pseudoxanthoma elasticum) - party in the dermis - thick purple elastic fibers scattered throughout the dermis (or black fibers on VVG stain for elastic fibers, or von Kossa) - ABCC6
Telogen Effluvium - increased telogen hairs (eosinophilic wrinkling of inner root sheath)
Anetoderma - normal H&E - loss of elastic fibers in superficial and mid dermis on Verhoeff-van Gieson (note loss of black fibers on left as compared to right)
Acne vulgaris - Infundibulum filled with laminated keratin and debris - Suppurative inflammation may be present
Irritated SK - squamous eddies - spindled keratinocytes - horn cysts - keratin becomes compact, eosinophilic, parakeratotic
Elastoma/Nevus elasticus - focally increased elastic tissue
Keloid - Whorled proliferation of fibroblasts and blood vessels - Broad, hyalinized, eosinophilic "bubble gum" collagen fibers
Tinea Capitis • Mixed inflammatory infiltrate, neutrophils present, eosinophils variable • Fungal spores within or surrounding hair shaft • MCC T. tonsurans
acantholytic acanthoma - acanthoma composed on bland keratinocytes - acantholysis
Section 5
(50 cards)
Lichenoid AK - Crowding, disorder, and atypia of epidermal keratinocytes - prominant lichenoid infiltrate
Vellus Hair Cyst - Wall resembles that of an epidermoid cyst - Many small vellus hairs within the cyst - Frequently arise in an eruptive fashion
Eccrine Hydrocystoma - 2 cuboidal cell layers; unilocular; "snooting"
Sebaceous Hyperplasia - Large cluster of sebaceous glands around a patulous follicular opening
Brachial Cleft Cyst - Epidermoid or pseudostrati ed columnar epithelium - Lymphoid tissue with germinal centers surrounding the cyst - Cyst usually appears empty
Aprocine Cystadenoma - 2 flattened cell layers; multi- or uni- locular; decapitation secretion - Schopf-Schulz-Passarge
Bronchogenic Cyst • Ciliated pseudostratifed columnar epithelium • Goblet cells • May have circumferential smooth muscle around cyst • May have cartilage
Pigmented spindle cell nevus of Reed - hyperkeratosis, hypergranulosis - vertically oriented nests along rete (bananas on a tree) with clefting - kamino bodies variable - small spindled cells - symmetric with sharply defined laterally - buckshot scatter only in the center
Sebaceoma reatly incr # layers blue basaloid cells (more than clear, ie <50% sebocytes); more haphazard maturation; still w/ duct form'n Muir Torre (MLH1, MSH2)
Pilar Cyst/Trichilemmal Cyst - Abrupt keratinization without a granular layer - Deeply eosinophilic dense keratin - Focal calci cation of contents common - Typically on scalp
Bowen's disease - full thickness atypia with loss of normal maturation (wind blown pattern), commonly involves follicle - malignant horn typically present - atypical cells in intraeepidermal buckshot or nested pattern
Sebaceous Adenoma Incr # layers blue basaloid cells (less than clear, ie >50% sebocytes); sharply circ'd seb lobules w/ CT septae, orderly maturation Muir Torre (MLH1, MSH2)
Keratoacanthoma - keratin filled crater - pale eosinophilic epithelial proliferation extends over crater
Balloon cell nevus - balloon cells - sharply defined - well nested at DEJ - matures and disperses
actinic keratosis - crowding, disorder, and atypia of epidermal keratinocytes (have enlarged hyperchromatic nuclei) - arises from basal layer - solar elastosis
Sebaceous Carcinoma May be predominantly red or blue at scan • Atypia and mitoses common • In ltrative border may be apparent • Foamy cells with scalloped nuclei • Atypical cells may extend into the epidermis or conjunctiva in a nested or buckshot pattern Muir Torre (MLH1, MSH2)
Deep penetrating nevus - not dendritic (spindled?) (vs blue nevus)
Spindled SCC - atypical spindled cells abutting the epidermis
Epidermoid Cyst/EIC/Infundibular • Lining resembles the surface epidermis (w/ granular layer), but with no adnexal structures • Loose lamellar "onion-skin" keratin within the cyst
Acantholytic AK - crowding, disorder, and atypia of epidermal keratinocytes - acanthoylsis in areas of atypia
sebaceous carcinoma - collection of atypical foamy cells with scalloped nuclei - mitosis Muir Torre (MLH1, MSH2)
SCC perineural invasion
actinic keratosis - focal parakeratosis above atypical keratinocytes - attenuation of granular layer
keratotic BCC - basaloid tumor with horn cysts or other follicular differentiation
Hypertrophic AK - Crowding, disorder, and atypia of epidermal keratinocytes - prominant overlying malignant horn
verrucous carcinoma - well differentiated glassy squamous epithelium - rounded border - HPV 6, 11
Pigmented Follicular Cyst
Acral nevus - pigmented parakeratosis over the dermatoglyphic furrows. - "Furrows are fine, ridges are risky", meaning that pigmented parakeratosis in the peaks of the ridges is more often seen with melanoma.
Recurrent Nevus - confluent, poorly nested, or irregularly nested - underlying scar - melanocytic proliferation confined to area overlying the scar
pigmented BCC - melanin and melanocytes within tumor
Nevus Sebaceous - enlarged sebaceous glands high in the dermis - Dilated apocrine glands in underlying dermis - Hyperkeratosis, acanthosis, and papillomatosis common - Secondary tumors, especially syringocystadenoma papilliferum and small trichoblastomas, are common
Thyroglossal Duct Cyst • Midline of neck • Typically lined by respiratory-type epithelium • May be lined by squamous epithelium • Surrounding thyroid follicles and lymphoid aggregates may be present
Spitz Nevus - hyperkeratosis, hypergranulosis - vertically oriented nests along rete (bananas on a tree) with clefting - kamino bodies - large spindled and epithelioid cells - symmetric with sharply defined laterally - buckshot scatter only in the center NK1/C-3, MART-1, S100 +; HMB45 inconsistent; CD68 -
Digital mucous cyst/myxoid cyst - acral skin - well circumscribed mucin (bluish) - not a true cyst (no epithelial lining)
Cutaneous Ciliated Cyst • on lower extremities • Debris- lled cyst • Lining variable
SCC - atypical keratinocytes invading the dermis - acantholysis and desmoplasia may be present
Median Raphe • Midline along anogenital raphe • Debris- lled cyst • Lining variable
Benign Nevus - well nested a DEJ -matures (melanocytes become smaller and spindled) - disperses at base - no deep mitoses - no deep pigment in melanocytic nests
infundibulocystic BCC - pink strands of squamous epithelium with blue basaloid buds at the tips of the strands, and horn cysts. - BCC differentiates toward follicular infundibulum - resembles basaloid follicular hamartoma
Lentigo Simplex (Lentigines) - pigmented basal layer - no solar elastosis
Steatocystoma • Wavy, eosinophilic "shark's-tooth" cuticle • Sebaceous glands in cyst wall • Oily contents, frequently containing vellus hairs • PC2 (6b/17)
Basosquamous cell carcinoma. - basaloid tumor with squamoid proliferation and keratin
Auricular Pseudocyst - Intracartilaginous space without true lining
Proliferating Trichilemmal Cyst • Rolls and scrolls • May form small new cysts within the con nes of the mother cyst • Trichilemmal keratinization
sclerosing/morpheaform BCC - thin strands of invasive basaloid cells in a fibrotic stroma.
SCCis - bowenoid papule variant - SCCis with more pigment
Halo Nevus - band like lymphoid infiltrate through the lesion (lymphocytes mixing with melanocytes) - melanomas have a band of lymphocytes (like there is a wall) - well nested at DEJ, matures, disperses, no deep mits or pigment
lymphocytes mixing with melanocytes
Solar lentigo - thin rete with bulbous tips dipped in chocolate - often solar elastosis
Dermoid Cyst - Wall commonly resembles that of an epidermoid cyst - Adnexal structures within cyst wall (terminal hair follicles, sebaceous glands, eccrine glands, and apocrine glands)
Kamino body of spitz nevi - made of basement membrane?
Section 6
(50 cards)
Cylindroma • Islands of blue cells with little cytoplasm • Dark and pale blue nuclei present • Jigsaw-puzzle pattern • Islands outlined by a deeply eosinophilic basement membrane • Deeply eosinophilic hyaline droplets may be noted in islands • Often inherited and multiple on the scalp (Brooke Spielgler, CYLD)
Neurotropic melanoma - variant of desmoplastic melanoma; fascicles of tumor invade nerves
Papillary "eccrine" adenoma (tubular apocrine adenoma) • No true distinction between papillary eccrine adenoma and tubular apocrine adenoma • Differentiation towards both secretory segment and duct • Dilated duct-like spaces • Blue papillary projections into spaces variable
Syringocystadenoma Pappilliferum • Opens to surface • Blue papillary fronds extending upward into clear spaces: "fjords and fronds" • Decapitation secretion • Plasma cells
Becker's Nevus - pigmented epidermis with underlying smooth muscle
Cutaneous Lymphadenoma • Tumor islands with 1-2 layers of basaloid cells peripherally • Centers of each island composed of clear cells/ in ammatory cells
perineurial invasion by melanoma
Dysplastic Nevus - junctional component extends beyond intradermal - club shaped hyperplasia of rete - horizontally oriented nests with bridging - concentric papillary dermal fibrosis - large oval melanocytes - matures, disperses, no deep pigment or mitosis
Trichoadenoma • Multiple red doughnuts in the dermis, each resembling a follicular infundibulum • Often in pairs resembling eyeglasses or toasted oat cereal
spindle cell melanoma - lentiginous melanocytic growth - Spindled cytology - SLAMmed against epidermis - Most reliable immunostain are S100 and SOX10
Eccrine Poroma • Monotonous, cuboidal cells with ample pink cytoplasm that "pore" down into the dermis (with rounded pushing borders) • maybe focal clear cell change • Cuticle-lined ducts • Hyalinization around perivascular spaces • Commonly found on the foot
Trichofolliculoma Central follicle w/ radiating, immature follicles (daughter follicles); tuft of protruding fine hairs
Trichoepithelioma Islands of basaloid cells embedded in distinct fibromyxoid cellular stroma; "rail-road tracking", peripheral palisading common; +/- horn cysts, swiss cheese spaces w/in islands; clefting w/in stroma rather than around tumor (as BCC); no connection to surface may be seen in Brooke-Spiegler (CYLD) or Rombo
Eccrine Mucinous Carcinoma • Islands of blue cells surrounded by mucin ("blue islands oating in a sea of snot") • Primary cutaneous mucinous carcinoma and metastatic mucinous carcinoma look identical
LM (lentigo maligna) - rete ridge commonly effaced - junctional growth of atypical melanocytes - extends down adnexal structures - no symmetric - cytologic atypia
Dilated Pore of Winer • Resembles a dilated follicular infundibulum • Small radiating red nger-like epithelial projections
LMM (lentigo maligna melanoma) with prominent regression - rete ridge commonly effaced - junctional growth of atypical melanocytes and melanocytes in the dermis - extends down adnexal structures - no symmetric - cytologic atypia
Hidradenoma Papilliferum • Blue dermal nodule with branching cystic spaces • Papillary fronds • Decapitation secretion
Clear cell syringoma - associated with DM - syringoma with clear cells containing glycogen
Congenital Nevus - aggregates of nevus cells around follicles, vessels walls, and nerves - single file interstitial pattern - no cytologic atypia
Superficial spreading MM - buckshot scatter of atypical melanocytes in the epidermis - nests are bizarre - no symmetric - fails to mature or disperse - dermal nests are larger than junctional nests - deep pigment - lymphoid infiltrate walling off lesion - cytologic atypia - HMB-45 and MIB1 stain strong deeply
Papillary Mesenchymal Body of Trichoepithelioma
Eccrine Spiradenoma • 2 populations of basaloid cells, one more pale than the other • basaloid cells form rosettes • Deeply eosinophilic hyaline droplets may be noted in islands may be Brooke-Spielgler (CYLD)
Hidroacanthoma Simplex • Intraepidermal nests • Cuboidal cells with ample pink cytoplasm • Cuticle-lined ducts • resembles clonal SK except has ducts
Nipple Adenoma
Blue Nevus (common) - spindled pigmented melanocytes - deep melanophages
acral lentiginous melanoma - pigmented parakeratosis - pagetoid spread - melanoma nests - "furrows are fine, ridges are risky"
Clear cell hidradenoma - hidradenoma with clear glycogen containing cells
Blue Nevus - wedge or bulbous outline - pigment to the base - melanocytes do not mature or disperse - distinctive sclerotic red stroma + for S100, MART-1, HMB45; CEA -
Pilar Sheath Acanthoma - Similar to dilated pore of Winer, but with thick acanthotic fingers - Pore of Winer on steroids
Syringoma "sperm in the derm" • Paisley-tie pattern of tadpole-shaped ducts • Ample pink cytoplasm • Dense red sclerotic stroma • Tumor is small and round
Fibrofolliculoma - Epithelial strands radiating outward from central follicle-like structure - pale, fibrotic, mucinous stroma - No hair fibers - Birt Hogg Dube (BHD, folliculin)
Hidrocystoma • Simple cyst • Lined by cuboidal or columnar cells • Decapitation secretion may be noted if of apocrine origin
Nevus of Ito/Ota - dendritic melanocytes between collagen bundles - melanocytes oriented east to west
Syringofibroadenoma - anastomosing net-like ductal proliferation in the dermis with a broad connection to the surface - reactive proliferation of eccrine ducts - Parallel or anastomosing ducts - Fibromyxoid stroma - Schopf-Schulz-Passarge syndrome
Mixed Tumor of the skin (Chondroid Syringoma) • Sweat ducts with ample pink cytoplasm embedded in a bluish-pink mesenchymal stroma (mucinous to cartilage-like) • Secretory elements with blue nuclei and little cytoplasm may be present • Bone formation may occur
Metastatic melanoma - very rarely exhibits junctional melanocytes except in the very rare epidermotropic metastatic melanoma
Hidradenoma like a poroma but in the dermis Cuboidal cells with ample pink cytoplasm • Cuticle-lined ducts • Large dermal nodule • Bright red zones of basement membrane zone reduplication commonly surround vessels
Adenoid cystic carcinoma • Sieve-like (cribriform) appearance in some areas • Tubular appearance in other areas • Atypia and mitoses variable
Paget's Disease - AE1/3, PAS, EMA, CEA, CAM 5.2, and CK7 (+) - S-100, HMB-45 (-)
Desmoplastic MM - dense desmoplastic stroma - nodular lymphoid aggregates - S100 and SOX10 are reliable stains - atypia of spindle cells - perineural extension common S-100, SOX-10 stain reliably
Microcystic adnexal carcinoma • Biphasic pattern (sweat duct-like and pilar) • Paisley-tie tadpole-shaped ducts with ample pink cytoplasm and horn cysts • Basaloid nests with pilar differentiation common • Dense pink to red sclerotic stroma • Deeply invasive • Lymphoid aggregates • Perineural extension
nodular MM - fails to mature or disperse - deep pigment - lymphoid wall - mitosis and cytologic atypia HMB-45, MIB-1 stain to base
Cellular blue nevus - wedge or bulbous outline - pigment to the base - dendritic melanocytes mixed with pale spindled cells - melanocytes do not mature or disperse - distinctive sclerotic red stroma
Desmoplastic Trichoepithelioma - Like trichoep but with incr density, hypocellular stroma, incr horn cysts - no sweat ducts to differentiate from syringoma
Eccrine Spiradenoma "blue ball in the dermis" Larger round islands of blue cells with little cytoplasm • Dark and pale blue nuclei present • Islands peppered with black lymphocytes • Deeply eosinophilic hyaline droplets may be noted in islands may be Brooke-Spielgler (CYLD)
Porocarcinoma • Invasive growth pattern • Atypia, mitoses, and necrosis variable • Some bland-appearing tumors metastasize
Basaloid Follicular Hamartoma • Resembles infundibulocystic basal cell carcinoma histologically - vertically-oriented basaloid cells centered upon a comedo-like follicle. • Often multiple with autosomal-dominant inheritance • Sometimes segmental Blaschkoid distribution
melanoma of animal type (Pigmented epithelioid melanocytoma) - epithelioid melanocytes - mitosis - heavy melanin pigmentation - histologically resembling melanoma of animals
Trichoblastoma • Family of blue follicular tumors composed of basaloid cells, often with no epidermal connection • Cells resemble those of basal cell carcinoma • Stroma resembles the normal brous sheath of the hair follicle, with concentric collagen and many broblasts • Papillary mesenchymal bodies may be present in the stroma • Mucin may be present within tumor islands, but never in the stroma • No retraction artifact
Section 7
(50 cards)
Chronic lymphocytic leukemia/small lymphocytic lymphoma - Proliferation of mature round lymphocytes of B-cell origin - Nodular and/or diffuse in ltration of the dermis with dark small round mature-appearing lymphoid cells - Grenz zone is often present - CD19+, CD20+ (usually weak), CD5+, CD23+, CD43+, - CD10−, cyclin D1−
CD19+, CD20+
Trichilemmoma • Often a warty surface • Smooth lobules of clear glycogenated cells hanging down from the epidermis • Peripheral palisading • Outlined by a thick glassy eosinophilic "vitreous" basement membrane - differentiate towards outer root sheath - Cowdens differentiate from clear cell acanthoma by thick BMZ and less sharp demarcation from normal skin
Mycosis Fungoides - Plaque stage - a denser, band-like infiltrate of atypical lymphocytes in the upper dermis - note pautrier's micro abscess in the picture - CD3+, CD4+, - CD5- , CD7-, CD8-, CD26-, CD30-
infantile hemangioma - solidly packed endothelial cells to more ecstatic vessels - GLUT1+
Tumor of the follicular infundibulum - thin anastomosing strands of clear cells, extending parallel to the epidermis, bridging between the infundibular portions of adjacent follicles
lymphomatoid papulosis, type A - Wedge-shaped dermal infiltrate with mixed population of cells - CD30+ Reed-Sternberg-like cells with large nuclei, prominent nucleoli, and abundant cytoplasm - Neutrophils, eosinophils, and small lymphocytes in background
TMEP (telangiectasia macular eruptiva perstans) - sparse mast cells - telangiectasias
Extranodal NK/T-cell lymphoma, nasal type - Dense lymphoid in ltrates in dermis, subcutaneous fat, ± epidermis - Angiocentricity, angiodestruction, and zonal necrosis - CD2+ CD3epsilon+, usually CD56+ (NK-cell marker)
CD56+
Primary cutaneous aggressive epidermotropic CD8+ cytotoxic T-cell lymphoma - Band-like, lichenoid lymphoid infiltrate with marked epidermotropism - Beta F1+ CD3+ CD8+
CD3+ CD8+ CD4-
lymphomatoid papulosis - central necrosis - epidermotropism - infiltrate of atypical lymphocytes - CD30+
Cutaneous Anaplastic large cell lymphoma - Sheets of large Reed-Sternberg-like cells in dermis ± subcutaneous fat - Reactive small lymphocytes, histiocytes, and eosinophils in background - CD30 expression by >75% of large cells in infiltrate - Nodal ALCL has a chromosomal translocation t(2;5) which expresses ALK-1; primary cutaneous is ALK-1 negative
CD30+ Reed Sternberg like cells
granulomatous slack skin variant of MF - Huge "Jabah the Hutt" cells w/in dense epidermotropic lymphoid infiltrate
CD3+ CD4+ CD8−
urticaria pigementosa - basal layer pigmentation - "fried egg" mast cells
subcutaneous T cell lymphoma - atypical cells line up around adipocytes - macrophages with empirepolesis (filled with karyorrhectic debris) - CD8+, alpha/beta T-cell receptor (BF1)+, gamma/delta T-cell receptor− - Clonal rearrangement of T-cell receptor genes
CD8+, alpha/beta T-cell receptor (BF1)+, gamma/delta T-cell receptor -
Reed Sternberg like cells - seen in anaplastic large cell lymphoma and lymphomatoid papulosis
Mycosis Fungoides - Patch stage - Epidermotropic (lower ½ epi and line up at basal layer); epi nuclei> dermal; no spongiossis; Pautrier's microabscesses; band-like infiltrate, cerebriform nuclei; eos common - CD3+, CD4+, CD8-, CD30- - frequently lose CD5, CD7 and CD26
Hobnail cells - plumb endothelial cells that protrude into the lumen of the dilated vessels
subcutaneous T cell lymphoma - Lace-like pattern of in ltration in the fat - Lymphoid cells rimming the individual adipocytes - No significant involvement of the dermis or epidermis - CD8+, alpha/beta T-cell receptor (BF1)+, gamma/delta T-cell receptor−
CD8+, alpha/beta T-cell receptor (BF1)+, gamma/delta T-cell receptor−
Primary cutaneous marginal zone lymphoma - Patchy, nodular, or diffuse in ltrate of lymphoid cells in the dermis and superficial panniculus - Characteristic "inverse" pattern of central darker benign reactive lymphocytes with surrounding neoplastic cells with paler abundant cytoplasm (marginal zone cells) - CD20+, CD79+, CD5−, CD10−, CD43−, BCL-6−, BCL-2+ - Clonal rearrangement of immunoglobulin (Ig) H gene in >70% of cases
CD20+, CD79+, bcl-2+
angioma serpiginosum - Dilated tortuous capillaries in dermal papillae and the upper dermis - Vessels lack alkaline phosphatase activity
Cutaneous gamma-delta T-cell lymphoma - Location of infiltrate: subcutaneous, dermal, epidermal - TCR gamma-delta+ Beta F1− CD3+ CD56+ CD4−
TCR gamma-delta+ Beta F1− CD3+ CD56+ CD4−
multiple myeloma - Diffuse plasma cells in the dermis - CD38+ and CD138+ - Immunostaining for κ or λ light chains, IgG, IgA, or IgD often reveals monoclonality
CD38+, CD138+
tufted angioma (angioblastoma) - "Cannonball" tufts of cells forming capillary-sized vessels in the dermis with rbcs
Pagetoid Reticulosis - Solitary or multiple patches or plaques on distal extremities - Atypical large lymphocytes extensively in ltrating the epidermis - CD3+ - CD4+ CD8− or CD4− CD8+ - Small reactive lymphocytes in papillary dermis
Cerebriform (brain like) cells in Paltrier micro abscess in MF
tufted angioma (angioblastoma) - "Cannonball" tufts of cells forming capillary-sized vessels in the dermis with rbcs
port wine stain/nevus flameus - dilated capillaries
angiolymphoid hyperplasia with eosinophils - Central thick-walled vessels with hobnail endothelium - Peripheral proliferation of smaller vessels - Nodular lymphoid aggregates with eosinophils
Kimora's disease • Lacks central thick-walled vessels with hobnail endothelium • Deep lymphoid nodules with eosinophils • Peripheral eosinophilia • Elevated immunoglobulin E • East and SE Asia • Large subcutaneous lymphoid nodules • Lymphadenopathy
admixed lymphocytes and eos
Diffuse cutaneous large B cell lymphoma, leg type - dense diffuse in literate of predominantly large round immunoblast-type cells with prominent nucleoli; occasional large cleaved, multilobated, or anaplastic cells may also be seen- - CD20, CD79, MUM-1, FOX-P1, bcl-2+, bcl-6+. - CD30-
CD20+, CD79, bcl-2+, bcl-6+
EBV+ via in situ hybridization in Extranodal NK/T-cell lymphoma, nasal type
EBV+
mastocytoma - characteristic low power appearance of evenly spaced, "fried egg" mast cells
Folliculotropic MF • Atypical lymphocytes infiltrate the follicular epithelium • Basaloid induction and hyperplasia of follicular epithelium • Eosinophils common • Follicular mucinosis (pools of mucin in the follicular epithelium) • Epidermis usually spared • CD3+ CD4+ CD8− in most cases
cherry angioma - collection of capillary sized vessels, hyalinized pink walls
Acute myeloid leukemia - Diffuse interstitial, perivascular, and periadnexal in ltrate in dermis and subcutis - No epidermotropism - Grenz zone separates the in ltrate from the epidermis - Single filing of cells splaying dermal collagen • Mononuclear cells (blasts) ranging from large to small • CD3− CD20− CD43+ • Lysozyme+ myeloperoxidase+ chloroacetate esterase+
CD3− CD20− CD43+, lysozyme +, myeloperoxidase+, chloroacetate esterase+
Primary cutaneous follicle center cell lymphoma - irregular nodular lymphoid proliferation - CD20+, CD79+, CD10 variable, - BCL-6+, BCL-2−, CD5−, CD43−
CD20+, CD79+, bcl-6+
Adult T-cell leukemia/lymphoma (ATCLL) - HTLV-1 - Dermal and/or subcutaneous lymphoid in ltrates - T cells with multilobed nuclei - Epidermotropism in some cases - CD3+ CD4+ CD8− CD25+ neoplastic cell population in blood, nodes, and skin - Japan, Caribbean, southeastern USA, and Central Africa
CD3+ CD4+ CD8− CD25+
CD30+ (Ki-1)
if this is LyP, what is the stain?
hobnail hemangioma (targeted hemosiderotic hemangioma) - Central superficial dilated vessels with hobnail nuclei - Peripheral proliferation of small vessels - crack like spaces - Peripheral vascular proliferation tends to surround pre-existing vessels and adnexae (like Kaposi's sarcoma)
leukemia cutis - Concentric rows around vessels and betw collagen (Indian filing/ Boxcar - elongated cells lined up end-on-end); very monotonous cells
CD3− CD20− CD43+, lysozyme +, myeloperoxidase+, chloroacetate esterase+
intravascular papillary endothelial hyperplasia - reanalyzing thrombus within a vascular space - fibrin in thrombus - papillary projections with hyalinized cores
angiolymphoid hyperplasia with eosinophils - Central thick-walled vessels with hobnail endothelium - Peripheral proliferation of smaller vessels - Nodular lymphoid aggregates with eosinophils
intravascular papillary endothelial hyperplasia - reanalyzing thrombus within a vascular space - fibrin in thrombus - papillary projections with hyalinized cores
granulomatous slack skin variant of MF - Massive dermal and subcutaneous in ltrate ± epidermal involvement - Small T lymphocytes with epidermotropism and mild cytologic atypia - Huge multinucleate giant cells with numerous nuclei, often in wreath-like arrangement - Phagocytosis of lymphocytes by multinucleate cells - Dermal edema or fibrosis - Loss of dermal elastic tissue fibers - CD3+ CD4+ CD8− immunophenotype
CD3+ CD4+ CD8−
plasmacytoma - collection of plasma cells, often with a grenz zone
angiokeratoma - Large dilated vessels expanding PD (sub-epidermal space which can appear intra-epidermal) - overlying acanthosis - hyperkeratosis appears like bloody SK
bullous mastocytoma - sub epidermal blister - diffuse mast cells
mast cells in the infiltrate
Intravascular large B-cell lymphoma - Highly malignant, rare neoplasm of large atypical B cells, which presents within the lumens of small vessels, particularly capillaries and venules - CD20, CD79a+, and may aberrantly coexpress CD5, CD10, CD11a
CD20, CD79a+
Mycosis Fungoides - Tumor stage - Dense, nodular lymphocytic infiltrate in the superficial and deep dermis - Many atypical lymphocytes present in the dermal in literate - Transformation to large-sized lymphocytes in some cases - Acquisition of CD30 expression in some cases - Loss of epidermotropism with progression - CD3+, CD4+, - CD5- , CD7-, CD8-, CD26-, CD30-/+
pseudo lymphoma - Epi hyperplasia or spongiosis; top heavy; nodular, few eos, plasmas; follicles w/ GCs
heavy infiltrate of non-atypical lymphocytes with some eos
Section 8
(50 cards)
spindle cell lipoma - well-circumscribed tumor of mature lipocytes intermixed zones of bland spindle cells and collagen - CD34+ spindle cells - may see mast cells
kaposi's sarcoma late patch/plaque - vascular wrapping, promontory sign - HHV8
nerve sheath myxoma/myxoid neurothekeoma • Multiple myxoid lobules containing sparse stellate cells • variable mucin in lobules • S100+
cutaneous ganglioneuroma • Localized dermal collection of Schwann cells with uniform wavy buckled nuclei • Admixed large polygonal ganglion cells with eccentric large round nucleus with prominent nucleolus - GFAP+
glomeruloid/papillary hemangioma - capillary loops within a dilated vascular space, resembling a glomerulus - sequestering degenerating erythrocytes PEOMS syndrome and Castleman's disease
arteriovenous malformation • Thick- and thin-walled vessels • Thick-walled vessels tend to be central
neuroma, traumatic - encapsulated - half hazardly arranged nerve fascicles within scar
spindle cell hemangioma (spindle cell hemangioendothelioma) - "hemorrhagic lung" with alveolar spaces at scanning power - solid areas of spindle cells - phleboliths
malignant peripheral nerve sheath tumor - hyper cellular intersecting fascicles of spindle cells - malignant transformation of plexiform neurofibromas
nerve sheath myxoma/myxoid neurothekeoma • Multiple myxoid lobules containing sparse stellate cells • variable mucin in lobules • S100+
kaposi's sarcoma nodule - Nodule composed of fascicles of parallel spindle cells - Erythrocytes between spindle cells - Eosinophilic globules - HHV8
epithelioid hemangioendothelioma - Dilated vascular channels with solid epithelioid and spindle cell areas - Intracytoplasmic lumens
glomus tumor - Rows of round dark nuclei with little cytoplasm ("string of black pearls") - Glomus cells surround delicate vascular spaces - Glomus cells are modified smooth muscle (SMA+/CD31-)
microvenular hemangioma - monomorphous, elongated blood vessels with small lumens - surrounding pericytes - seen in POEMS syndrome with glomeruloid hemangioma
vascular wrapping in kaposi's sarcoma plaque stage
hemangiopericytoma - Endothelial-lined vessels surrounded by a proliferation of spindled pericytes - Stag-horn ectatic vascular spaces fibrous tumor with stag horn vessels
bacillary angiomatosis - not distinctly lobular - clusters of neutrophils within the lesion - amphiphilic collections of organism
neurilemmoma (schwannoma) - Circ'd, encapsulated - Antoni A (spindle-shaped Schwann cells w nuclei in rows/ palisades, cell processes fused forming Verocay bodies) - less cellular Antoni B areas - NF2, Carney/NAME (PRKP..)
degenerating RBCs in glomeruloid hemangioma
eccrine angiomatous hamartoma - discrete lobules composed of capillaries, mature eccrine glands, and ducts
lipoma - well circumscribed tumor with thin capsule - mature lipocytes familial multiple lipomatosis, Madelung's, Dercum's disease, Gardners, Bannayan, Cowden, Proteus
Psammomatous melanotic schwannoma - variant with psammoma bodies and melanin - Carney/NAME (PRKP..)
Kaposiform hemangioendothelioma - large lobules - less well circumscribed and deeper than tufted angioma - Slit-like, crack-like and staghorn vascular spaces Kasabach-Merritt coagulopathy
angiosarcoma - Crack-like spaces between collagen bundles - Spaces lined by hyper chromatic, atypical endothelial cells - CD31, CD34, factor VIII, cytokeratin positive, D2-40, and Ulex europeus lectin
pyogenic granuloma (lobular capillary hemangioma) - solidly packed endothelial cells in lobules - crust on top - collarette
Subungual exostosis - bony stalk with fibrocartilaginous cap
granular cell tumor - Sheets of large polygonal cells with abundant eosinophilic granular cytoplasm with central nucleus • Discrete round eosinophilic giant lysosomal granules (pustulo-ovoid bodies of Milian) • pseudoepitheliomatous hyperplasia • derived from Schwan cells • S100+, PAS+ (diastase labile)
neuroma, palisaded and encapsulated - Super cial dermal tumors with a thin, delicate capsule - Fascicles of spindle cells separated by clefts - histologically resemble mucosal neuroma of MEN2b
superficial microcytic lymphatic malformation (lymphangioma) - dilated lymphatic in contact with the epidermis (a sub epidermal space) - no, or very few, erythrocytes - D2-40+
intracytoplasmic lumen of epithelioid hemangioendothelioma
retiform hemangioendothelioma - Arborizing blood vessels reminiscent of rete testis
kaposi's sarcoma nodule - Nodule composed of fascicles of parallel spindle cells - Erythrocytes between spindle cells - crack like spaces and fronds - HHV8
rudimentary meningioma • Pseudovascular spaces dissect through collagen bundles • Spaces are lined by small round epithelioid meningothelial cells • Psammoma bodies may be present
sclerosing perineuroma - perineurial fibroblasts - EMA+
merkel cell tumor (this pic has bowenoid change as well) -small blue cells with scant cytoplasm and tightly packed nuclei in sheets or a trabecular array • Nuclear molding, apoptotic cells, and mitoses are often present
neurofibroma Pale staining, poorly circ'd, loose texture, wavy (S shaped , comma shaped, bucket handle) spindle cells, Grenz zone, few mast cells - NF1 with café-au-lait macules, axillary freckling, and pigmented hamartomas of the iris (Lisch nodules).
angiosarcoma - Crack-like spaces between collagen bundles - Spaces lined by hyper chromatic, atypical endothelial cells - CD31, CD34, factor VIII, cytokeratin positive, D2-40, and Ulex europeus lectin
kaposi's sarcoma patch - Bizarre stag-horn ectatic lymphatic-like vessels - plasma cells - HHV8
merkel cell carcinoma, trabecular pattern -small blue cells with scant cytoplasm and tightly packed nuclei • Nuclear molding, apoptotic cells, and mitoses are often present
pleomorphic lipoma - well circumscribed superficial tumor - hyperchromatic adipocytes, bizarre floret giant cells that have overlapping nuclei, a pseudomalignancy, resembles liposarcoma but only has rare lipoblasts and has no necrosis.
cellular neurothekeoma • Nests and fascicles of epithelioid or spindled cells • Myxoid stroma is absent or sparse - PGP-9.5 and S100-a6 +, S100-
cellular neurothekeoma • Nests and fascicles of epithelioid or spindled cells • Myxoid stroma is absent or sparse - PGP-9.5 and S100-a6 +, S100-
granular cell tumor - Sheets of large polygonal cells with abundant eosinophilic granular cytoplasm with central nucleus • Discrete round eosinophilic giant lysosomal granules (pustulo-ovoid bodies of Milian) • pseudoepitheliomatous hyperplasia • derived from Schwan cells • S100+, PAS+ (diastase labile)
glomangioma - One to two layers of glomus cells around prominent vessels (spectators) - Glomus cells are modified smooth muscle (SMA+/CD31-)
Angiolipoma - mature fat cells - vascular proliferation of capillary size vessels - may see RBCs and scattered fibrin thrombi in the lumens
plexiform neurofibroma - worm like fascicles of neurofibroma surrounded by perineurium - embedded in background neurofibroma - NF1
venous lake - irregular, thin-walled, ectatic vessel - usually collapses after biopsy
super nummerary digit - acral papule with nerve bundles
pleomorphic liposarcoma - lipoblasts, mitosis, no floret cells, and deep location
• Synaptophysin, chromogranin, and neuron-specific enolase+ • CK20+ in a paranuclear dot pattern
what is the staining for merkel cell
Section 9
(50 cards)
Calcifying aponeurotic fibroma - plump, epithelioid fibroblasts palisading around chondroid foci with or without calcification
pleomorphic fibroma - scattered large hyper chromatic stellate nuclei - may be multinucleate cells - never hyper cellular - no mitosis
DFSP - dense, storiform (woven) pattern of spindle cells
cutaneous endometriosis - glands - extravasated rbcs and hemosiderin
IP (incontinentia pigmenti) - spongiosis +/- vesicles - eosinophils - NEMO
super nummurary digit - dense collagen with nerve bundles
ADFK (acquired digital fibrokeratoma) - hyperkeratosis giving collarette - dense vertical collagen with spindled cells - Stellate, factor XIIIa+ stromal cells may be present
super nummurary nipple • Subtle epidermal thickening with underlying pilosebaceous structures • Surrounding scattered smooth muscle bundles typical of areola • Central mammary duct may be visible - along the milk line
accessory tragus - delicate epidermis with lots of villus hairs - may see cartilage - anomaly of 1st brachial arch - may be associated with oculo-auriculo-vertebral syndrome (Goldenhar syndrome).
piloleiomyoma - circumscribed but not encapsulated dermal nodule composed of smooth muscle (arrector pili) - Hereditary leiomyomatosis is an inherited defect of fumarate hydratase (Reed syndrome)
leiomyosarcoma - dermal collection of atypical spindled cells - desmin, smooth muscle actin + to differentiate from spindled SCC (keratin) or melanoma (s100)
nodular fasciitis - "tissue culture" fibroblasts - erythrocyte extravasation - loose myxoid pattern - foci of inflammatory cells
myxoid liposarcoma - Deep myxoid mass - Not a cellular lesion like nodular fasciitis - Tiny delicate spindle cells - Lines: collapsed blood vessels, embedded in a myxoid background with spindle cell proliferation
Angiomyolipma - Well-circumscribed tumor - Smooth muscle radiating in a pinwheel fashion from the walls of muscular vessels - Mature fat not associated with TS like the renal ones
Giant cell fibroblastoma - juvenile variant of dermatofibrosarcoma protuberans - multinucleated giant cells lining vascular like spaces
Sclerosing perineuroma - concentric perineurial fibroblasts - Epithelial membrane antigen (EMA)+
Epithelioid Sarcoma • Mimics a palisaded granuloma • Biphasic (transition between epithelioid and spindle cells) • Central necrosis • Stains for both keratin and vimentin • CK5+, INI-1-. CD68+. • acral location on young person
Myofibroma - pink nodules of spindled cells made of myofibroblasts - peripheral fibrovascular proliferation (staghorn vessels)
Aneurysmal dermatofibroma (sclerosing hemangioma) -dermatofibroma with aneurysmal dilation of vessels
dermatofibroma - ill defined collection of whorling spindled cells (both areas of hyper and hypo-cellularity) - collagen trapping - tabled rete ridges - factor XIIIa+, cd 34- (surrounding stroma is cd34+)
giant cell tumor of tendon sheath - collagenous nodule containing osteoclast like giant cells (w/ randomly distributed nuclei; cytoplasm is deeply pink and has scalloped edges) - plump fibroblasts - hemosiderin pigment
angioleiomyoma - Subcutaneous nodule of smooth muscle containing round and slit-like vascular spaces
metastatic RCC - collection of clear cell lobules with prominent vessels - often grenz zone - stains with RCC
lipidized siderophage of DF - pathognomonic for DF - both lipid and hemosiderin peripheral to nuclei
infantile digital fibroma - proliferation of spindle cells with eosinophilic inclusions
nodular fasciitis - "tissue culture" fibroblasts - erythrocyte extravasation - loose myxoid pattern - foci of inflammatory cells
DFSP: cd34+, factor VIIa -, Stromelysin-3 -
fibrous hamartoma of infancy - disorderly growth of benign tissues - myxoid areas, mature fibrous areas, and fat
angiolipoma - mature fat cells - vascular proliferation of capillary size vessels - may see RBCs and scattered fibrin thrombi in the lumens
DF with monster cells - large cells with vesicular nuclei and prominent nucleoli (arrows in the photo) - hyper chromatic (dark nuclei) - benign (although looks alarming)
MFH (malignant fibrous histiocytoma) or pleomorphic undifferentiated sarcoma - deeper mass than AFX, not sun exposed, more likely to stain for CD74
metastatic breast cancer - epithelioid islands with small glandular spaces -atypical cells are seen in single file (in dermis and subcutaneous lymphatics) -often a grenz zone
myxoid liposarcoma - Fusiform or stellate cells, abundant mucoid stroma, delicate plexiform network of sm capillaries; var multivacuolated lipoblasts
Fibrolipoma - well circumscribed tumor of mature lipocytes containing large bundles of mature collagen
fibrosarcoma - densely hypercellular - herringbone or fir tree pattern common - nuclei may be large and hyperchromatic
fibrous papule - perifollicular fibrosis - stellate, XIIIa+ stromal cells - TS and MEN1
desmoid tumor - myofibroblastic proliferation with deep infiltration (infiltrates muscle) - beta catenin expression - Gardner's syndrome (or sporadic)
Juvenile Hyaline Fibromatosis - AR - Nodular hyaline fibrosis in the dermis - Linked to CMG2 or ANTXR2 mutations (gene encoding capillary morphogenesis protein-2 on chromosome 4q21)
mobile, encapsulated lipoma (localized fat necrosis) - Lobules of necrotic fat (non-nucleated adipocytes) surrounded by fibrous capsule - induced by trauma
nevus lipomatosis superficialis of Hoffmann and Zurhelle - mature adipocytes replacing much of the dermis - disseminated body involvement in Michelin tire baby syndrome
dermatomyofibroma - east-west oriented spindle cells which respect adnexal structures - some corkscrew nuclei
Fibromatosis (Dupuytren's, Peyronie's, Ledderhose, infantile) • Myofibroblastic proliferation • Locally in ltrative, but does not metastasize • Corkscrew-shaped myofibroblasts + collagen
focal dermal hypoplasia (Goltz) - fat high in the papillary dermis - X linked dominant mutation in PORCN
fibroma of tendon sheath (plantar fibromatosis) - dense hyalinized collagenous neoplasm with scattered fibroblasts
sclerotic fibroma - "Plywood" appearance (laminated; storiform and whorled); circ'd, unencapsulated - associated with Cowden's syndrome
AFX (atypical fibroxanthoma, superficial malignant fibrous histiocytoma) - dermal collection of bizarre spindled cells, multinucleate giant cells (idaho potato looking cells) - vimentin, actin, CD10+, S100A6+, and procollagen+
DFSP (dermatofibrosarcoma protuberans) - densely hyper cellular mass which infiltrates the fat - cd34+, factor XIIIa- - t(17;22) translocation collagen 1 and PDGF so can use PDGFr inhibitor such as imatinib - progression to fibrosarcoma with p53 mutation
hibernoma - well circumscribed - multivaculoated lipocytes (mulberry cells) - differentiation toward brown fat
leiomyosarcoma - dermal collection of atypical spindled cells - design, smooth muscle actin + to differentiate from spindled SCC (keratin) or melanoma (s100)
fibrous papule - concentric perivascular fibrosis - collagen perpendicular to epidermis with dilated vessels - stellate, XIIIa+ stromal cells - TS
Section 10
(50 cards)
Lead tattoo - Black deposits - Inert doesn't initiate an inflamm response - Clumps of pigment (may get tattoo granuloma if allergic to dye of tattoo)
Bednar tumor - DFSP with melanin
Aspergillus - branching septate hyphae - may see vessel invasion and necrosis - A. flavus, fumigatus, niger
Orf - Epidermal necrosis - Epidermal vacuolization (reticular degeneration) with red viral inclusion bodies (may be both cytoplasmic and intranuclear) - Parapox virus, dsDNA
Tinea - - sandwich sign: parakeratosis overlying orthokeratosis - Non-pigmented hyphae in stratum corneum
Mucormycosis - plump hyphae with no septa - may see vessel invasion - Rhizopus, Mucor, Absidia
Atypical mycobacteria - pseudoepitheliomatous hyperplasia - macrophages (upper dermal arrow) and lymphocytes (lower dermal arrow) - intraepithelial micro abscesses (mid dermal arrow)
Verruca - koilocyte Koilocytes (vacuolated cells with hyperchromatic shriveled nuclei)
Cocci - fungal spore - Large spherules with gray lacy and granular cytoplasm, may be w/in giant cells
metastatic breast cancer, instersitia (carcinoma en cuirasse) -atypical cells are seen in single file (in dermis and subcutaneous lymphatics) - indian filing also seen in leukemia cutis
Braided Suture
HSV - Ballooning degeneration of keratinocytes - Multinucleated keratinocytes with nuclear molding - Herpetic cytopathic effect (basophilic eggshell of chromatin at the periphery of the nucleus) - Herpesvirus, dsDNA
Botryomycosis - Large staphylococcal grains in tissue - Abscesses and sinus tracts
Lepromatous Leprosy • Perivascular lymphohistiocytic in ltrate • Ample amphophilic cytoplasm • May form sheets of histiocytes with grenz zone • Globi (contain organisms) •M leprae
Lepromatous Leprosy - Globi contain organism and stain with Fite stain - M leprae
Tattoo - most tattoos are black with H&E
Leishmaniasis • Granulomatous dermatitis • Plasma cells common • Intracellular organisms • Organisms often line up at periphery of vacuole
Lobomycosis (GMS stain) - string of pearls spores - Lacazia loboi
Rhinosclerema • Russell bodies (plasma cells with eosinophilic cytoplasm) • Mikulicz cells (histiocytes containing large round collections of bacilli) - Klebsiella rhinoscleromatis
Epidermodysplasia Verruciformis - bluish keratinocytes - HPV 5, 8
Chromomycosis - copper pennies - Fonsecaea (Phialophora) pedrosi MCC (Fonsecaea, Rhinocladiella, Phialophora, Cladosporium)
Pheohyphomycosis - brown hyphae in giant cells - Alternaria, Curvularia, Exophiala, Bipolaris
Necrolytic Acral Erythema - psoriasiform hyperplasia with necrotic keratinocytes - Hep C
Granuloma Inguinale (Warthin Starry stain) - Organisms within histiocytes (Donovan bodies)
Demodex - small mites in the pilosebaceous unit -
Atypical mycobacteria on Ziehl Neelsen
Hypergranulotic discornification
Tuberculoid Leprosy • Epithelioid granulomas running east-west in the dermis ("lavender sausages") • Unlikely to nd organisms with Fite stain •M leprae
HSV - intraepidermal vesicle - Ballooning degeneration of epidermal and follicular keratinocytes - Herpesvirus, dsDNA
Tinea - Non-pigmented hyphae in stratum corneum
Tinea Versicolor • Loose lamellar or basket-weave hyperkeratosis • Groups of round spores and short curved hyphae in the stratum corneum ("ziti and meatballs") • Malassezia furfur
Histoplasma - Small uniform dots within histiocytes - Each surrounded by a pseudo capsule - Evenly spaced within histiocyte
Candida (PAS stain) - pseudohyphae oriented north-west (as opposed to dermatophyte being east-west)
BANGLE • Blue rubber bleb nevus • Angiolipoma • Neuroma, neurilemmoma • Glomus tumor • Leiomyoma
what are the tender tumors?
Molluscum Contagiosum • Cup-shaped or crateriform lesion with scalloped border • Henderson-Paterson bodies (molluscum bodies - eosinophilic to basophilic intracytoplasmic inclusions) - Molluscipox, dsDNA
Pilomatricoma -Basophilic cells that resemble those of the hair matrix keratinize to form shadow cells (pink material with shadow of nuclei) • Often calcify • Giant cell granulomas adjacent to calci cations • Bone formation common • Multiple pilomatricomas are associated with myotonic dystrophy
Tattoo reaction (red) - granulomatous reaction is allergic
Scabies - Eggs or mites, or scybala (brown feces) are present in the sub corneal zone - Sarcoptes scabiei
Tinea Nigra - pigmented hyphae in the stratum corner - Hortaea werneckii
Blastomycosis - few organisms with thick refractile walls - broad based budding
Cryptococcus - Clear gelatinous capsules containing small groups of organisms ("gelatinous condominiums") - Amount of capsular material is inversely proportional to granulomatous infiltrate
Cocci - endospore - endospore
Verruca Vulgaris - Exophytic - Papillomatosis - Compact eosinophilic hyperkeratosis - Hypergranulosis - Koilocytes
Actinomycosis - Large sulfur granule - Splendore-Hoeppli phenomenon (basophilic organisms with eosinophilic border) - Actinomycosis israelii
Pitted Keratolysis - acral skin - dell in stratum corner - rods and cocci at base of dell - Kytococcus sedentarius
Paracocci - Narrow-based budding - Mariner's wheel pattern of budding occasionally
Verruca Plana - flat - acanthosis, hypergranulosis - kilobytes - HPV 3, 10
pilomatricoma -Basophilic cells that resemble those of the hair matrix keratinize to form shadow cells (pink material with shadow of nuclei) • Often calcify • Giant cell granulomas adjacent to calci cations • Bone formation common • Multiple pilomatricomas are associated with myotonic dystrophy
Erythrasma -Bacterial Rods forming vertical laments in stratum corneum - Inflammation variable - C. minutissimum
Impetigo • Neutrophilic crust • Chains or clusters of cocci
Section 11
(27 cards)