Flashcards in Chapter 2 Pathology of Skin Lesions Deck (39)
_______ biopsies are best for cases where most of the pathology is in the epidermis or superficial dermis
For most inflammatory dermatoses, a _____ biopsy produces the best results.
_______ biopsies are used for complete removal of a cutaneous neoplasm as well as in cases of panniculitis or fasciitis where substantial deep tissue is needed
For patients with unusual or persistent dermatoses, or if ________________ is suspected, more than one biopsy can be beneficial.
When a biopsy is performed for _______, two 4-mm punch biopsies are optimal: one for horizontal sections and one for vertical sections
cutaneous T-cell lymphoma
Enhanced cell proliferation accompanied by an enlargement of the germinative cell pool and increased mitotic rates lead to an increase of the epidermal cell population and thus to a thickening of the epidermis --> ___________
___________ --> in which faulty and accelerated cornification leads to retention of pyknotic nuclei of epidermal cells at the epidermal surface
In some diseases, dyskeratosis is the expression of a genetically programed disturbance of keratinization as is the case in _________. Dyskeratosis may occur in _________ and ________.
actinic keratosis and squamous cell carcinoma
The most common result of disturbed epidermal cohesion is the __________,
____________ is a primary loss of cohesion of epidermal cells
Dermal–epidermal attachment is enforced by ________________ that anchor basal cells onto the basal lamina
In bullous pemphigoid, cleft formation runs through the _________________ of the ______ membrane and is caused by autoantibodies directed against specific antigens on the cytomembrane of basal cells (junctional blistering)
lamina lucida of the basal
In both interface and lichenoid processes, lymphocytes are present along the _________________ associated with vacuolar alteration of basal layer keratinocytes.
Examples of diseases?
infiltrate composed mostly of neutrophils associated with fibrin and hemorrhage is typical of _________________________ that presents clinically as palpable purpura.
In contrast, perivascular lymphocytes with hemorrhage is typical of __________________
small vessel or leukocytoclastic vasculitis
Schamberg’s pigmented purpuric dermatosis
Perieccrine inflammation is not specific, but it is often a clue that leads to a diagnosis of__________, ________, perniosis, or syringotropic mycosis fungoides
lupus erythematosus, neutrophilic eccrine hidradenitis
Nodular or diffuse pattern:
Nodular collections of lymphocytes raise a differential diagnosis of _________, cutaneous lymphoid hyperplasia (pseudolymphoma), and angiolymphoid hyperplasia
If neutrophils predominate in a nodular infiltrate, one considers ___________, ________, follicular rupture, or abscess formation
cutaneous B-cell lymphoma
Sweet syndrome, pyoderma gangrenosum
Palisading granulomas surround hypocellular areas of the connective tissue with histiocytes in radial alignment. _____________, _____________, and rheumatoid nodules belong to this group
Granuloma annulare, necrobiosis lipoidica
The hallmark of scleroderma and morphea is the homogenization, thickening, and dense packing of the ___________, and a narrowing of the ___________ within the reticular dermis
The fragmentation and curled and clumped appearance of elastic fibers are diagnostic in __________________
______________ staining is often used to highlight presence, absence, or alteration of elastic fibers in the dermis
___________ are identified by small round nuclei, perinuclear halos, and clumping of keratohyaline granules. They tend to be localized in the upper ___________ and ___________ in newer warts, and may be absent in more mature verrucae
stratum spinosum and stratum granulosum
While papillomatosis is a common feature, the surface of condyloma acuminata show rounded crests (so-called _________) as compared to verrucae vulgaris, which demonstrate elongated, pointed spires
____________ is reserved for SCC in situ of sun-protected anatomic sites such as the anogenital region
Multiple keratoacanthomas may arise spontaneously, in the context of genetic syndromes such as in _____________, or as a side effect of taking certain medications, notably the BRAF (v-raf murine sarcoma viral oncogene homolog B) inhibitors ________, _________, _________
sorafenib, vemurafenib, and dabrafenib
The lobules display palisading of columnar cells at the periphery. Within the lobules, mitotic figures and apoptotic cells (often referred to as ______________) are observed
____________ demonstrate lobules of basaloid cells in embedded in the dermis, which have a cribriform or lace-like appearance. ______ are often present within the basaloid lobules.
A variant of a trichoepithelioma is the desmoplastic trichoepithelioma, which classically occurs on the _____ of young adult women.
desmoplastic trichoepitheliomas show elongated thin islands of basaloid cells set within a _____________ stroma
Unlike BCC, however, ____________ are NOT commonly observed in trichoblastomas. Another distinguishing feature compared to BCC is the stroma surrounding the basaloid islands, which is richer in ______ and ______, lacking mucinous ground substance
fibroblasts and compacted
The “shoulder” refers to the junctional component of a nevus that extends at least _____________ beyond a central area of dermal nevus cells
______________ is a phenomenon in which nests of nevic cells from adjacent rete appear to grow toward each other and fuse.
_______________ is commonly observed in dysplastic nevi, and indicates fibrosis in the papillary dermis that runs in parallel to areas of bridging in the epidermis
at least 3 rete pegs
__________ are a characteristic feature of Spitz nevi. These are acellular, globular eosinophilic inclusions in the epidermis, which are thought to be derived from _________ material.
Solar elastosis is also frequently present, particularly in the ________ and ________ types
The epidermis is ______ in superficial spreading melanoma and often ______ in lentigo maligna melanoma
superficial spreading and lentigo maligna
Acral lentiginous and mucosal lentiginous melanomas, similar to lentigo maligna melanomas, show a predominance of _________ over nested growth along the dermal–epidermal junction
desmoplastic melanomas have a distinct immunohistochemical staining profile com- pared to conventional melanomas; they are typically MART-1 negative and positive for _____ and _____ stains.
S-100 and SOX10
Dermatofibromas are benign lesions, which tend to have a hyperplastic epidermis and hyperpigmented, flattened rete, which are described as “________.”
“____________” is frequently seen, particularly at the periphery of dermatofibromas, in which spindle cells encircle collagen bundles
The cells intercalate between adipocytes in the subcutaneous fat, resulting in a “_________” appearance. A ______ or ______ pattern of the cells is commonly observed in the dermal com- partment
storiform or whorled
In contrast to dermatofibrosarcoma protuberans, atypical fibroxan- thomas (AFXs) demonstrate marked ___________ of spindled and epithelioid cells in the dermis
Typically, there is an _________ around the dermal vascular proliferation
epidermal col- larette
The lesional cells are high- lighted by endothelial cell markers, including ____ and ____
CD31 and CD34
They are dermal tumors that consist of small, bland neural cells with wavy, S-shaped nuclei, set within a light pink stroma
_______ areas are more cellular, with areas of palisading of nuclei in parallel to one another around a relatively an acellular extracellular matrix, also referred to as ________.
_________ areas demonstrate spindled cells within a looser and often myxoid extracellular matrix