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Dermatology > Pathology > Flashcards

Pathology Flashcards

1
Q

This is the condition where there is partial or complete autoimmune loss of pigment producing melanocytes.

A

Vitiligo

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2
Q

What is the condition that results in the inability to produce melanin pigment because of the loss of tyrosinase?

A

Albinism

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3
Q

This is a pigmented lesion of childhood and gingers, appear after skin exposure, and there is increased malanosomes.

A

Freckle (Ephelis)

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4
Q

Are the melocytes normal or increased in # in Ephelis?

A

Normal in #, slightly enlarged

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5
Q

This is the condition where there is masklike zone of facial hyperpigmentation of the cheeks, commonly seen in prengnacy and with use of oral contraceptives.

A

Melasma

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6
Q

True or False: Melasma typically resolves spontaneously after pregnancy.

A

True

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7
Q

Which type of melasma is there increased melanin deposition along the basal layer of the epidermis?

A

Epidermal type

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8
Q

Which type of cell has increased melanin in the dermal type of Melasma?

A

Macrophages

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9
Q

This is the first disorder which involves a proliferation of benign melanocytes, and refers to the hyperplasia of melanocytes which occurs at all ages and there is no gender or racial predilectation.

A

Lentigo.

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10
Q

True or False: like freckles, lentigines darken with exposure to sunlight.

A

False

They do not

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11
Q

What is the morphology of the individual melanocytes along the basal layer of the epidermis in Lentigo?

A

Melanocyte hyperplasia

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12
Q

What happens to the epidermis in lentigo?

A

Acanthosis (thickening) and elongation of rete ridges

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13
Q

These are benign neoplasma of melanocytes and show a nested prolfieration of melanocytes at the dermo-epidermal jxn ONLY.

A

Benign Melanocytic Nevus (Pigmented Mole)

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14
Q

What is is called where there is a Benign Melanocytic Nevus within the dermis only?

A

Intradermal melanocytic nevus

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15
Q

What is the general appearance of the Benign Melanocytic Nevus?

A

Flat macule or raised papule with symmetry, sharp borders, even color, and small diameter (<6mm).

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16
Q

What does a congenital nevus often present with at birth?

A

A hair

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17
Q

These are flat macules or slightly raised plaques with various pigmentationa nd irregular borders, and have an increased risk of developing malignant melanoma.

A

Dysplastic nevi

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18
Q

What are the histological features of Dysplastic nevi?

A

Junctional or compount
Surrounding lamellar fibrosis
Mild superficial perivascular infiltrate of lymphocytes and histiocytes

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19
Q

What % of pts with Dysplastic nevi develop malignant melanoma over an 8-yr follow up?

A

5%

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20
Q

What is the inheritance for dysplastic nevi, which is on p1 near Rh?

A

AD

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21
Q

This is the malignant deadly neoplasm of melanocytes.

A

Malignant melanoma

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22
Q

What 2 factors are malignant melanomas + for?

A

S-100 +

HMB-45 Ag

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23
Q

What is the treatment for malignant melanomas?

A

Surgical removal

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24
Q

What type of growth is described for a malignant melanoma if it grows along the skin surface?

A

Radial growth

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25
Q

This is the type of radial malignant melanoma of the face of sun-damaged old people.

A

Lentigo meligna

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26
Q

What is the prognosis of the superficial spreading type of radial malignant melanoma?

A

Great!

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27
Q

What type of growth of a malignant melanoma has an increased risk for mtastasis?

A

Vertical growth

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28
Q

What measure can u use for vertical malignant melanomas, which measures the thickness, which is the most importnat prognostic factor in predicting metastasis?

A

Breslow thickness

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29
Q

What type of malignant melanoma growth shows early vertical growth and has a poor prognosis?

A

Nodular growth

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30
Q

At what depth (in mm) does the risk of metastasis of a malignant melanoma becomes great?

A

> 0.76mm

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31
Q

This is the type of malignant melanoma which arises on the palms or soles, often in dark-skinned individuals, and is not related to UV exposure?

A

Acral lentiginous

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32
Q

Describe the following Clark levels for malignant melanomas:

I
II
III
IV
V
A 
I- only epidermis
II- into paillary dermis
III- filling the papillary dermis
IV- into reticular dermis
V- into subQ
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33
Q

Which is worse: ocular spindle cell malignant melanomas, or ocular epithelioid malignant melanomas?

A

Ocular epithelioid

metastasis to liver

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34
Q

These are common benign tumors of hte squamous epidermis, typically in the elderly, and appear as round, waxy, flat, coin-like plaques.

A

Suborrheic keratosis

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35
Q

What are the histologyical features of Suborrheic keratosis around the hair follicle?

A

Benign basaloid keratinocytes with hyperkeratosis and horn pseudocyst formation.

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36
Q

This is a variant of Suborrheic keratosis, where there is an explosive # of Suborrheic keratosis and suggests an underlying carcinoma of the GI tract.

A

Leser-Trelat

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37
Q

This is the thickened and hyperpigmented skin (like velvet), and are common over flexural areas like the axillae, groin, and groin.

A

Acanthosis nigricans

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38
Q

What is the inheritance of Acanthosis nigricans?

A

AD

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39
Q

What endocrine abnormalitis is Acanthosis nigricans associated with?

A

DM

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40
Q

What other cancer is associated with Acanthosis nigricans, typically in persons of middle-age or older?

A

Internal adenocarcinoma (gastric carcinoma)

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41
Q

This is the lesion (aka acrochordon, squamous papilloma, or skin tag), around the neck.

A

Fibroepithelial polyp

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42
Q

What are the histological features of Fibroepithelial polyps?

A

Fibrovascular cores, covered by benign squamous epithelium

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43
Q

What 2 things are Fibroepithelial polyps assocaited within your body?

A

DM

Intestinal polyposis

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44
Q

These are lesions formed by the down growth and cystic expansion of the epidermis or keratinizing epitheloum forming the hair follicle.

A

Epithelial cyst (Wen)

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45
Q

What are Web filled with?

A

Keratin and various amts of admixed lipid containing debris from sebaceous glands.

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46
Q

Which form of Epithelial cyst are lined by benign epithelium resembling normal epidermis?

A

Epidermal inclusion cyst

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47
Q

Which form of Epithelial cyst are lined by epithelium resembling the follicular epithelium without a granular layer and are fileld with homogenous eosinophilic material that can undergo dystrophic calcification?

A

Pilar or Trichilemmal cysts

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48
Q

Which form of Epithelial cyst are similar to the epidermal inclusion cysts but it also shows epidermal appendages surrounding the wall of the cyst?

A

Dermoid cyst

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49
Q

Which form of Epithelial cyst are lined by epitheloum resembling a sebasceous gland duct in which there are numerous compressed lobules of sebaceous glands?

A

Stetocytoma multiplex

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50
Q

This is a rapidly developing neoplasm of the epidermis, resembles squamosu cell carcinoma, but is benign and heals spontaneously.

A

Keratoacantoma

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51
Q

What filles the fleshy dome Keratoacantomas?

A

Keratin (cup shaped)

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52
Q

This is the class of tumors which arise from the epidermal appendages (hair follicels, sebaceous glands, eccrine sweat glands and ducts, and apocrine sweat glands and ducts).

A

Adnexal (appendage) tumors

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53
Q

This is the lesion to sun-exposed skin that precedes invasive squamous cell carcinoma.

A

Actinic keratosis

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54
Q

What are the gross features of Actinic keratosis?

A

<1cm
Tan-brown/red/skin colored
Sandpaper consistency

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55
Q

This si the most common malignant tumor arising form sun-exposed areas in elderly pts.

A

Squamous cell carcinoma (SCC)

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56
Q

What are the risk factors for SCC?

A

Sun
Aresnic exposure
Chronic cutaneous ulcers
Xeroderma pigmentosum

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57
Q

True or False: SCC are sharply-defined, have red-scaling plaques, hyperkeratoic lesions, and have invasion through the BM.

A

False

They dont invade through the BM

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58
Q

Which lip does SCC present on?

A

Lower lip

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59
Q

What is it called when there is insitu SCC, and can presents as leukoplakia?

A

Bowen’s disease

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60
Q

These are common, slow-growing, cutanous carcinomas which rarely metastisize, often in sun-exposed areas, oftne in XP patients.

A

Basal cell carcinoma (BCC)

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61
Q

What is the gross appearance of BCC?

A

Pearly papules
Telangiectasias
Possible ulceration and invasion (rodent ulcers)

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62
Q

Which lip do BCC present on?

A

UPPER lip

“”"”B”””
(__S__)

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63
Q

Which cell layer of the epidermis does BCC resemble?

A

Basal layer

lol

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64
Q

What are the histplogical features of BCC?

A

Palisated growht of basaloid epithelial cells surrounded by a benign proliferation of fibroblasts.

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65
Q

Which type of BCC is aggressive and is composed of small nests of malignant cells surrounded by desmoplastic fibrous connective tissue?

A

Fibroblastic or Morphea subtype

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66
Q

What is teh Tx for BCC?

A

CUT IT OUT

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67
Q

This is the rare malignant neoplasm derived from Merkel cells, NCC derived.

A

Merkel cell carcinoma (cutaneous neuroendocrine carcinoma)

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68
Q

What ar ethe histological features of Merkel cell carcinoma?

A

Small, round, malignant cells which contain neurosecretory-type cytoplasmic granules

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69
Q

This is the heterogenous family of related benign dermal neoplasms of fibroblasts and histiocytes, seen in adults and seen in the legs of young and middle aged women?

A

Benign Fibrous Histiocytoma

70
Q

What are the gross features of Benign Fibrous Histiocytoma?

A

Tan-brown firm papules

Slightly tender

71
Q

What type of Benign Fibrous Histiocytoma is a benign prolfieration of fibroblasts with deposition of dense collagen and may show an infiltrate of histiocytes including foamy macrophages or even giant epitheloid histiocytes?

A

Dermatofibroma

72
Q

This is a well-differentiated primary fibrosarcoma of the skin, slow growing, locally aggressive, and rarely metastasize.

A

Dermatofibrosarcoma Protuberans

73
Q

What are the common location for theese firm, solid Dermatofibrosarcoma Protuberans?

A

Trunk

74
Q

What can Dermatofibrosarcoma Protuberans form, which there is a firm, indurated plaque and ulceration?

A

Protuberant tumors

75
Q

What are the histological features of Dermatofibrosarcoma Protuberans?

A

Atypical fibroblasts arranged in a basket-weave pattern (storiform)

76
Q

What is the Tx for Dermatofibrosarcoma Protuberans?

A

CUT IT OUT

77
Q

These are tumor-like collections of foamy histiocytes within the dermis, often assocaited with hyperlipidemia or lymphoproliferative malignancies.

A

Xantoma

78
Q

What type of xanthomas occur as sudden showers of yellow papules which increase and decrease secondary to variations in plasma triglyceride and lipid content, and occur on buttocks, posterior thighs, knees, and elbows?

A

Eruptive xanthomas

type I, IIB, III, IV, and V

79
Q

What type of xanthomas occur as yellow nodules and the tendinous type frequently are found on the Achilles tendon and extensor tendons of the fingers?

A

Tuberous and tendinous

80
Q

What type of xanthomas are linear yellow lesions in the skin folds, particularly the palmar creases?

A

Plane xanthomas

81
Q

Waht is the term for the soft yellow plaques on the eyelids?

A

Xanthelasma

82
Q

These are benign vascular neoplasms, malformations, multifocal angioproliferative, and malignant vascular tumors.

A

Dermal vascular tumors

83
Q

This is the disease where there is solitary or multiple lesions from papules to nodules to scaling erythematous plaques which in infants may resemble seborrheic dermatitis.

A

Histiocytosis X

aka Langerhans cell histiocytosis

84
Q

What are the histological features of Histiocytosis X?

A

Infiltration of skin by histiocytes which show Birbeck granules and eosinophilic granulomas

85
Q

This is the lymphoproliferative disorder, where there is scaly, red-brown pathces, raised, scaling plaques, and fungating nodules.

A

Mycosis fungiodes

cutaneous T-cell malignant lymphoma

86
Q

What is the condition in Mycosis fungiodes where there is malignant T-lymphoid cells accompaniesd by diffese erythema and scaling of the entire body surface?

A

Sezary syndrome

87
Q

What is the buzzoword for the Sezary cell hsitological features?

A

Cerebriform contour

88
Q

What is the treatment for early Mycosis fungiodes?

A

Topical glucocorticoids or UV light

89
Q

This is the spectrum of various cutaneous disorders which are characterized by the infiltration of mast cells in the skin.

A

Mastocytosis

90
Q

What is the form of Mastocytosis where there is a localized cutaneous form of this disease which predominantly affects children and accounts for more than 50% of all cases?

A

Urticaria pigmentosa

91
Q

What are the gross features of Urticaria pigmentosa?

A

multiple and widely distributed red-brown non-scaling papules and small plaque (can be solitary too)

92
Q

This is a sign of Urticaria pigmentosa where there is a localized area of dermal edema and erythema (wheal) which occurs when lesional skin is rubbed.

A

Darier’s sign

93
Q

This is a sign of uticaria pigmentosum where there is an area of dermal edema resembling a hive which occurs in normal skin as the result of localized stroking with a pointed instrument.

A

Dermatographism

94
Q

Which stains can see uricaria pigmentosums?

A

Metachromatic stains (toluidine blue or Giemsa)

95
Q

This a common disorder of skin characterized by localized mast cell degranulation and resultant dermal microvascular hyperpermeability which results in pruritic edematous plaques known as wheals.

A

Uticaria (hives)

96
Q

What is the thing that is closely related to uticaria and is characterized by edema of deeper dermis and subcutaneous adipose tissue?

A

Angioedema

97
Q

What are the gross features of Uticaria?

A

small, pruritic papules to large edematous plaques

98
Q

What are the histological features of uticaria?

A

there is a very sparse, superficial, peri-vascular infiltrate of lymphocytes, histiocytes, eosinophils, and rare neutrophils

99
Q

What type of HS rxn is uticaria?

A

type I

IgE stuff

100
Q

What is the condition where there is an inherited deficiency of C1 activator (C1 esterase inhibitor) which results in uncontrolled activation of early components of the complement system?

A

Hereditary angioneurotic edema

101
Q

This is the conditon where there is red, papulovesicular, oozing, and crusted lesions, and with persistence will change into raised, scaling plaques.

A

Eczematous dermatitis

102
Q

What type of HS rxn is Eczematous dermatitis?

A

Type I

103
Q

What 2 conditions is Eczematous dermatitis associated with?

A

Asthma and allergic rhinitis

104
Q

This is a rare, self-limited skin disorder which is believed to be a hypersensitivity response to certain infections and drugs, has a cytotoxic rxn pattern and can affect anyone.

A

Erythema multiforme

105
Q

What infections can cause Erythema multiforme?

A 
Mycoplasma
HSV
Histoplasmosis
Coccidiomyosis
Typhoid fever
Leprosy
106
Q

What drugs can cause Erythema multiforme?

A

Sulfonamides
PCN

Barbs, sailcylates, hydantoins, and antimalarials

107
Q

What cancers can cause Erythema multiforme?

A

Carcinomas

Malignant lymphomas

108
Q

What collagen vascular diseases can cause Erythema multiforme?

A

SLE
Dermatomyositis
PAN

109
Q

What is the typical gross morphology of erythema multiforme?

A

target lesion which consists of red macule or papule with a pale vesicular or eroded center

110
Q

What is the condition of erythema multiforme where there is an extensive and symptomatic febrile issue in kids?

A

Stevens-Johnson syndrome

111
Q

Where are the lesions in Stevens-Johnson syndrome?

A

Oral mucosa

conjuntiva, urethra, junk

112
Q

What is the severe variant of Stevens-Johnson syndrome where there is diffuse necrosis and sloughing of the entire cutaneous and the mucosal epithelial surfaces, and can result in a clinical syndrome analogous to an extensive burn?

A

Toxic epidermal necrolysis

113
Q

This is an inflammatory reaction of the subcutaneous adipose tissue which can affect either principally the connective tissue septa separating lobules of fat or predominantly the lobules of fat themselves.

A

Panniculitis

114
Q

What is the most common form of panniculitis and usually shows an acute presentation, and is often associated with various infections, drugs, sarcoidosis, IBD, cancers, and idiopathic?

A

Erythema nodosum

115
Q

Where does panniculitis usually affect?

A

Lower legs

116
Q

What are the Sx to erythema nodosum?

A

Poorly defined, tender, fever, malaise, eventually flatten and do not leave scars.

117
Q

This is a rare type of panniculitis which usually occurs in adolescence and menopausal women, occurs as the result of a primary vasculitis which affects the deep blood vessels.

A

Erythema iduratum

118
Q

What are the Sx to erythema iduratum?

A

erythematous, slightly tender nodule which usually goes on to ulcerate

119
Q

This is a rare form of lobular, nonvasculitic panniculitis which is most often seen in children and adults, consists of erythematous plaques or nodules, occurs predominantly on lower extremities, and shows aggregates of foamy histiocytes which are admixed with lymphocytes, neutrophils and giant epithelioid phistiocytes

A

Weber-Christian disease

relapsing febrile nodular panniculitis

120
Q

This is the form of panniculitis from trauma.

A

Factitial panniculitis

121
Q

What are the initial histological features of erythema nodosum?

A

widening of the connective tissue septa in early lesions secondary to edema, fibrin deposition and infiltrate of neutrophils

122
Q

What are the later histological features of erythema nodosum?

A

infiltration with lymphocytes, histiocytes, multi-nucleated epithelioid histiocytes.

Vasculitis is not present in erythema nodosum.

123
Q

What are the histological features of erythema induratum?

A

fat lobule showing granulomatous inflammation and zones of caseous necrosis, and early lesions show necrotizing vasculitis which affects small to medium-sized arteries in deep dermis and subcutis

124
Q

What ar ethe common locations for psoriasis?

A

elbows, knees, scalp, lumbosacral areas, intergluteal cleft, and the glans penis (all areas of trauma)

125
Q

What are the gross features of psoriasis?

A

well-demarcated pink (salmon) plaque covered by loosely adherent silver-white scale

126
Q

What is the rare form of psoriasis where there are multiple small pustules, local or systemic, and potentially life-treatening?

A

Pustular psoriasis

127
Q

What are the histological fetures of psoriasis?

A

Acanthosis
Squirting papillae
Parakeratoic scale

128
Q

What is the sign for psoriasis where the parakeratoic scale bleeds when lifted?

A

Auspitz sign

129
Q

What is the term in psoriasis where neutrophils form small aggregates in the perakeratoic scale of the stratum corneum?

A

Munro’s microabscesses

130
Q

What HLA is psoriasis associated with?

A

HLA-C

131
Q

What is the Tx of psoriasis?

A

Corticosteroids, UVA with psoralen, or immune-modulating therapy

132
Q

What is the condition where there is Pruritic, flat Papules which form Plaques?

A

Lichen “P”lanus

133
Q

What is the term for the white dots or lines of the Papules in Lichen Planus?

A

Wickham’s striae

134
Q

Where are the common locations for Lichen Planus?

A

Extremitis and glans penis

135
Q

Why do we say there is a “saw-tooth” appearance to the Lichen Planus on histology?

A

Vacuolar degeneration dermoepidermal junction and moderate to severe band-like infiltrate of lymphocytes and histiocytes which hugs the dermoepidermal junction

136
Q

What infeciton is assocaited with Lichen Planus?

A

HCV

137
Q

What form of Lichen Planus affects the epithelium of hair follicles, particularly in the scalp?

A

Lichen Planopilaris

138
Q

What are the gross characteristics of the cutaneous lesions in SLE?

A

consist of either poorly defined malar erythema on the face (usually seen in SLE) or large, sharply demarcated erythematous scaling plaques

139
Q

Exposure to what makes things worse in SLE?

A

The sun

140
Q

In SLE, what is identified at the dermo-epidermal junction along with a mild superficial and deep peri-vascular and peri-appendageal ?

A

Vacuolar degneration

141
Q

What structure does acne surroung?

A

Hair follicle

142
Q

What is teh noninflammatory type of acne where there a small follicular papule containing a central black keratin plug and the color is the result of oxidation of the melanin pigment and not dirt?

A

Comedones

143
Q

What substance rapidly expand in comedones, which causes dilation of the hair follicle, inflammatory infiltrate, and rupture of the follicle?

A

Keratin and lipid material

144
Q

What enzyme does P. acnes release to cause release of proinflammatory fatty acids, resulting in pustule or nodule formation?

A

Lipases

145
Q

How does benzoyl peroxide treat acne?

A

Antimicrobial

146
Q

How does vitamin A treat acne?

A

Reduces keratin production

147
Q

This is a rare autoimmune blistering disorder which occurs because of the loss of normal intercellular attachments between normal keratinocytes of the epidermis and squamous mucosal epithelium.

A

Pemphigus

148
Q

What is the msot common pemphigus, which are superficial vesicles and bullae which rupture easily and leave shallow erosions covered with serum and crust, typically from the oral region?

A

Pemphigus vulgaris

149
Q

What is the rare form of pemphigus which presents not with blisters, but with moist verrucous (wart-like) plaques usually associated with pustules on groin, axilla, and flexural surfaces of the skin?

A

Pemphigus vegetans

150
Q

Waht form of pemphigus is epidemic to south america, and the bullae are very superficial so that zones of erythema and crusting from sites of previous rupture are identified on physical examination?

A

Pemphigus foliaceus

151
Q

What form of pemphigus is a localized, less severe form of pemphigus foliaceus which can involve the malar area of the face similar to lupus erythematosus?

A

Pemphigus erythematosus

152
Q

What happens to the dermis in all forms of pemphigus?

A

Acantholysis

153
Q

Which layer of the epidermis has acantholysis in pemphigus vulgaris and vegetans?

A

Striatum spinosum

154
Q

Which type of pemphigus has suprabasal layers, and the basal layer reamins attached to the BM via hemidesmosomes (tombstone appearance)?

A

Pemphigus folicaeus and erythematosus

155
Q

What Ig is seen along the borgers of keratinocytes in the epidermis in pemphigus?

A

IgG

156
Q

What is the term/sign where the tin-walled bulale rupture easily, leading to shallow erosions with dried crust in pemphigus?

A

Nikolsky sign

157
Q

Where will the IgG’s be directed to cause Pemphigus?

A

Demoglein (cement substance)

158
Q

What is the pattern of IgG on IF in Pemphigus that surroudns the keratinocytes?

A

Fish Net pattern

159
Q

This is an autoimmune bullous disease (against hemidesmosomes between basal cells and the underlying BM) usually affecting elderly patients.

A

Bullous pemphigoid

160
Q

Do the bullae rupture more or less easily in Bullous pemphigoid than Pemphigus?

A

Less easily

161
Q

Know these things

A

malignant melanoma (granular layer down will determine the rate of metastasis)

merkel cell carcinoma (it’s a neuroendocrine proliferation)

morphea subtype of BCC is the most aggressive

mycoses fungiodes is CD3/CD4+

Koebner phenomenon is psoriasis at the point of trauma

162
Q

What is the gross presentation of Bullous pemphigoid?

A

a subepidermal, nonacantholytic blister

163
Q

What is the pattern of IgG deposition in Bullous pemphigoid on IF?

A

linear basement zone deposition

164
Q

This is the Autoimmune deposition of IgA at the tips of dermal papillae.

A

Dermatitis herpetiformis

165
Q

What GI condition is Dermatitis herpetiformis associated with?

A

Celiac disease

166
Q

What is the treatment for Dermatitis herpetiformis?

A

Gluten-free diet

167
Q

What is the major Sx to the lesions of Dermatitis herpetiformis?

A

Extremely pruritic

168
Q

What form of pophyrias have urticaria and vesicles which heal with scarring and are exacerbated by exposure to sunlight?

A

Porphyria cutanea tarda

169
Q

What is is a group of disorders which have in common blisters which develop at sites of pressure, rubbing or trauma at or soon after birth?

A

Epidermolysis bullosa

170
Q

What form of Epidermolysis bullosa has blisters that occur in histologically normal skin at the level of lamina lucida?

A

Junctional type

171
Q

What form of Epidermolysis bullosa has blisters that develops beneath lamina densa supposedly with defective anchoring fibrils to the dermis?

A

Scarring dystrophic type

172
Q

What form of Epidermolysis bullosa has degeneration of basal cell layer of epidermis results in bullae?

A

Simplex type

Dermatology (4 decks)

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