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Anatomic pathology > Skin > Flashcards

Skin Flashcards

0
Q

Vitiligo: Typically spared areas (2).

A

Scalp and eyelashes.

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1
Q

Dermatophytosis: The “sandwich sign”.

A

Fungal hyphae between the parakeratotic layer and the overlying orthokeratosis.

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2
Q

Urticarial vasculitis:

A. Clinical features (3).
B. Duration of urticaria.

A

A. Recurrent urticaria, arthralgia, abdominal pain.

B. More than 24 hours.

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3
Q

Urticarial vasculitis: Histology.

A

Leukocytoclastic vasculitis without significant fibrin in vascular walls.

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4
Q

Urticarial vasculitis: Useful adjunctive laboratory tests (2).

A

Complement studies (CH50, C1q-binding assays).

DFA: May show vascular deposits of complement, immunoglobulins, or fibrin.

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5
Q

Urticarial vasculitis: Clinical associations (3).

A

Infectious hepatitis.

Infectious mononucleosis.

Autoimmune diseases.

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6
Q

Telangiectasia macularis eruptiva perstans: Histologic differences from urticaria (2).

A

Mast cells rather than eosinophils.

No significant dermal edema.

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7
Q

Lichen planus: Microbiological association.

A

Hepatitis C.

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8
Q

Lichen planus: Anatomic predilection of lesions (3).

A

Flexor surfaces.

Lower back.

Glans penis.

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9
Q

Oral lichen planus: Histologic differences from lichen planus of skin (3).

A

Parakeratosis.

Less epidermal hyperplasia.

Frequent ulceration.

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10
Q

Lichenoid drug eruption: Histologic differences from lichen planus (2).

A

Parakeratosis.

Eosinophils (sometimes).

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11
Q

Lichen striatus:

A. Age group.
B. Clinical appearance.

A

A. Children.

B. Unilateral eruption on extremities, trunk, neck.

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12
Q

Lichen striatus: Histologic differences from lichen planus.

A

Inflammatory infiltrate deep in reticular dermis around hair follicles and sweat glands.

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13
Q

Lichen nitidus:

A. Age group.
B. Clinical appearance.

A

A. Children.

B. Small, flat-topped papules.

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14
Q

Lichen nitidus: Histologic differences from lichen planus (4).

A

“Ball-in-claw” infiltrate.

Focal parakeratosis.

Epidermal atrophy.

Many histiocytes.

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15
Q

Lichen planopilaris vs. alopecia areata: Histology (2).

A

Lichen planopilaris: Infiltrate at base of follicular bulb; scarring.

Alopecia areata: Infiltrate along infundibulum; usually no scarring.

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16
Q

Erythema multiforme:

A. Infectious cause.
B. Pharmacological cause.

A

A. HSV.

B. Sulfonamides.

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17
Q

Toxic epidermal necrolysis: Drugs that cause it (3).

A

Sulfonamides.

β-lactam antibiotics.

NSAIDs.

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18
Q

Erythema multiforme: Histological feature of late lesion.

A

Dermal melanophages.

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19
Q

Erythema multiforme: Immunofluorescence.

A

IgM and C3 in the walls of superficial dermal vessels.

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20
Q

Angioedema: Histology.

A

Extension of the edema into the subcutis.

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21
Q

Acute GVHD:

A. Timing.
B. Clinical triad.

A

A. Within 3 months after transplant.

B. Rash, diarrhea, liver dysfunction.

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22
Q

Acute GVHD: Grade I.

A

Vacuolar change in basement membrane.

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23
Q

Acute GVHD: Grade II.

A

Necrotic keratinocytes, satellite necrosis.

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24
Q

Acute GVHD: Grade III.

A

More widespread necrosis of keratinocytes; separation at dermoepidermal junction.

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25
Q

Acute GVHD: Grade IV.

A

Full-thickness necrosis and loss of epidermis.

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26
Q

Chronic GVHD: Early phase.

A

Lichenoid, resembling lichen planus; satellite necrosis may be seen.

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27
Q

Chronic GVHD: Late phase.

A

Sclerosis, resembling scleroderma, but with epidermal atrophy.

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28
Q

Discoid lupus: Histology (4).

A

Hyperkeratosis with follicular plugging.

Epidermal atrophy.

Basal vacuolar change.

Thickened basement membrane.

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29
Q

Verrucous lesions of lupus: Histology (2).

A

Epidermal hyperplasia, papillomatosis.

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30
Q

Tumid lupus: Histology.

A

Superficial and deep infiltrate that spares epidermis; increased dermal mucin.

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31
Q

Lupus panniculitis: Histology.

A

Lobular panniculitis with hyaline fat necrosis.

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32
Q

Subacute and neonatal lupus: Histologic differences from discoid lupus (3).

A

Subacute and neonatal lupus show

− Prominent changes at the D-E junction.
− Less hyperkeratosis.
− Less inflammation.

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33
Q

Cutaneous lupus: Immunofluorescence.

A

Continuous granular deposition of IgG, IgM, and C3 at the dermoepidermal junction.

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34
Q

Cutaneous lupus: How to distinguish from polymorphous light eruption.

A

PLE: More papillary dermal edema than tumid lupus; no dermal mucin.

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35
Q

Cutaneous lupus: Lymphoma that may be in the differential diagnosis.

A

Subcutaneous panniculitis-like T-cell lymphoma must be distinguished from lupus panniculitis.

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36
Q

Lupus band test.

A

Direct immunofluorescence . . .

Discoid lupus: Positive in lesional skin only.

Systemic lupus: Positive in “normal” skin as well.

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37
Q

Anatomic location:

A. Heliotrope rash.
B. Gottron’s papules.

A

A. Eyelids.

B. Knuckles, knees, elbows.

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38
Q

Dermatomyositis may resemble which type of cutaneous lupus histologically?

A

Subacute lupus.

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39
Q

Dermatomyositis: Age group.

A

Children.

Adults aged 45-65.

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40
Q

Dermatomyositis: Immunofluorescence.

A

C5b-C9 around blood vessels.

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41
Q

Dermatomyositis: Lupus-band test.

A

Negative.

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42
Q

Id reaction:

A. Synonym.
B. Leading cause.

A

A. Autoeczematization.

B. Remote dermatophytosis.

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43
Q

Spongiotic dermatitis: Changes that indicate chronicity (3).

A

Epidermal hyperplasia.

Hyperkeratosis.

Papillary dermal fibrosis.

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44
Q

Seborrheic dermatitis: Histology (2).

A

Mild spongiosis.

Parakeratosis at follicular ostia.

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45
Q

Pityriasis rosea: Histology (3).

A

Focal spongiosis.

Mounds of parakeratosis.

Extravasated erythrocytes.

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46
Q

Eosinophilic spongiosis: Differential diagnosis (4).

A

Allergic contact dermatitis.

Bullous pemphigoid, early.

Pemphigus, early.

Incontinentia pigmenti.

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47
Q

Incontinentia pigmenti:

A. Inheritance.
B. Epidemiology.

A

A. X-linked dominant.

B. Mostly females.

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48
Q

Histology of incontinentia pigmenti: Vesicular stage (3).

A

Eosinophilic spongiosis.

Single dyskeratotic keratinocytes.

Whorls of squamous cells.

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49
Q

Histology of incontinentia pigmenti: Verrucous stage (4).

A

Hyperkeratosis.

Papillomatosis.

Dyskeratosis.

Occasional eosinophils.

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50
Q

Incontinentia pigmenti: Gene and its location.

A

IKBKG (a.k.a. NEMO) on Xp28.

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51
Q

Histology of incontinentia pigmenti:

A. Hyperpigmented stage.
B. Hypopigmented stage (3).

A

A. Many melanophages in the upper dermis.

B. Epidermal atrophy, loss of melanin, loss of adnexa.

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52
Q

Psoriasis: Anatomic sites (3).

A

Scalp.

Lumbosacral skin.

Extensor surfaces.

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53
Q

Psoriasis: Eponymous collections of neutrophils.

A

Microabscesses of Munro (stratum corneum).

Spongiform pustules of Kogoj (stratum spinosum).

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54
Q

Psoriasis: Appearance of granular layer.

A

Hypogranulosis underlying areas of parakeratosis.

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55
Q

Guttate psoriasis: Histology.

A

Less epidermal hyperplasia than in classic psoriasis.

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56
Q

Psoriatic arthritis:

A. Incidence.
B. Affected joints.

A

A. 15% of patients with psoriasis.

B. The DIP joints.

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57
Q

Psoriasis: Risk factor for severe disease.

A

AIDS.

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58
Q

Pityriasis rubra pilaris: Clinical appearance of fully developed disease.

A

Orange-red scaly plaques containing islands of normal skin.

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59
Q

Pityriasis rubra pilaris:

A. Stratum corneum.
B. Follicles.

A

A. Horizontal and vertical alternation of orthokeratosis and parakeratosis.

B. Dilatation of infundibula; follicular plugging.

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60
Q

Pityriasis rubra pilaris: Histological differences from psoriasis (4).

A

Thick suprapapillary plates.

Short, thick rete pegs.

Hypergranulosis.

No neutrophils in the parakeratotic layer.

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61
Q

Polymorphous light eruption: Typical patient and season.

A

Young woman, summer.

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62
Q

Polymorphous light eruption: Anatomic distribution.

A

Upper chest, extensor surfaces of arms.

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63
Q

Polymorphous light eruption: Histology (3).

A

Normal or slightly spongiotic epidermis.

Marked papillary dermal edema.

Superficial and deep perivascular lymphocytes.

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64
Q

Pityriasis lichenoides: Histology (5).

A

Parakeratosis and scale-crust.

Spongiosis and necrotic keratinocytes.

Basal vacuolar change.

Papillary dermal edema with extravasated RBCs.

Lymphocytes obscure the DEJ and form superficial and deep perivascular infiltrates.

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65
Q

Pityriasis lichenoides et varioliformis acuta, ulceronecrotic variant: Histology.

A

There may be lymphocytic vasculitis.

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66
Q

Pityriasis lichenoides: Distinction from lymphomatoid papulosis.

A

The latter has atypical, CD30-positive lymphocytes.

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67
Q

Fixed drug eruption: Histology (4).

A

Basal vacuolar change that may progress into bullae.

Necrotic keratinocytes.

Superficial and deep perivascular lymphocytes, neutrophils, eosinophils; sometimes also lichenoid.

Melanophages in the upper dermis.

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68
Q

Fixed drug eruption: Distinction from erythema multiforme.

A

Not always possible, but fixed drug eruption is more likely when there is a deeper infiltrate that includes neutrophils and eosinophils.

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69
Q

Fixed drug eruption: Instigators (3).

A

Sulfa drugs.

Aspirin.

Phenolphthalein.

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70
Q

Lymphomatoid papulosis: Infiltrate.

A

Wedge-shaped and consists of neutrophils, eosinophils, plasma cells, and atypical lymphocytes.

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71
Q

Lymphomatoid papulosis: Morphology of atypical lymphocytes.

A

May resemble the cells of

Mycosis fungoides (cerebriform nuclei).

Hodgkin’s lymphoma (Reed-Sternberg cells)

Anaplastic large-cell lymphoma.

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72
Q

Lymphomatoid papulosis: Feared outcome.

A

Progression to anaplastic large-cell lymphoma.

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73
Q

Secondary syphilis: Histology (5).

A

Parakeratosis with neutrophils.

Psoriasiform epidermal hyperplasia.

Focal spongiosis.

Basal vacuolar change.

Lichenoid mononuclear inflammation.

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74
Q

Lues maligna: Histology.

A

Thrombotic endarteritis of deep dermal vessels, leading to ischemic necrosis and ulceration.

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75
Q

Sweet’s syndrome: Clinical triad.

A

Fever.

Rash.

Leukocytosis.

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76
Q

Sweet’s syndrome: Anatomic locations of rash.

A

Face.

Trunk.

Extremities.

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77
Q

Sweet’s syndrome: Association (3).

A

AML or other myeloproliferative neoplasm.

Inflammatory disease.

Solid tumor.

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78
Q

Sweet’s syndrome: Histology (3).

A

Dense infiltrate of neutrophils with nuclear dust but without leukocytoclastic vasculitis.

Papillary dermal edema.

Dilated blood vessels with plump endothelial cells and extravasated RBCs.

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79
Q

Pyoderma gangrenosum: Associations (4).

A

Connective-tissue disease.

Hematopoietic malignancy.

Inflammatory bowel disease.

Liver disease.

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80
Q

Pyoderma gangrenosum: Inflammation.

A

Center of lesion: Neutrophils.

Border: Mixed infiltrate.

Periphery: Mononuclear.

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81
Q

Pyoderma gangrenosum: Vasculitis.

A

Secondary vasculitis may arise in the necrotic, neutrophil-rich center.

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82
Q

Pyoderma gangrenosum in Crohn’s disease.

A

May contain granulomas.

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83
Q

Eosinophilic cellulitis: Clinical presentation.

A

Red patches evolve into painful plaques; recurrent.

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84
Q

Eosinophilic cellulitis: Association with peripheral eosinophilia.

A

Seen in at least half of cases.

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85
Q

Eosinophilic cellulitis: Histology (3).

A

Dense, diffuse dermal infiltrate of eosinophils, sometimes with

− Flame figures.
− Necrobiosis with palisades of histiocytes.

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86
Q

Eosinophilic cellulitis: Possible causes (5).

A

Insect bites.

Parasites.

Infections.

MPNs.

Drugs.

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87
Q

Scabies: Name of mite.

A

Sarcoptes scabei.

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88
Q

Scabies: Most common sites of burrows (3).

A

Webs between fingers.

Palms.

Male genitals.

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89
Q

Xanthogranuloma: How many are congenital?

A

About 20%.

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90
Q

Xanthogranuloma: Constituent cells.

A

Histiocytes.

Touton giant cells.

Neutrophils, eosinophils, lymphocytes.

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91
Q

Xanthogranuloma: Immunohistochemical distinction from Langerhans’ cell histiocytosis.

A

Langerhans’ cells express CD1a, S100, and langerin.

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92
Q

Reticulohistiocytosis: Clinical forms.

A

Localized: Limited to skin.

Systemic: Involves skin, heart, bone, joints, lymph nodes.

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93
Q

Systemic reticulohistiocytosis: Associations (3).

A

Hyperlipidemia.

Internal malignancies.

Autoimmune disease.

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94
Q

Reticulohistiocytoma: Morphology of defining cell.

A

Epithelioid histiocyte with abundant, pale-pink, glassy cytoplasm.

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95
Q

Granuloma annulare: Typical anatomic sites.

A

Dorsa of hands and feet, knees, ankles, elbows.

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96
Q

Granuloma annulare: Distribution of histiocytes.

A

Palisaded, interstitial, or a combination of both.

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97
Q

Granuloma annulare: Histological distinction from rheumatoid nodule.

A

Rheumatoid nodule:

  • Necrobiosis is more eosinophilic and sometimes fibrinoid; no mucin.
  • Subcutaneous location.
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98
Q

Granuloma annulare in children.

A

May be subcutaneous and hence difficult to distinguish from rheumatoid nodule.

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99
Q

Rheumatoid nodule: Anatomic sites (2).

A

PIP joints, MCP joints.

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100
Q

Necrobiosis lipoidica: Classic anatomic site.

A

Shins.

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101
Q

Necrobiosis lipoidica: Appearance of necrobiosis.

A

Basophilic degeneration of collagen.

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102
Q

Necrobiosis lipoidica: Relevance to diabetes (2).

A

Occurs in less than 1% of diabetics.

Occurs at a later age in diabetics than in non-diabetics.

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103
Q

Necrobiotic xanthogranuloma:

A. Clinical association.
B. Typical anatomic location.

A

A. Paraproteinemia.

B. Periorbital skin.

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104
Q

Necrobiotic xanthogranuloma: Histology (3).

A

Foam cells, Touton giant cells, lymphocytes.

Intervening zones of necrobiosis.

Lymphoid follicles sometimes.

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105
Q

Lupus pernio:

A. Site of lesions.
B. Clinical significance.

A

A. Central face.

B. Increased risk of pulmonary sarcoidosis.

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106
Q

Löfgren’s syndrome: Clinical triad.

A

Hilar adenopathy, acute polyarthritis, erythema nodosum.

A variant presentation of sarcoidosis.

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107
Q

Sarcoidosis: Appearance of granulomas.

A

Noncaseating; minimal peripheral lymphocytic infiltrate.

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108
Q

Sarcoidosis: Appearance of panniculitis.

A

Lobular pattern; noncaseating granulomas.

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109
Q

Foreign substances that can cause sarcoidal granulomas (3).

A

Silica.

Beryllium.

Zirconium.

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110
Q

Inflammatory infiltrate of leprosy:

A. Tuberculoid.
B. Lepromatous.
C. Borderline.

A

A. Granulomas.

B. Foam cells; few lymphocytes.

C. Foam cells and epithelioid histiocytes in poorly formed granulomas; many lymphocytes.

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111
Q

Leprosy: Where to find organisms.

A

Abundant in lepromatous leprosy; few in tuberculoid leprosy.

Found in histiocytes, nerves, arrectores pilorum.

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112
Q

Histoid leprosy.

A

Histologically resembles a histiocytoma but is full of acid-fast bacilli.

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113
Q

Lupus vulgaris: Etiologies (2).

A

Hematogenous spread to skin from reactivated pulmonary focus of TB.

Lymphatic spread to skin from cervical lymph nodes.

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114
Q

Lupus vulgaris:

A. Anatomic site.
B. Clinical course.

A

A. Central face.

B. Peripheral extension with atrophy and occasional ulceration.

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115
Q

Lupus vulgaris: Histology (3).

A

Tuberculoid granulomas with little or no caseation.

In older lesions, fibrosis replaces granulomas.

Epidermis may be atrophic, ulcerated, or hyperplastic.

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116
Q

Lupus vulgaris: Demonstration of bacilli.

A

Special stains rarely help.

PCR is better.

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117
Q

Lupus vulgaris: Complication.

A

Development of SCC or BCC.

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118
Q

Deep mycoses: Typical histology.

A

Pseudoepitheliomatous hyperplasia with extensive dermal suppurative and granulomatous inflammation.

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119
Q

Deep mycoses: Appearance of panniculitis.

A

Lobular; suppurative and granulomatous.

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120
Q

Blastomycosis: Histology of spores (3).

A

8-15 μm, thick-walled, broad-based budding.

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121
Q

Paracoccidiomycosis: Histology of spores (2).

A

6-20 μm, narrow-based budding.

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122
Q

Chromoblastomycosis: Histology of spores (3).

A

6-12 μm, thick-walled, dark-brown and in clusters (“copper pennies”).

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123
Q

Cryptococcus: Histology of spores.

A

2-4 μm (4-12 μm with capsule), narrow-based budding.

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124
Q

Histoplasmosis: Histology of spores.

A

2-4 μm, clear halo.

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125
Q

Sporotrichosis: Histology of spores.

A

4-6 μm, round or oval.

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126
Q

Pseudoepitheliomatous hyperplasia with suppurative and granulomatous inflammation: Differential diagnosis (3).

A

Deep mycoses.

Atypical mycobacterial infections.

Halogenodermas.

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127
Q

Cryptococcus: Alternative histology.

A

Xanthomatous infiltrate, especially in the immunocompromised.

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128
Q

Tuberculoid leprosy: Appearance of granulomas.

A

Elongated, surrounded by lymphocytes, arranged along neurovascular bundles.

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129
Q

Cutaneous leishmaniasis: Causes (3).

A

Old World: L. tropica.

New World: L. brasiliensis, L. mexicana.

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130
Q

Cutaneous leishmaniasis: Detection of parasites in a biopsy (2).

A

More likely to be seen in early lesions.

Giemsa stain can help.

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131
Q

Cutaneous leishmaniasis: Histology of late lesion.

A

Tuberculoid granulomas and lymphocytes.

Parasites may be undetectable.

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132
Q

Rhinoscleroma: Classic cell.

A

Mikulicz cell: Large histiocyte.

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133
Q

Granuloma inguinale:

A. Cause.
B. Inflammatory infiltrate.
C. Classic histologic finding.

A

A. Calymmatobacterium granulomatis.

B. Histiocytes and neutrophils.

C. Donovan body: Encapsulated, round to oval, 2-3 μm.

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134
Q

Leukocytoclastic vasculitis: Typically affected vessel in the skin.

A

Superficial dermal postcapillary venule.

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135
Q

Leukocytoclastic vasculitis: Bacterial cause.

A

Neisseria meningitidis.

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136
Q

Leukocytoclastic vasculitis: Immunofluorescence (2).

A

Most cases: IgM, C3, and fibrinogen around dermal vessels.

Henoch-Schönlein purpura: IgA.

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137
Q

Leukocytoclastic vasculitis: Chronic forms (2).

A

Erythema elevatum diutinum.

Granuloma faciale.

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138
Q

Livedo vasculitis: Anatomic location.

A

Lower legs.

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139
Q

Livedo vasculitis: Histology.

A

Fibrinoid matter in vessel walls leads to occlusion and ulceration.

Usually little inflammation.

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140
Q

Septic vasculitis: Histology.

A

Thrombi accompany leukocytoclastic vasculitis.

There may be intraepidermal pustules.

141
Q

Causes of noninflammatory vasculitis of small vessels with deposits of pink matter in and around vascular lumens (4).

A

Monoclonal cryoglobulinemia.

TTP.

Warfarin- or heparin-induced vasculitis.

142
Q

Superficial migratory thrombophlebitis: Associations (3).

A

Malignancy.

Hypercoagulable states.

Behçet’s disease.

143
Q

Superficial migratory thrombophlebitis: Typically affected vessel.

A

Small or medium-sized vein in deep dermis or subcutis of lower extremity.

144
Q

Superficial migratory thrombophlebitis: Histology (3).

A

Occluding thrombus.

Neutrophils, lymphocytes, and histiocytes infiltrate muscle of vein.

Recanalization and resorption of thrombus occur with granulomatous reaction.

145
Q

Superficial migratory thrombophlebitis: Histologic distinction from nodular vasculitis.

A

Nodular vasculitis affects arteries as well as veins.

146
Q

Subcorneal pustular dermatosis: Clinical appearance.

A

Sterile pustules involving flexural surfaces and axillary and inguinal folds.

Groups of pustules may assume annular or serpiginous patterns.

147
Q

Subcorneal pustular dermatosis: Histology (2).

A

Neutrophils beneath the stratum corneum and around superficial vessels.

Mild acantholysis may occur.

148
Q

Subcorneal pustular dermatosis: Helpful ancillary tests.

A

Gram stain to exclude bullous impetigo.

Immunofluorescence to exclude autoimmune bullous diseases.

149
Q

Subcorneal pustular dermatosis: Possible clinical association.

A

Monoclonal gammopathy, esp. IgA.

150
Q

Pustular drug eruption / acute exanthematous pustular dermatosis: Histology (3).

A

Subcorneal or intraepidermal pustules.

Spongiosis.

Dermal eosinophils.

151
Q

Pemphigus: Clinical appearance of bullae.

A

Large, flaccid, fragile; positive Nikolsky’s sign.

152
Q

Pemphigus: Anatomic distribution.

A

Scalp, around eyes, sternum, mid-back, umbilicus, groin.

Oral lesions can occur.

153
Q

Pemphigus vulgaris: Histology of early lesion.

A

Eosinophilic spongiosis.

154
Q

Pemphigus vulgaris:

A. Location of split.
B. Contents of bulla.
C. Inflammatory infiltrate.

A

A. Suprabasal.

B. Acantholytic keratinocytes.

C. Superficial dermal, often with eosinophils.

155
Q

Pemphigus vegetans.

A

Variant of pemphigus vulgaris in which lesions heal with verrucous vegetations.

156
Q

IgA pemphigus:

A. Histology.
B. Antigen.

A

A. Resembles subcorneal pustular dermatosis.

B. Desmocollin.

157
Q

Pemphigus vulgaris: Direct immunofluorescence.

A

Intercellular IgG.

158
Q

Location of staining by direct immunofluorescence in

A. Pemphigus vulgaris.
B. Pemphigus vegetans.
C. Pemphigus foliaceus.

A

A,B. Deep epidermis.

C. Superficial epidermis.

159
Q

Location of staining by direct immunofluorescence in pemphigus erythematosus.

A

Superficial epidermis, or along the DEJ as in SLE.

160
Q

Paraneoplastic pemphigus: Characteristic histological feature.

A

Interface dermatitis.

161
Q

Paraneoplastic pemphigus: Direct immunofluorescence (2).

A

Intercellular IgG.

Granular IgG or IgM at DEJ may also be seen.

162
Q

Paraneoplastic pemphigus:

A. Antigen.
B. Substrate for indirect immunofluorescence.

A

A. Desmoplakin.

B. Rat bladder.

163
Q

Antigens involved in

A. Pemphigus vulgaris.
B. Pemphigus erythematosus.

A

A. Desmoglein III.

B. Desmoglein I, desmoglein III.

164
Q

Hailey-Hailey disease:

A. Inheritance.
B. Histologic features not found in pemphigus vulgaris.

A

A. Autosomal dominant.

B. Full-thickness acantholysis, sparing of follicular epithelium.

165
Q

Grover’s disease: Histologic distinction from pemphigus vulgaris.

A

Grover’s disease:

Acantholysis is more focal.

A single specimen may show a combination of keratinocytic abnormalities.

166
Q

Darier’s disease:

A. Inheritance.
B. Clinical appearance.

A

A. Autosomal dominant.

B. Hyperkeratotic papules in a follicular distribution.

167
Q

Darier’s disease: Histologic features not found in pemphigus vulgaris.

A

Corps ronds, grains.

Both diseases show suprabasal acantholysis.

168
Q

Staphylococcal scalded-skin syndrome: Location of split.

A

In the granular layer.

169
Q

Bullous pemphigoid: Clinical appearance of bullae.

A

Large, tense; negative Nikolsky’s sign.

170
Q

Bullous pemphigoid:

A. Location of split.
B. Contents of bulla.

A

A. Subepidermal.

B. Many eosinophils (except in the cell-poor variant).

171
Q

Bullous pemphigoid: Histology of early lesion (2).

A

Eosinophilic spongiosis.

Superficial dermal eosinophils.

172
Q

Bullous pemphigoid: Immunofluorescence (2).

A

DIF: C3 and IgG at the DEJ.

Salt-split skin: Antibodies on the ceiling of the bulla.

173
Q

Bullous pemphigoid: Involved antigens.

A

BP1 and BP2 in the hemidesmosomes.

174
Q

Pemphigoid gestationis: Distinction from bullous pemphigoid (2).

A

May show more neutrophils and necrosis of basal cells.

Clinical correlation often required.

175
Q

Epidermolysis bullosa acquisita: Clinical presentation.

A

Acral blisters that heal with scarring.

176
Q

Epidermolysis bullosa acquisita: Distinction from bullous pemphigoid.

A

Salt-split skin: Antibodies on the floor of the bulla.

177
Q

Porphyria cutanea tarda: Histologic features (3).

A

Subepidermal bulla with minimal inflammation.

Festooning extension of dermal papillae into the cavity of the bulla.

PAS-positive perivascular deposits in the papillary dermis.

178
Q

Cicatricial pemphigoid: Clinical presentation.

A

Bullae that involve mucous membranes and heal with scarring.

179
Q

Dermatitis herpetiformis: Anatomic sites (5).

A

Elbows, knees, back, buttocks, scalp.

180
Q

Dermatitis herpetiformis:

A. Location of split.
B. Contents of bullae.

A

A. Subepidermal.

B. Neutrophils, variable numbers of eosinophils.

181
Q

Dermatitis herpetiformis: Histologic features in addition to bullae (2).

A

Neutrophils in tips of dermal papillae.

Superficial perivascular lymphocytes, neutrophils, eosinophils.

182
Q

Dermatitis herpetiformis: Direct immunofluorescence.

A

Granular IgA in dermal papillae of normal skin and lesional skin.

183
Q

Linear IgA dermatosis: Distinction from dermatitis herpetiformis.

A

Histology: May not be possible.

Direct immunofluorescence: Linear IgA at the DEJ.

184
Q

Bullous systemic lupus erythematosus: Distinction from dermatitis herpetiformis.

A

Direct immunofluorescence: Granular IgG and C3 at the DEJ.

185
Q

Eosinophilic pustular folliculitis:

A. Typical patients.
B. Histology.

A

A. Infants, immunocompromised.

B. Eosinophils in subcorneal pustules, in perifollicular infiltrates, and in spongiotic foci.

186
Q

Majocchi’s granuloma: Leading cause.

A

Trichophyton rubrum.

187
Q

Follicular-occlusion triad.

A

Hidradenitis suppurativa.

Acne conglobata.

Perifolliculitis capitis abscedens et suffodiens.

188
Q

Morphea / scleroderma: Early histology (2).

A

Perivascular and interstitial lymphocytes and plasma cells.

Thickening of bundles of collagen in the reticular dermis.

189
Q

Morphea / scleroderma: Later histology (4).

A

Closely packed bundles of collagen.

Minimal inflammation.

Superficial displacement of eccrine glands.

Loss of other adnexa and of capillaries.

190
Q

Morphea / scleroderma: Autoantibodies (2).

A

Morphea / CREST syndrome: Anticentromere.

Systemic sclerosis: Anti-Scl-70 (anti-topoisomerase).

191
Q

Scleredema: Histology (2).

A

Collagen bundles are thickened but not hyalinized.

Hyaluronic acid fills widened spaces between collagen bundles.

192
Q

Lichen sclerosus: Histology (4).

A

Epidermal atrophy.

Follicular plugging.

Basal vacuolar change.

Edema and homogenization of papillary dermis.

193
Q

Radiation dermatitis: Vascular changes (2).

A

Superficial dermal telangiectasia.

Deep dermal blood vessels with fibrous thickening.

194
Q

Nephrogenic systemic fibrosis:

A. Association.
B. Anatomic sites.

A

A. Renal disease.

B. Trunk and extremities.

195
Q

Nephrogenic systemic fibrosis: Histology.

A

Thickened collagen bundles and CD34-positive spindled fibroblasts extending into subcutis and fascia.

196
Q

Eosinophilic fasciitis: Histology.

A

Sclerosis and eosinophilic infiltrate of deep fascia.

197
Q

Erythema nodosum: Anatomic location (2).

A

A. Acute: Extensor surfaces of legs; symmetrical.

B. Chronic: Legs; unilateral; recurrence at other sites.

198
Q

Erythema nodosum: Associations (3).

A

Streptococcal pharyngitis.

Crohn’s disease.

Sarcoidosis.

199
Q

Erythema nodosum: Typical histology.

A

Granulomatous septal panniculitis that begins with lymphocytic and granulocytic inflammation.

200
Q

Erythema nodosum: Ancillary test.

A

Special stains to exclude infectious (esp. tuberculous) panniculitis.

201
Q

Subcutaneous fat necrosis of the newborn: Possible complications (2).

A

Hypercalcemia.

Thrombocytopenia.

202
Q

Subcutaneous fat necrosis of the newborn: Histology.

A

Predominantly lobular inflammation.

Fat necrosis surrounded by macrophages and giant cells that contain a radial (or stellate) arrangement of needle-shaped lipid crystals.

203
Q

Sclerema neonatorum: Distinction from subcutaneous fat necrosis of the newborn (2).

A

Sclerema neonatorum

Affects premature rather than full-term newborns.

Exhibits little or no inflammation.

204
Q

Post-steroid panniculitis: Histology.

A

May resemble subcutaneous fat necrosis of the newborn; clinical history is essential.

205
Q

Pancreatic fat necrosis: Distinguishing histologic features (2).

A

Ghostlike fat cells with thick borders.

No radially arranged lipid crystals.

206
Q

Lipodystrophy: Histologic distinction from subcutaneous fat necrosis of the newborn.

A

Absence of needle-shaped crystals.

207
Q

Erythema induratum: Histology.

A

Mixed lobular and septal panniculitis with vasculitis and zones of fat necrosis.

208
Q

Epidermal-inclusion cyst:

A. Synonym.
B. Inherited cause of multiplicity.

A

A. Infundibular cyst.

B. Gardner’s syndrome.

209
Q

Steatocystoma multiplex: Inheritance.

A

Autosomal dominant.

210
Q

Seborrheic keratosis: Name of keratin-filled cysts.

A

Horn cysts (pseudo−horn cysts if they communicate with the stratum corneum).

211
Q

Squamous eddies vs. keratin pearls.

A

Squamous eddies: Whorls of keratinocytes without central parakeratosis; seen in irritated seborrheic keratoses.

Keratin pearls: Central parakeratosis; seen in SCC.

212
Q

Dermatosis papulosa nigra: Histology.

A

Same as that of seborrheic keratosis.

213
Q

Clear-cell acanthoma:

A. Age group.
B. Anatomic site.
C. Clinical appearance.

A

A. Middle-aged and older.

B. Lower extremities.

C. Ulceration; oozing surface.

214
Q

Clear-cell acanthoma: Histology (3).

A

Abrupt change to pale keratinocytes.

Elongated rete ridges with well-vascularized dermal papillae.

Neutrophils among keratinocytes and in the overlying parakeratosis.

215
Q

Clear-cell acanthoma: Cause of clearing of cells.

A

Glycogen.

216
Q

Verruca plana: Anatomic sites (2).

A

Face.

Dorsa of hands.

217
Q

Verruca plana: Histology (3).

A

Blunt epidermal papillae.

Parakeratosis but minimal hyperkeratosis.

Keratinocytes with viral changes.

218
Q

Actinic keratosis vs. SCC in situ.

A

AK: Alternating parakeratosis and orthokeratosis; orthokeratosis at the follicular ostia.

SCC: Confluent parakeratosis.

219
Q

Bowenoid papulosis vs. SCC in situ.

A

Indistinguishable by histology.

Bowenoid papulosis occurs as papules on genitals.

220
Q

Keratoacanthoma: Inflammatory feature.

A

Microabscesses.

221
Q

Verrucous carcinoma: Histology.

A

Tunnels of parakeratosis extending deep into the neoplasm.

Bulbous expansion of rete pegs (“elephant’s feet”).

222
Q

Marjolin’s ulcer.

A

SCC arising on the edge of a longstanding ulcer or scar.

223
Q

Trichoepithelioma: Inheritance of multiplicity.

A

Autosomal dominant.

224
Q

Trichoepithelioma vs. BCC: Immunohistochemistry.

A

Trichoepithelioma: CD10 in stromal cells only.

BCC: CD10 in epithelial and stromal cells.

225
Q

Giant solitary trichoepithelioma.

A

Several centimeters in size; found in deep dermis and subcutis.

226
Q

Pilomatricoma:

A. Age group.
B. Anatomic sites (3).

A

A. Children, adolescents.

B. Face, neck, upper extremities.

227
Q

Pilomatricoma: Clinical association of multiplicity.

A

Myotonic dystrophy.

228
Q

Pilomatricoma: Significance of shadow cells.

A

They are matrical cells that are failing to form hair shafts.

229
Q

Trichilemmoma:

A. Silhouette.
B. Histology of desmoplastic type.

A

A. Verruciform.

B. Irregular extensions of clear cells into sclerotic dermis simulate invasive carcinoma.

230
Q

Cowden’s disease:

A. Inheritance.
B. Affected organs.

A

A. Autosomal dominant.

B. Malignancies may occur in breast, gastrointestinal tract, thyroid gland, reproductive organs.

231
Q

Syndrome of multiple basal-cell carcinomas:

A. Name.
B. Other abnormalities (2).

A

A. Basal-cell-nevus syndrome.

B. Palmar keratotic pits, jaw cysts.

232
Q

Syringoma: Clinical appearance.

A

Multiple yellow, firm papules, 1-3 mm.

233
Q

Syringoma: Histology (3).

A

Cords and nests of monomorphous epithelial cells.

Comma-shaped ducts lined by two layers of cells and filled with proteinaceous matter.

Densely fibrotic stroma.

234
Q

Syringoma: Special stain.

A

PAS

− May highlight contents of ducts.
− May stain cells of clear-cell syringoma (glycogen).

235
Q

Syringoma vs. trichoepithelioma.

A

Trichoepithelioma contains keratin-filled infundibulocystic structures rather than ducts.

236
Q

Syringoma vs. microcystic adnexal carcinoma.

A

MAC is solitary, larger, and extends deep into the dermis.

237
Q

Poroma: Cell types.

A

Poroid cells: Dark.

Cuticular: Pale and forming tubules.

238
Q

Poroma: Stroma.

A

Richly vascular.

239
Q

Painful tumors of the skin.

A 
Blue-rubber-bleb nevus.
Eccrine spiradenoma.
Neuroma, neurilemmoma.
Glomus tumor.
Angiolipoma.
Leiomyoma.
240
Q

Spiradenoma:

A. Anatomic site.
B. Number.

A

A. Trunk and extremities.

B. Usually single but can be multiple.

241
Q

Spiradenoma: Cell types (3).

A

Small, dark cells in the periphery of nodules.

Large, pale cells occupy the centers and line the tubules.

Lymphocytes.

242
Q

Spiradenoma: Extracellular elements (2).

A

Hyaline basement-membrane-like matter.

Rich vascular supply.

243
Q

Spiradenoma: Why painful?

A

Contains many unmyelinated axons.

244
Q

Cylindroma: Type of differentiation.

A

Apocrine.

245
Q

Cylindroma: Cell types.

A

Small, dark cells in the peripheral of nodules.

Large, pale cells occupy the centers and line the tubules.

246
Q

Multiplicity of cylindromas:

A. Inheritance.
B. Gene and its location.

A

A. Autosomal dominant.

B. CYLD on 16q12.1.

247
Q

Multiplicity of cylindromas may occur with multiplicity of what other tumor?

A

Trichoepithelioma.

248
Q

Clear-cell hidradenoma:

A. Synonyms (3).
B. Basic architecture.

A

A. Nodular hidradenoma, solid-cystic hidradenoma, eccrine acrospiroma.

B. Nodule consisting of cellular lobules and cystic spaces.

249
Q

Clear-cell hidradenoma: Cell types (2).

A

Clear cells make up the bulk of the tumor.

Cuboidal or columnar cells with decapitation secretion line the tubules.

250
Q

Syringocystadenoma papilliferum:

A. Anatomic sites.
B. Associated proliferation.

A

A. Scalp, face.

B. Naevus sebaceus.

251
Q

Syringocystadenoma papilliferum: Cells that line the papillae.

A

Luminal row: Columnar cells with occasional decapitation secretion.

Deeper row: Cuboidal cells.

252
Q

Syringocystadenoma papilliferum: Stroma.

A

Full of plasma cells.

253
Q

Syringocystadenoma papilliferum vs. hidradenoma papilliferum (2).

A

Hidradenoma papilliferum:

− No connection to the skin’s surface.
− Papillae have one layer of cells (apocrine).

254
Q

Syringocystadenoma papilliferum vs. tubular apocrine adenoma.

A

Tubular apocrine adenoma: No connection to skin’s surface.

255
Q

Microcystic adnexal carcinoma: Anatomic sites (4).

A

Upper lip (#1).

Chin, nasolabial fold, cheek.

256
Q

Microcystic adnexal carcinoma: Histology.

A

Bland-appearing ductal structures, with or without keratin-filled cysts, infiltrate deep dermis, subcutis, and muscle, getting smaller toward the base.

Usually no connection to the surface.

257
Q

Microcystic adnexal carcinoma: Clue to malignancy.

A

Perineural invasion.

258
Q

Microcystic adnexal carcinoma: Behavior.

A

Locally aggressive but rarely metastasizes.

259
Q

Naevus sebaceus: Age group.

A

Present at birth.

260
Q

Naevus sebaceus:

A. Clinical development.
B. Histologic development.

A

A. Plaque-like in infancy, linear in childhood, verrucous and nodular at puberty.

B. Sebaceous glands are large at birth and in puberty, small in childhood.

261
Q

Naevus sebaceus: Non-sebaceous histology (3).

A

Papillomatosis.

Follicular germs resembling BCC.

Apocrine glands deep in the dermis.

262
Q

Naevus sebaceus: Tumors that can arise in it (3).

A

Benign: Trichoblastoma, syringocystadenoma papilliferum.

Malignant: BCC.

263
Q

Naevus sebaceus vs. epidermal nevus.

A

Epidermal nevus lacks sebaceous lobules.

264
Q

Sebaceous adenoma: Histology.

A

Increased basaloid cells at periphery of sebaceous lobules.

Mitotic figures may be present, but no nuclear atypia.

265
Q

Sebaceous adenoma, rippled-pattern: Histology.

A

Parallel rows of monomorphous, fusiform cells that resemble Verocay bodies.

Sebaceous cells and ducts also present.

266
Q

Sebaceous adenoma: Ancillary study.

A

IHC for loss of mismatch-repair proteins (MSH2/MLH1) should be considered.

267
Q

Sebaceous carcinoma: Anatomic site.

A

Eyelid, particularly the meibomian glands and the gland of Zeis.

268
Q

Sebaceous carcinoma: Histology (2).

A

Irregular lobules consisting of pleomorphic basaloid cells, sometimes with a few sebaceous cells in the center.

Eyelid: Pagetoid spread into conjunctiva or epidermis.

269
Q

Sebaceous carcinoma: Relationship to SCC (2).

A

Sebaceous carcinoma can

− Arise in a site of SCC.
− Contain SCC-like squamoid areas.

270
Q

Sebaceous carcinoma: Hormonal receptor.

A

Androgen receptor (demonstrable by IHC).

271
Q

Sebaceous carcinoma: Predictors of poor prognosis (5).

A

Size greater than 1 cm.

Poor differentiation.

Multicentricity.

Extensive invasion of tissues.

Lymphovascular invasion.

272
Q

Sebaceous carcinoma: Behavior in the Muir-Torre syndrome.

A

Much less likely to metastasize.

273
Q

Giant congenital nevus: Benign associations (2).

A

Leptomeningeal melanocytosis.

Neurological disorders.

274
Q

Giant congenital nevus: Malignant associations (2).

A

Melanoma, rhabdomyosarcoma.

275
Q

Giant congenital nevus: Typical histologic feature.

A

Infiltration of nevus cells into septa of subcutaneous fat.

276
Q

Congenital melanocytic nevus: Histology (2).

A

Nevus cells congregate around adnexa and blood vessels and infiltrate between collagen bundles.

277
Q

Congenital melanocytic nevus: Histologic pitfall.

A

Presence of occasional mitotic figures in dermal nodules does not make it a melanoma.

278
Q

Spitz nevus: Mitotic figures.

A

May be present but are usually not atypical and do not occur at the base of the lesion.

279
Q

Spitz nevus: Non-melanocytic histology (3).

A

Epidermal hyperplasia with hyperkeratosis and orthokeratosis.

Papillary dermal vascular ectasia.

Patchy perivascular lymphocytes and histiocytes.

280
Q

Halo nevus:

A. Age group.
B. Anatomic site.

A

A. Children and young adults.

B. Back.

281
Q

Halo nevus: Histology of melanocytes.

A

Early: Large and atypical.

Late: Absent.

282
Q

Special sites of melanocytic nevi (6).

A

Scalp.

Acral skin.

Periauricular skin.

Periumbilical skin.

Breasts.

Genitals.

283
Q

Lentigo maligna: Clinical definition.

A

Melanoma in situ on sun-exposed skin.

284
Q

Superficial spreading melanoma.

A

Melanoma with extensive pagetoid spread.

285
Q

Clark’s levels.

A

I: Melanoma in situ.

II: Extension into papillary dermis.

III: Filling of papillary dermis.

IV: Extension into reticular dermis.

V: Extension into subcutis.

286
Q

Genes implicated in the pathogenesis of melanoma (6).

A

CMM1.

p16.

CDK4.

BRAF.

NRAS.

MEK (a kinase of MAP kinase).

287
Q

Desmoplastic melanoma: Immunohistochemistry.

A

Positive: S100.

Negative: Mart-1, HMB45.

288
Q

Angiokeratoma: Non-vascular histology.

A

Epidermal hyperplasia with hyperkeratosis.

289
Q

Cavernous hemangioma: Syndromes (3).

A

Maffucci’s: CH + multiple enchondromas.

Kasabach-Merritt: CH with thrombosis leading to consumptive coagulopathy.

Blue-rubber-bleb: CH + vascular proliferations in the gastrointestinal tract.

290
Q

Pyogenic granuloma vs. bacillary angiomatosis.

A

Bacillary angiomatosis contains clumps of granular basophilic material in which bacilli can be identified with Warthin-Starry or Giemsa stain.

291
Q

Kaposi’s sarcoma: Epidemiological types (4).

A

Classic: Elderly men in S. and E. Europe.

Endemic: Young natives of Central Africa.

Epidemic: HIV patients.

Iatrogenic: Immunosuppressed patients.

292
Q

Epidemic Kaposi’s sarcoma: Anatomic sites.

A

Trunk, mucous membranes.

293
Q

Kaposi’s sarcoma, patch stage: Histology (3).

A

Slit-like spaces between collagen bundles.

Promontory sign.

Extravasated red blood cells.

294
Q

Kaposi’s sarcoma, plaque stage: Histology (3).

A

Short fascicles of spindle cells.

Diffuse proliferation of irregular vascular spaces.

Intracytoplasmic hyaline globules.

295
Q

Kaposi’s sarcoma, nodular stage: Histology (4).

A

Spindle cells and vascular spaces form nodules.

Nuclear atypia and mitotic figures.

Extravasated red cells and hemosiderin-laden macrophages.

Conspicuous hyaline globules.

296
Q

Kaposi’s sarcoma, late aggressive stage: Histology.

A

Resembles aggressive sarcoma.

297
Q

Kaposi’s sarcoma: Special staining of hyaline globules.

A

PAS positive, diastase resistant.

298
Q

Epithelioid angiosarcoma: Morphology of neoplastic cells.

A

Large and pleomorphic; abundant eosinophilic cytoplasm; large nucleus with large nucleolus.

299
Q

Epithelioid angiosarcoma: Histologic architecture (2).

A

Asymmetrical proliferation.

May lack distinct vascular spaces and thus resemble carcinoma or melanoma.

300
Q

Epithelioid angiosarcoma vs. epithelioid hemangioma.

A

Epithelioid hemangioma:

− Symmetrical.
− No nuclear atypia.

301
Q

Angiosarcoma: Immunohistochemistry (4).

A

CD31, CD34, ERG.

Lymphatic tumors: D2-40.

302
Q

Angiosarcoma: Electron microscopy.

A

Weibel-Palade bodies (rod-shaped; resemble lysosomes).

303
Q

Dabska tumor.

A

Malignant intravascular papillary angioendothelioma.

304
Q

Angioleiomyoma: Anatomic site.

A

Extremities, esp. lower extremities.

305
Q

Dartoic leiomyoma:

A. Anatomic sites.
B. Clinical presentation.

A

A. Scrotum, labium majus, areola.

B. Painless (unlike other leiomyomas).

306
Q

Cutaneous leiomyosarcoma:

A. Age group.
B. Anatomic sites.

A

A. Second and third decades.

B. No anatomic predilection.

307
Q

Cutaneous leiomyosarcoma:

A. Histologic architecture.
B. Metastasis.

A

A. Asymmetrical; forms fascicles; intermixed zones of hypercellularity and of better differentiation.

B. Hematogenous.

308
Q

Keloid: Change in histology with age.

A

Early lesions: More vascular.

Older lesions: More fibrous.

309
Q

Keloid vs. hypertrophic scar.

A

Hypertrophic scar:

− Limited to area of injury.
− Less myxoid matrix.

310
Q

Dermatofibrosoma: Clinical sign.

A

Fitzpatrick’s sign: Pinching the lesion results in a dimple.

311
Q

Dermatofibroma: Aneurysmal variant.

A

Vascular proliferation and hemosiderin.

312
Q

Dermatofibroma: Cellular type.

A

Densely cellular; increased mitotic figures.

313
Q

Dermatofibroma: Immunohistochemistry.

A

Positive: Factor XIIIa.

Negative: CD34 (except at periphery of cellular DF).

314
Q

Dermatofibrosarcoma protuberans: Change in clinical appearance with age.

A

Early: Tan or brown nodule, slow-growing.

Later: Blue-red, multilobular nodule, rapidly growing.

315
Q

Dermatofibrosarcoma protuberans:

A. Overlying epidermis.
B. Invasion of fat.
C. Cytological atypia and mitosis.

A

A. Atrophic.

B. Replacement or lacelike infiltration.

C. Present but not prominent.

316
Q

Dermatofibrosarcoma protuberans: Translocation.

A

t(17;22) :: COL1A1−PDGFB.

317
Q

Dermatofibrosarcoma protuberans: Variant.

A

Bednar tumor contains pigmented spindle cells.

318
Q

Neurofibroma: Preferred anatomic sites (2).

A

Palms, soles.

319
Q

Neurofibroma: Cellular components.

A

Schwann cells.

Fibroblasts.

(Mast cells in the background.)

320
Q

Schwannoma: Zones of Antoni.

A

Antoni A: Hypercellular.

Antoni B: Hypocellular; mucinous background.

321
Q

Dermatofibroma vs. neurofibroma: Overlying epidermis.

A

DF: Hyperplastic, with pigmented basal cells.

NF: Atrophic, with indistinct rete ridges.

322
Q

Merkel-cell carcinoma: Anatomic sites.

A

Head.

Extremities.

323
Q

Merkel-cell carcinoma: Associated epithelial malignancy.

A

Squamous-cell carcinoma.

324
Q

Merkel-cell carcinoma: Cytokeratin stain.

A

Positive for CK20.

325
Q

Merkel-cell carcinoma: Electron microscopy.

A

Membrane-bound dense granules; perinuclear bundles or whorls of intermediate filaments.

326
Q

Merkel-cell carcinoma: Divergent differentiation (3).

A

Squamous.

Adnexal.

Melanocytic.

327
Q

Urticaria pigmentosa: Four forms.

A

Arising in infancy or childhood without systemic lesions.

Arising in adolescence or adulthood without systemic lesions.

Systemic mast-cell disease.

Mast-cell leukemia.

328
Q

Urticaria pigmentosa: Age group in which ___ lesions appear.

A. solitary
B. diffuse erythrodermic
C. telangiectasia macularis eruptiva perstans

A

A, B. Infants.

C. Adults.

329
Q

Urticaria pigmentosa: Age group in which ___ lesions appear.

A. maculopapular
B. nodular and plaquelike

A

Both: Infants and adults.

330
Q

Urticaria pigmentosa: Arrangement of mast cells in ___ lesions.

A. nodular and plaquelike
B. maculopapular and TMEP
C. erythrodermic

A

A. Throughout the dermis.

B. Around upper dermal blood vessels.

C. In a dense band in the upper dermis.

331
Q

Urticaria pigmentosa: Location of split in the bullous type.

A

Subepidermal.

332
Q

Urticaria pigmentosa: Stains for mast cells (5).

A

Giemsa, toluidine blue, Leder’s.

CD117, tryptase.

333
Q

Systemic mast-cell disease: Affected organs (6).

A

Bones.

Lymph nodes, spleen.

Liver.

Gastrointestinal tract.

Central nervous system.

334
Q

Letterer-Siwe disease:

A. Age group.
B. Clinical presentation.
C. Locations of skin lesions.

A

A. 3 months to 3 years.

B. Constitutional symptoms, extraosseous lesions.

C. Scalp, face, mouth, neck, trunk.

335
Q

Hand-Schüller-Christian disease:

A. Age group.
B. Clinical presentation.
C. Classic triad.

A

A. 2-6 years.

B. Otitis media plus all or part of the classic triad.

C. Defects in cranial bones, exophthalmos, diabetes insipidus.

336
Q

Hand-Schüller-Christian disease: Locations of skin lesions (3).

A

Chest, axillae, groin.

337
Q

Eosinophilic granuloma:

A. Age group.
B. Locations of internal lesions.
C. Locations of skin lesions.

A

A. 2-5 years.

B. Bones, lungs.

C. Scalp, face, mouth, groin.

338
Q

Langerhans’-cell histiocytosis: Arrangement of Langerhans’ cells.

A

Throughout the dermis and often in the epidermis.

339
Q

Langerhans’-cell histiocytosis:

A. Immunohistochemistry.
B. Electron microscopy.

A

A. Positive: S100, CD1a, langerin.

B. Birbeck granules within Langerhans’ cells.

340
Q

Langerhans’-cell histiocytosis: Possible genetic defect.

A

Activating mutation of BRAF.

341
Q

Congenital self-healing reticulohistiocytosis: Clinical course.

A

Appears at birth or shortly thereafter.

Involution begins at 2-3 months.

Gone within 1 year.

342
Q

Mycosis fungoides, patch stage: Histology.

A

Lymphocytes form a patchy infiltrate in a papillary dermis with thickened collagen bundles.

Lymphocytes form small collections within a minimally spongiotic epidermis.

There may be psoriasiform hyperplasia.

343
Q

Mycosis fungoides, plaque stage: Histology.

A

Similar to that of patch stage, but with denser and more bandlike infiltrate.

344
Q

Mycosis fungoides, tumor stage: Histology.

A

Atypical lymphocytes form diffuse infiltrate.

There are more medium and large lymphoid cells.

345
Q

Mycosis fungoides: Large-cell transformation.

A

More than 25% of tumor cells are large cells, or there are discrete nodules of large cells.

346
Q

Mycosis fungoides: Immunophenotype (4).

A

Positive: CD3, CD4, CD5.

Negative: CD8 (except in younger patients).

CD7 is diminished or lost.

CD30 is positive in large-cell transformation.

347
Q

Mycosis fungoides: Sézary’s syndrome.

A

Erythrodermic mycosis fungoides + circulating tumor cells.

348
Q

Mycosis fungoides: Related skin lesion.

A

Follicular mucinosis.

349
Q

Cutaneous anaplastic large-cell lymphoma: Epidermal change.

A

Ulceration.

350
Q

Cutaneous anaplastic large-cell lymphoma vs. lymphomatoid papulosis.

A

LP: Mixed infiltrate; fewer atypical lymphocytes.

351
Q

CD30-positive lymphomas of the skin (3).

A

Anaplastic large-cell lymphoma.

Mycosis fungoides, late stage.

Pleomorphic T-cell lymphoma.

Anatomic pathology (17 decks)

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