Derm Path Flashcards by David Saulino

Histological findings in Uticaria?

Gross findings?

A sparse (not much) perivascular mixed inflammatory infiltrate with slight dermal edema

Wheals (white to red plaques) surrounded by a red halo with itching

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Name some common spongiotic dermatitis types? Name 4

Contact dermatitis, atopic dermatitis, pityriasis rosea, nummular dermatitis (discoid eczema)

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Name the histological features of pityriasis rosea?

Gross features?

Angulated mounds of parakeratosis, and spongiotic vesicles with lymphocytes and extravasated RBCs. Also epidermal spongiosis.

Pink or salmon colored oval papules, trunk and arms. follows skin tension lines creating the Christmas tree pattern

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What features compose the psoriasiform pattern?

What are the special names for neutrophil collections in this disease and where are they specifically located?

Epidermis- Hyperplasia with confluent parakeratosis, a diminished granular layer, and clubbed shaped rete ridges.

We have dilated blood vessels in the tips of the dermal papillae

We have a special name for the neutrophils in this one.

The neutrophils in the corneal layer are called “Munro microabsesses” and those in the spinous layer are called spongiform pustules of Kogoj

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Name the neutrophillic spongiosis? Name 5

Pustular psoriasis (an emergency), acute generalized exanthematous pustulosis (AGEP), dermatophytosis, bacterial infections, Reiter’s syndrome

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Name the two major diseases with a lichenoid interface dermatitis pattern?

Name three key features microscopically?

What are the necrotic keratinocytes called

Gross appearence?

Erythema Multiform, Graft vs. Host disease

Basal vacuolization, lymphocytes at the DEJ, necrotic keratinocytes

Civatte or Colloid bodies

Targetoid lesions on the extensor surfaces and face

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Name the two key features of TEN microscopically?

Full thickness epidermal necrosis and interface dermatitis

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Name two infections associated with EM minor?

HSV, mycoplasma

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What is the usual etiology of EM major?

Usually drugs, NSAIDs, sulfonamides

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Name the four grades of GVHD?

Normal skin
Vacuolar change at the DEJ
Dyskeratotic cells in the epidermis and/or follicle, lymphocytes in the dermis
Fusion of basal vacuoles to form clefts and microvesicles
Seperation of Epi from dermis

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What common rash demonstrates a interface pattern that is not usually lichenoid?

Lupus Erythematosus

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What is the histological pattern of lupus erythematosus?

Interface dermatitis but NOT usually lichenoid. Basal cells become KERATINIZED.
Compact ortho keratosis.
Superficial and deep perivascular and perieccrine inflammation

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Acute irritation is associated with what type of keratosis?

Parakeratosis. It’s a fast process so they retain their nuclei. in chronic processes, it’s more likely to be orthokeratosis.

An example with chronic inflammation would be lupus which has orthokeratosis typically.

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What two stains can be used in lupus to stain the interstitial mucin?

Colloidal iron, alcian blue

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Grossly, what is the name of the papules that are associated with dermatomyositis?

What is a key IHC stain and finding to diagnose dermatomyositis?

Gottron papules

The Membrane Attack Complex IHC should highlight a line along the basement membrane at the DEJ.

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What are the histological features of dermatomyositis?

Interface dermatitis with basal layer degeneration and colloid bodies in the papillary dermis (eosinophillic areas formed by apoptotic keratinocytes)

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What is the two key histologic patterns of syphilis?

Psoriasiform and lichenoid

Name the histologic features of lichen planus?

Band-like lymphocyte infiltrate
Necrotic keratinocytes at the DEJ
Epidermal changes (sawtoothing, hypergranulosis)

What are the 3 main lesions with a palisaded granulomatous pattern?

What is the main concept/feature of this pattern?

What else must always be in the differential?

Granuloma annulare (mucin), rheumatoid nodule (fibrin), necrobiosis lipoidica (degenerated collagen)

Histiocytes surrounding material (different types depending on what type) in the dermis

Infectious causes

Bullous pemphigoid is caused by what type of autoantibodies? Where are they directed?

Antibodies against BGAP1 and BGAP2 on hemidesmosomes at the DEJ

Where is the “split” located in bullous pemphigoid?

Subepidermal

Where are the antibodies directed in pemphigus foliaceus?

Against desmoglein 1

Subcorneal pustular dermatosis is also known as ____-___ disease.

What is the key histologic feature of this disease?

Sneddon-Wilkinson disease

Subcorneal pustules filled with neutrophils, occasional eosinophils

What are the histologic features of pemphigus vulgaris?

What are the antibodies in PV targeted against?

What is the DIF pattern of this disease?

Suprabasilar (above the basal layer) acanthosis with the remaining basal keratinocytes appearing like “tombstones”

Autoantibodies against desmoglein 3

Intercellular IgG and C3.

Where does Hailey Hailey disease usually present? What is the "buzzword" for this disorder?

Intertriginous areas (armpits, groin, below breasts) Dilapitated brick wall

What is porphyria cutanea tarda? What enzyme deficiency causes this? Name some microscopic features.....

Photsensitivity in sun exposed areas uroporphyrinogen Subepidermal blister with a sparse inflammatory infiltrate. You can have this ribbon-like formation of the dermal papillae (festooning) with hyalinized blood vessels and catepillar bodies towards the roof of the blister.

A young patient with an autoimmune disease has grouped vesicles on their extensor surfaces, diagnosis? Describe the histological features?

Celiac disease patient with dermatitis herpetiformis. Subepidermal blistering with neutrophils, neutrophils are often clustered in adjacent dermal papillae.

Paraneoplastic pemphigus is a combination of two common patterns, what are they?

Pemphigus and lichen planus

How does Grover disease appear grossly? What are the key microscopic features?

Pruitic round papules and papulovesicles Focal acanotholysis (loss of intracellular connections between keratinocytes), dyskeratosis (abnormal keratosis), clefting, and superficial perivascular inflammation.

Darier disease is inherited autosomal _____, and is grossly characterized by 3 primary gross changes.... It is caused by a mutation is the ______ gene It is characterized microscopically by....

Dominant. Greasy hyperkeratotic papules, nail abnormalities, mucus membrane changes ATP2A2 Acantholytis dyskeratosis, columns of parakeratosis, sparse superficial perivascular infiltrate

Describe a "warty dyskeratoma"

Acantholysis and dyskeratosis within an hypperplastic epithelial "cup"

How is morphea related to scleroderma? Describe the microscopic features....

A variant of scleroderma Early lesions- Superficial and deep perivascular and periadenexal lymphocytic infiltrate in the reticular dermis Possibly thickened collagen bundles Perineural inflammation Later lesion- Inflammatory not prominent Thick, prominent collagen bundles

Describe the gross appearance of morphea...

A iliac/violet ring surrounding a white, sclerotic center. Often in pressure areas.

Describe the gross appearance of Lichen sclerosus et atrophicus... Microscopic?

White, atrophic patches with petechia on the penis? Atrophic (thin) epithelium with vacuolar change of the basal layer and a thick hyalinized connective tissue band in the papillary dermis.

What is sclerederma? Describe the microscopic... What is a serious complication of this disease?

Rare, self-limited cutaneous mucinosis Sometimes effacement of the rete ridges Thickened collagen bundles with insterstitial mucin Can become systemic and involve skeletal muscle and lungs

Staph scalded skin syndrome gross findings? Microscopic?

Blistering skin disease with blisters on flexoral skin surfaces Superficial subcorneal splitting at the granular layer often "sterile" with sparse to absent PMNs.

What is the histological appearence of Varicella/Herpes Zoster?

An intraepidermal blister with acantholysis and the 3 "Ms" Multinucleation, molding, margination

Mulluscum contagiosum is caused by what virus? Describe it microscopically?

Poxvirus Epidermal hyperplasia with a crater that is filled with mulluscum bodies (large, eosinophillic intracytoplasmic inclusions)

What is verruca vulgaris? What virus can it be associated with> Describe it microscopically?

Aka, the common wart Associated with HPV virus (many types) An exophytic proliferation of hypergranulosis, paraketratosis, and hyperkeratosis (ortho?) with intracorneal hemorrhage.

What is dermatophytosis? What is the gross appearance? Describe it microscopically?

A superficial fungal infection with dermatophytes An annular plaque of erythema with scaling at the advancing border Sandwich sign- Para or compact orthokeratosis underlying basket weave orthokeratosis (the fungi are in between). Neutrophils in the stratum corneum. Spongiosis in the epidermis.

What is epidermotropism?

Atypical lymphocytes within the epidermis