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Histopathology > Histopathology 11 - Dermatopathology > Flashcards

Histopathology 11 - Dermatopathology Flashcards

1
Q

Give an example of vesiculobullous inflammation?

A

Bullous pemphigoid

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2
Q

What are the aetiological agents of pemphigoid

A

IgG and C3
They attack the basement membrane and destroy the adhesion molecules

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3
Q

How can you confirm the diagnosis of pemphigoid?

A

Immunofluorescence of fresh samples to show IgG and C3

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4
Q

What causes pemphigus vulgaris?

A

Pemphigus antibody attacks proteins that holds cells together in the stratum spinosum, causing “akantholysis”, which leads to formation of *suprabasilar bulla*

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5
Q

On which surfaces does psoriasis tend to present?

A

Extensor

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6
Q

On which surfaces does eczema tend to present?

A

Flexor

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7
Q

What is the appearance of basal cell carcinomas?

A

Pearly white border
Central area of ulceration

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8
Q

What do pre-cancerous skin cells (Bowen’s disease) look like histologically?

A

Pleomorphic
Atypical mitotic figures
All within the epidermis

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9
Q

What is the upward spread of melanocytes known as?

A

Pagetoid spread

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10
Q

When would mitotic figues in the skin not be alarming?

A

Pregnancy

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11
Q

The Breslow thickness is used to stage which skin cancer?

A

Malignant melanoma

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12
Q

Which common skin cancer does not metastasise?

A

Basal cell carcinoma

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13
Q

Is diameter or thickness more important for malignant melanoma?

A

Thickness

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14
Q

Which patient group is most at risk of pemphigus foliaceus?

A

The elderly - but it’s rare

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15
Q

Which cells of the immune system are most involved in eczema?

A

T-cell mediated pathology
Eosinophils recruited to sites of inflammation

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16
Q

Where does fluid build in eczema?

A

Between keratinocytes

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17
Q

Which skin pathology appears as “silvery plaques”?

A

Psoriasis

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18
Q

Which immune-mediated skin condition causes a rapid turnover of keratinocytes?

A

Psoriasis

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19
Q

Which skin condition appears as white lines?

A

Lichen planus

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20
Q

Which skin condition appears as a “pigmented cauliflower”?

A

Seborrhoeic keratosis

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21
Q

Which skin condition forms “keratin horns”?

A

Seborrhoeic keratosis

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22
Q

Describe the appearance of a sebaceous cyst?

A

Round, smooth surface, central punctum

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23
Q

Which types of invasion is basal cell carcinoma most likely to exhibit?

A

Perineural or vascular

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24
Q

What is Bowen’s disease?

A

Pre-cancerous stage of **squamous cell carcioma**

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25
Q

Which type of skin cancer is most likely to become invasive?

A

Squamous cell carcinoma

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26
Q

What is the fancy name for a mole?

A

Benign junctional naevus

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27
Q

Which type of skin cancer demonstrates upward migration of melanocytes?

A

Malignant melanoma

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28
Q

A lump on the upper lip may be due to which type of cancer?

A

Metastatic renal cell carcinoma

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29
Q

Describe the layers of the skin

A
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30
Q

What is parakeratosis?

A

Increased nuclei in S. corenum (when there shouldn’t be)

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31
Q

What s acanthosis?

A

^ in stratum spinosum

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32
Q

what is acantholysis?

A

decrease in cohesions between keratinocytes

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33
Q

What is spongiosis?

A

intercellular oedema

*(*this is what you get in eczema= fluid buildup between the keratinocytes*

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34
Q

define lentiginous

A

Lentiginous – linear pattern of melanocyte proliferation within epidermal basal cell layer

(reactive or neoplastic)

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35
Q

define lichenoid

A

sheeny plaque

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36
Q

what does psoriaform mean?

A

thickened

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37
Q

characteristic feature of eczema rash

A

ITCHY

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38
Q

what is eczema also called?

A

dermatitis

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39
Q

what are the 3 types of eczema/dermatitis?

A

atopic dermatitis

contact dermatitis

seborrheic dermatitis

–all have the same histology but different aetiology

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40
Q

Histology of ALL dermatitis

A

ACUTE: ● Spongiosis ● Inflammatory infiltrate in
dermis ● Dilated dermal
capillaries

CHRONIC: ● Acanthosis ● Crusting, scaling

**so acutely affects the dermis (hence dermatitis…) and then chronically affects the epidermis as well

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41
Q

distribution of eczema in infants and older people

A

infants: face, scalp
older: flexural areas

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42
Q

what is a potential clinical feature of chronic eczema?

A

lichenification

43
Q

Clinical features of contact dermatitis

A

Type IV hypersensitivity – e.g. to nickel, rubber Erythema, swelling, pruritis Commonly affects ear lobes and neck (from jewellery), wrist (leather watch straps), feet (from shoes)

**tends to present more so in adults than children, as you need repeated exposure to the trigger for contact dermatitis to develop (from clinic)

44
Q

What is seborrheic dermatitis?

A

Inflammatory reaction to a yeast - Malassezia

Infants: cradle cap (large yellow scales on scalp)

Young adults: mild erythema, fine scaling, mildly
pruritic- affects face, eyebrow, eyelid, anterior chest, external ear

45
Q

What is psoriasis?

A

Common chronic inflammatory dermatosis with well-demarcated red scaly plaques

46
Q

Most common form of psoriasis?

A

chronic plaque psoriasis

47
Q

description and distribution of chornic plaque psoriasis

A

salmon pink plaques with silver scale affecting extensor aspects of knees, elbows and scalp.

48
Q

Key signs in psoriasis

A

Auspitz sign

Koebner phenomeon

AK

49
Q

What is auspitz’s sign?

A

rubbing the lesions causes pin-point bleeding

*positive in psoriasis*

50
Q

what is koebner phenomenon?

A

lesions form at sites of trauma

51
Q

What is the key feature of cells within a proriatic plaque?

A

increased proliferation rate

52
Q

histology of psoriasis (x5)

A
  • parakeratosis - increase in nuclei within the stratum corneum (bc of increased proliferation)
  • loss of granular layer (maybe bc of increased proliferation?)
  • clubbing of rete ridges
  • test tubes in a rack appearance
  • munro’s microabscesses
53
Q

what type of hypersenstiivty reaction is psoriasis?

A

type 4 T-cell mediated

54
Q

Forms of psoriasis

A
  1. chronic plaque psoriasis
  2. flexural psoriasis
  3. guttate psoriasis
  4. erythrodermic/pustular psoriasis
55
Q

What is flexural psoriasis?

A

seen later in life, usually groin, natal cleft and sub-mammary areas

**think intimate areas**

56
Q

what is guttate psoriasis?

A

“rain-drop” plaque distribution, often in children, usually seen 2 weeks
post-Strep throat

57
Q

what is erythrodermic/pustular psoriasis?

A

severe widespread disease, often systemic symptoms,
can be limited to hands and feet = palmo-plantar psoriasis

58
Q

Associated features of prosiasis

A
  1. Nail changes (PSO- PSOriasis):
    o Pitting

o Subungual Hyperkeratosis

o Onycholysis

  1. Arthritis (5-10%)
59
Q

What is lichen planus?

A

think Ps

Lesions are “pruritic, purple, polygonal, papules and plaques” with a mother-of-pearl sheen, and fine white network on their surface called Wickam’s striae

**wickam’s striae are usually seen in the oral manifestation of this**

60
Q

What do you see Wickam’s striae in?

A

Lichen planus

61
Q

Where do you get lichen planus?

A

Inner surface of wrists

Can also affect oral mucous membrane- lacy appearance

62
Q

Lichen planus histology

A

hyperkeratosis with saw-toothing of rete ridges and basal cell degeneration

(saws are plain??)

**contrast with psoriasis - clubbing of rete ridges

63
Q

Type of lesion in erythema multiforme

A

annular target lesions

pleimorphic lesions

combination of macules, papules, urticarial weals, vesicles, bullae and petechiae

64
Q

Where do you get erythema multiforme?

A

Extensor surfaces of hands and feet

65
Q

causes of erythema multiforme

A

1) infections

  • hsv
  • mycoplasma

2) drugs- SNAPP

Sulphonamides (trimethoprim, sulfamethoxazole)

NSAIDS

Allopurinol

Penicillin

Phenytoin

66
Q

What is steven john syndrome an extreme version of?

A

erythema multiforme

67
Q

What are the 3 bullous diseases?

A
  1. dermatitis herpetiformis
  2. bullous pemphigoid
  3. pemphigus vulgaris
68
Q

Dermatitis herpetiformis: pathophysiology

A

Associated with coeliac
IgA Abs bind to basement membrane
Itchy vesicles on extensor surfaces of→ elbows, buttocks
subepidermal bullae

69
Q

Clinical features of dermatitis herpetiformis

A

itchy vesicles

on extensor surfaces of elbows, buttocks

70
Q

histology of dermatitis herpetiformis

A

Microabscesses which coalesce to form subepidermal bullae

Neutrophil & IgA deposits at tips of dermal papillae

71
Q

Pathophsyiology of bullous pemphigoid

A
72
Q

Clinical features of bullous pemphigoid

A

Large tense bullae on erythematous base. Often on forearms, groin,
and axillae. ELDERLY. Bullae do not rupture as easily as pemphigus.

73
Q

Histology of bullous pemphigoid

A

Subepidermal bulla with eosinophils

Linear deposition of IgG along basement membrane

74
Q

Pathophysiology of pemphigus vulgaris

A

IgG Abs bind to desmoglein 1 & 3 → INTRAepidermal bulla PemphiguS - Bullae are Superficial

vulgar - easy to burst

vulgar - bind to two proteins (desmoglein 1 & 3); 13 = unlucky

75
Q

What is Nikolsky’s sign +ve?

A

Intra-epidermal lesions such as pemphigus vulgaris

**when you apply lateral pressure to the blister the epidermis comes off**

76
Q

clinical features of pemphigus vulgaris

A

Bullae are easily ruptured –> raw red surface. Found on skin AND
mucosal membranes. Nikolsky’s sign +ve. Mucosal involvement.

***pemhigoid does not have mucosal involvement***

77
Q

histology of pemphigus vulgaris

A

Intraepidermal bulla

Netlike pattern of intercellular IgG deposits
Acantholysis

78
Q

What is a benign epidermal cutaneous neoplasm?

A

seborrheic keratosis

79
Q

What are the premalignant cutaneous neoplasms?

A

actinic keratosis

keratocanthoma

bowen’s disease

80
Q

what is actinic keratosis?

A

Rough, sandpaper like texture, scaly lesions on sun-exposed areas

81
Q

Histology of solar keratosis

A

SPAIN - sunny in spain

Solar elastosis

Parakeratosis

Atypia/dysplasia

Inflammation

Not full thickness

82
Q

What is keratocanthoma?

A

Rapidly growing dome shaped nodule which may develop a necrotic, crusted
centre. Grows over 2-3 weeks and clears spontaneously

**so kinda looks like BCC but regresses spontaneously whereas BCC would be growing??**

83
Q

What condition has similar histology to keratocanthoma?

A

SCC- difficult to differentiate

84
Q

What is bowen’s disease?

A

Intra-epidermal squamous cell carcinoma in situ
Flat, red, scaly patches on sun-exposed area

85
Q

Histology of bowen’s disease

A

Full thickness atypia/dysplasia (unlike actinic keratosis - not full thickness)

Basement membrane intact - not invading the dermis

86
Q

what are the main malignant epidermal skin tumours (i.e. tumours of keratinocytes)

A

squamous cell carcinoma

basal cell carcinoma

87
Q

What is squamous cell carcinoma?

A
88
Q

Histology of squamous cell carcinoma

A
89
Q

What is a basal cell carcinoma?

A
90
Q

Histological features of basal cell carcinoma

A
91
Q

What are the benign melanocytic tumours?

A

Benign – melanocytic nevi (=moles). They can be junctional, compound or intradermal.

92
Q

Histology of malignant melanoma

A

atypical melanocytes; initially grow horizontally in epidermis (radial growth phase);
then grow vertically into dermis (vertical growth phase); vertical growth produces “buckshot appearance” (=Pagetoid cells)

**starting climbing stairs- horizontal along corridor then vertical**

93
Q

Important prognostic factor in melanoma

A

Breslow thickness

94
Q

Subtypes of melanoma

A
  1. lentigo maligna melanoma
  2. superficial spreading malignant melanoma
  3. nodular malignant melanoma
  4. acral lentiginous melanoma
95
Q

what is lentigo maligna melanoma?

A

occurs on sun exposed areas of elderly
caucasians, flat, slowly growing black lesion

96
Q

what is superficial spreading malignant melanoma?

A

irregular borders with variation in colour

97
Q

what is nodular malignant melanoma?

A

can occur on all sites, more common in the
younger age group.

98
Q

what is acral lentiginous melanoma?

A

occurs on the palms, soles and subungual areas

acral = extremities

lentiginous = freckled

99
Q

which melanoma is more common in young ppl?

A

nodular malignant melanoma

100
Q

SJS vs TEN

A

SJS - <10% of body surface area

TEN - >30% body surface area

*also: SJS caused by infections and drugs; TEN usually just caused by drugs*

101
Q

What sign is positive in SJS and TEN?

A

Nikolsky’s sign positive

i.e. involves the epidermis

102
Q

Which drugs can cause SJS and TEN?

A

Sulfonamide antibiotics

Anticonvulsants

103
Q

Presentation of pityriasis rosea

A

Salmon pink rash appears first (=herald patch) followed by oval macules in Christmas tree distribution.

  • Appears after viral illness.
  • Remits spontaneously
104
Q

most common skin cancer

A

bcc

Histopathology (18 decks)

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