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# !! DERMATOPATHOLOGY by Shammy !! # > INFECTIONS AND INFESTATIONS > Flashcards

INFECTIONS AND INFESTATIONS Flashcards

(42 cards)

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1
Q

Patterns for syphilis

A

Psoriasiform +lichenoid

  • Superficial and deep perivascular and periadnexal infiltrates
  • +/- long, thin rete ridges
  • band-like infiltrates: may see endothelial swelling
  • +/- hyperkeratosis
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2
Q

What are the features of syphilis

A
  • Predominant infiltrate: plasma cell (has eccentric, clock-face nucleus)
  • Endothelial swelling
  • Warthin-Starry: stains spirochetes
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3
Q

stain for spirochetes

A

Warthin-Starry stain

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4
Q

features of TB VERRUCOSA CUTIS

A

Scanty focal granuloma, psoriasiform + lichenoid AFB typically negative

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5
Q

features of LUPUS VULGARIS

A

More organized granuloma, caseation necrosis, variable epidermal changes AFB +/-

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6
Q

features of scrofuloderma

A

Mixed inflammation, granuloma, marked fibrosis, caseation necrosis AFB +/-

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7
Q

hallmark of cutaneous TB

A

TUBERCULOID GRANULOMA

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8
Q

Identify the type of granuloma

A

Tuberculoid granuloma
- epithelioid histiocytes with surrounding mantle of lymphocytes

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9
Q

identify the pointed structure

A

Langhans giant cells - granuloma with multinucleated giant cells

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10
Q
A

Tuberculoid Caseating Granuloma

  • Caseation: focal eosinophilic area od necrotic collagen surrounded by rim of histiocytes
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11
Q
A

Caseation necrosis

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12
Q

Pattern of cutaneous tuberculosis

A

GRANULOMATOUS

TVC: psoriasiform + Lichenoid

Scrofuloderma: diffuse

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13
Q

pattern of erythema induratum

A

Predominantly lobular panniculitis with vasculitis

Features:
- Histiocytes + mutinucleated giant cells
- Mixed cell infiltrate
- Small to medium-sized vasculitis

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14
Q

pattern of tuberculoid leprosy

A

Granulomatous - nodular (superficial and deep)

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15
Q

pattern of lepromatous leprosy

A

Granulomatous - diffuse (superficial and deep)

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16
Q

Identify spectrum of leprosy

A

TUBERCULOID LEPROSY

  • (-) grenz zone
  • Well-organized granulomas (may be elongated/linear)
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17
Q

Identify spectrum of leprosy

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A

LEPROMATOUS LEPROSY

  • (+) grenz zone
  • diffuse foamy histiocytes
18
Q
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A

Tuberculoid: nodular (tight, ‘stretched-out’ granulomas)

Tuberculoid: epithelioid +/- giant cells

19
Q
Study These Flashcards
A

Lepromatous: foamy + globi

20
Q

Identify spectrum of leprosy

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A

BORDERLINE TUBERCULOID

  • Focal/incomplete grenz zone
  • Epithelioid histiocytes +/- giant cells
21
Q

Identify spectrum of leprosy

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A

BORDERLINE BORDERLINE

  • Poorly organized epithelioid granulomas
  • Epithelioid + Foamy histiocytes
22
Q

Identify spectrum of leprosy

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A

BORDERLINE LEPROMATOUS

  • Poorly to moderately defined, loose granulomas
  • Epithelioid < Foamy histiocytes
23
Q

Pattern of Erythema Nodosum Leprosum

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A

Pattern: Predominantly lobular panniculitis with vasculitis

Superficial and deep, nodular and diffuse infiltrates

Feature: Diffuse infiltrates of neutrophils

24
Q
  1. Diagnosis
  2. Pattern?
  3. mechanism of vesicle formation
Study These Flashcards
A
  1. HERPES SIMPLEX/VARICELLA
  2. Intraepidermal vesicular + ballooning deganeration (cytoplasmic swelling)
  3. ballooning degeneration

Intraepidermal blister

  • ballooning of keratinocytes (INTRACELLULAR EDEMA)
  • acantholysis

✓ Pale necrotic keratinocytes
✓ Steel gray nuclei
✓ Molding and margination of nuclear chromatin
✓ Multinucleation of keratinocytes
✓ Ground glass inclusions
✓ +/- leukocytoclastic vasculitis

25
1. Diagnosis 2. Etiologic agent 3. Pathognomonic feature
1. MOLLUSCUM CONTAGIOSUM 2. DNA Poxvirus 3. Henderson-Patterson bodies Endophytic bulbous acanthosis / Crateriform invagination Henderson-Patterson bodies (intracytoplasmic inclusion bodies)
26
1. Diagnosis 2. etiologic agent
1. VERRUCA VULGARIS 2. Human papillomavirus Papillomatous architecture Inward bending of rete ridges Features: - Koilocytes: vacuolated cells with basophilic nuclei surrounded by a clear halo - Hyperkeratosis with tiers of parakeratosis - Hypergranulosis with enlarged keratohyaline granules - Dilated vessels in the dermis
27
Dermatophytosis
28
1. Diagnosis? 2. What is the pattern? 3. Stain used to highlight the organisms
1. DERMATOPHYTOSIS 2. Superficial perivascular; Spongiosis 3. Periodic Acid-Schiff - Sandwich sign: PAS positive hyphae in the parakeratotic stratum corneum - Subcorneal pustule as a clue
29
TINEA VERSICOLOR Pattern/s: Superficial perivascular dermatitis / invisible dermatosis - Intracorneal hyphae (spaghetti) and spores (meatballs)
30
1. Diagnosis 2. Etiologic agent 3. Pattern?
1. MAJOCCHI'S GRANULOMA 2. Trichophyton rubrum 3. Granulomatous Periinfundibulitis, perifolliculitis + neutrophilic microabscess - Spores and hyphae within the dermis and follicular infundibulum - Mixed cell infiltrate +/- ruptured follicle
31
1. Diagnosis 2. Pattern? 3. Characteristic finding 4. Give 1 etiologic agent 5. Treatment
1. CHROMOMYCOSIS (AKA CHROMOBLASTOMYCOSIS) 2. Granulomatous + Pseudoepitheliomatous hyperplasia +Suppurative 3. Round, brown, thick-walled yeast forms: Medlar bodies/ sclerotic bodies (“copper pennies”) 4. Fosecaea pedrosoi, Philaophora verrucosa, Fonsecaea compactum, Wangiella dermatitidis, Cladophialophora carrionii 5. Itraconazole 200 mg once daily or Terbinafine 250 mg once daily or IV amphotericin B (up to 1 mg/kg/day) - Neutrophilic abscesses within epidermis
32
1. Diagnosis? 2. Identify the phenomenon shown in the photo 3. give 1 etiologic agent 4. Stains that can highlight the organisms
1. EUMYCETOMA 2. Splendore-Hoeppli phenomenon: eosinophilic rim surrounding granule; not specific 3. Madurella mycetomatis 4. Grocott methenamine silver (GMS) or Periodic Acid-Schiff (PAS) stain - Granulomatous, nodular to diffuse - Granules - Diffuse mixed cell infiltrate - Focal neutrophilic abscesses - (+/-) giant cells ## Footnote REVIEW!! Mycetoma (maduromycosis, Madura foot) - can be caused by either fungi or bacteria - Fungal (eumycetoma): Madurella mycetomatis, Madurella grisea, Pseudallescheria boydii - Filamentous bacteria (actinomycetoma): Nocardia brasiliensis, Actinomadura madurae, Actinomadura pelletieri, Streptomyces somaliensis
33
1. Diagnosis 2. Etiologic agent 3. Pattern 4. Stains 5. MC clinical manifestation of the disease 6. Treatment
1. CRYPTOCOCCOSIS 2. Cryptococcus neoformans 3. Granulomatous, diffuse; Suppurative 4. STAINS: PAS highlights cell wall with red; Yeast cells stain black with GMS; Capsule stains with alcian blue and mucicarmine - descriminate cryptococcosis with other fungal cells 5. Meningoencephalitis 6. IV amphotericin B + flucytosine x 10-14 days; alternative: fluconazole or itraconazole ## Footnote - “soap bubble appearance” (in low immune response): due to mucoid dermal infiltrate - Giant cells - Spherical yeast with mucoid capsule
34
1. Diagnosis 2. Pattern 3. Etiologic agent 4. Vector 5. Stain
1. AMASTIGOTES OF LEISHMANIASIS 2. Granulomatous 3. Leishmania spp. 4. Sandfly 5. Giemsa stain: highlights intracellular amastigotes AKA Leishman-Donovan bodies - Histiocytes with amastigotes (Leishman-Donovan bodies) - Dense dermal infiltrate of lymphocytes, histiocytes, plasma cells
35
1. Diagnosis 2. Etiologic agent 3. Pattern
1. SCABIES 2. Sarcoptes scabiei var hominis 3. Nonspecific; sometimes with spongiosis; Epidermal hyperplasia - Eosinophils - Dense diffuse and nodular mixed infiltrate - Eggs, mites or sycbala (eggs) in the stratum corneum
36
What are the features of cutaneous tuberculosis? What is the stain used to visualize organisms?
* Hallmark: tuberculoid granuloma (histiocytes with mantle of lymphocytes) * +/- Langhans giant cells * +/- caseation necrosis * Stain: Ziehl-neelsen stain
37
stain for leprosy
Fite-faraco stain
38
What are clues for dermatophytosis?
39
1. Diagnosis 2. Pattern? 3. Etiologic agent
1. Tinea versiclor 2. Superficial perivascular dermatitis / invisible dermatosis 3. Malassezia furfur/ globosa
40
Clues for deep fungal infection
41
diagnosis
Scabies
42
1. Diagnosis? 2. Pattern? 3. Most common etiologic agent 3. Treatment?
1. Cutaneous Larva Migrans 2. Spongiotic / diffuse infiltrate 3. Ancylostoma braziliense 3. Albendazole 400 mg OD x 3 days ## Footnote * Eosinophils * Subcorneal/intraepidermal larval tracks * Perineural eosinophils * +/- dermal edema

# !! DERMATOPATHOLOGY by Shammy !! # (18 decks)

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