Path Flashcards

Question

Pit rosea histology

Answer 1

Undulating epidermis with focal parakeratosis and spongiosis - may resemble small Pautrier microabscess Lymphocyte exocytosis Perivascular infiltrate Extravasasted RBCs

Answer 2

Blue; common mucin stain

Answer 3

Red; typical for staining amyloid fibres

Answer 4

Violet; can stain glia and neurons

Answer 5

Black/pink or red; stains melanin

Answer 6

Purple/black; can stain mast cells and elastin

Answer 7

Blue; stains the rough endoplasmic reticulum in neurons

Answer 8

Red/magenta; used to stain glycogen, basement membranes, reticular fibres, cartilage, glycoproteins, glycolipids and mucins in tissues.

Answer 9

Red; used to stain fat emboli

Answer 10

Blue/black; stains reticular fibres

Answer 11

Brown-black; stains myelin tissue

Answer 12

Blue; stains mast cell granules

Answer 13

Red/blue/yellow; used to study blood vessels and skin, can stain collagen, nucleus, red blood cells, cytoplasm

Answer 14

HC uses primary antibodies to label a protein, then uses a secondary antibody which is bound to the primary one. In immunoperoxidase staining, an antibody is joined to an enzyme, peroxidase, that catalyses a reaction in which the protein is specifically stained brown. IHC can also involve fluorescently labelled antibody so that when viewed under a light microscope a certain pattern will be observed from the emitted fluorescence.

Answer 15

Used to distinguish between basal cell carcinomas and trichoepitheliomas

Answer 16

T-cell marker; strongly positive in mycosis fungoides

Answer 17

Helper T-cell marker

Answer 18

Suppressor T-cell marker

Answer 19

B-cell marker

Answer 20

Can be used in the diagnosis of Hodgkin lymphoma and anaplastic lymphomas. Large cells: Golgi apparatus and membranous staining

Answer 21

Helps to identify endothelial tumour

Answer 22

Distinguishes different endothelial tumours and is positive in dermatofibrosarcoma

Answer 23

Used in the diagnosis of non-Hodgkin lymphomas, leukaemias and small cell carcinomas

Answer 24

Marker for KIT receptor and positive in various tumours including mastocytosis

Answer 25

Tumour suppressor marker positive in HPV-associated tumours, actinic keratoses and squamous cell carcinoma

Answer 26

Cytokeratins can be used to help distinguish benign from malignant adnexal tumours

Answer 27

Specific for Merkel cell carcinoma. Can help identify adenocarcinomas of the gastrointestinal and reproductive system as well as gastrointestinal epithelial tumours

Answer 28

Used to detect ductal carcinomas, squamous cell carcinomas and other epithelial neoplasms

Answer 29

Muscle marker

Answer 30

Used to identify eccrine neoplasms, Paget disease and sebaceous carcinomas

Answer 31

Can help clinicians distinguish between dermatofibrosarcoma and dermatofibroma

Answer 32

Used to detect melanocytes, especially in melanoma but negative in desmoplastic melanoma

Answer 33

Can help identify melanocytic naevus cells and melanomas

Answer 34

Used to mark tumours of the melanocytes, both naevi and melanoma

Answer 35

Smooth muscle antigen

Answer 36

Nuclear marker for melanocytic tumours

Answer 37

PAS (periodic acid Schiff) for neutral mucin Alcian Blue for acid mucin Mucicarmine

Answer 38

Fontana-Masson

Answer 39

Perl's Prussian Blue

Answer 40

Von Kossa | Alizarin red

Answer 41

MSB (Martius Scarlet Blue)

Answer 42

EVG (Elastic Van Geisen) for reticular dermis | Orcein for papillary dermis

Answer 43

Oil Red-O (Fat is dissolved in tissue processing, frozen section required)

Answer 44

Toluidine Blue | Giemsa

Answer 45

Gram (gram-negative organisms are very difficult to demonstrate) Ziehl-Neilson for most mycobacteria (ZN for AFB) Wade-Fite for M. Leprae

Answer 46

PAS | Grocott / Gomori methenamine silver (GMS)

Answer 47

CD20 and CD79a

Answer 48

Leukocyte common antigen

Answer 49

Cylindroma Thickened basement membrane material Elongated duct like spaces These are apocrine

Answer 50

- Encapsulated, well-circumscribed lesion beneath uninterrupted epidermis - Antoni A: more cellular -> composed of haphazard arrangement of bland cells with spindled and oval nuclei - Antoni B: lose, less cellular areas, with loose oedematous and mucinous stroma with fibrillar collagen. Vessels are prominent and often surrounded by dense sclerosis - Verocay bodies: parallel columns of elongated nuclei either side of homogenous acellular material - Positive for S100

Answer 51

- Neurofibroma: won't be encapsulated - Plexiform neurofibroma -> have nerves coursing through the mass - Perineuroma: stains positive for EMA and S100 - DFSP: CD 34 positive, S100 negative and lacks Antoni A and Antoni B pattern of schwannoma

Answer 52

CD31 and CD34

Answer 53

Pig tail sign Lymphocytes, histiocytes, eosinophils Lymphoid aggregates

Answer 54

Neutrophils

Answer 55

Melanocytes | Adipocytes

Answer 56

More Haem malignancy

Answer 57

Leider- goes red

Answer 58

Cimex lectularis

Answer 59

``` Candida, tinea Pustular psoriasis Subcorneal pustular dermatosis IgA pemphigus/IgG pemphigus Pyoderma vegetans ```

Answer 60

Sarcoidal (granulomatous) Hypersensitive Infectious --> suppurative

Answer 61

TB/Leprosy | Sarcoidosis --> 25% of granulomas can be perineural

Answer 62

CXR, Quant Gold, Tuberculin skin test? | Ziehl Neelson stain, Mycoplasma PCR

Answer 63

Perforating Interstitial Necrobiotic Sarcoidal

Answer 64

``` SCC Melanoma AFX - more spindly Histiocytes Lymphomas - CD34 Angiosarcoma ```

Answer 65

Warthin starry

Answer 66

Apocrine stains CD15 | Apocrine has snouting /decapitation

Answer 67

Langerhans | T lymphocytes

Answer 68

``` Paget’s disease Melanoma Bowen’s Sebaceous carcinoma Histocytosis ```

Answer 69

S100, SOX10, Melan-A, HMB45, PRAIME - latter good for margin control, but is an evolving subject

Answer 70

Nodule - blue cells: large cytoplasm with granules, S100 positive. Rare. Occurs in the subcutaneous tissue in 30-40%, nearly 25% in the tongue. 1-3 cm, painless. 98% benign, malignant change rarely can occur

Answer 71

Transglutaminase IgA Anti-endomyosin antibodies Gliadin

Answer 72

s100 and SOX 10

Answer 73

Spindle cells | brightly eosinophilic cytoplasm, blunt-ended, cigar-shaped nuclei

Answer 74

Pearl stain

Answer 75

Blue | Mucin

Answer 76

Toluidine blue | Giemsa

Answer 77

anti-Saccharomyces cerevisiae antibodies

Answer 78

BerEP4 MOC31 Can be positive in adnexal tumours

Answer 79

Cytokeratin 7 and 19 - positive in BCC, negative SCC, can be positive in adnexal If the SCC has arisen from Bowen’s it can be cytokeratin 7 positive Cytokeratin 20 is also a LMW

Answer 80

CK 5/6 CK 34 beta E 12 Can be positive in BCC, always positive in SCC, and almost invariably positive in adnexal tumors

Answer 81

Negative in BCC and SCC but can be positive in adnexal tumours and is a good way to differentiate

Answer 82

Negative in BCC and SCC, can be positive in adnexal

Answer 83

CEA cytokeratin 20 | Can use GCDF 15

Answer 84

Reduces properties of melanin to stain granules blue green | Easier than Fontana Mason

Answer 85

Has urticaria and eczema overlap The more eos the more you need to think of BP Biopsy: dermal dermatitis with mixed inflammatory cells in the dermis and minimal spongiosis in the epidermis

Answer 86

S100 PGP9.5 - Neuron specific peptide Neuron specific enolase Nerve growth factor receptor Can have histiocytic markers: CD68, NKI/C3 Can have markers of melanocytic differentiation: MITF SOX10 True neural granular cell tumours have all of the above, non neural are the histiocytic markers (congenital granular cell tumour)

Answer 87

EMA Claudin 1 Type IV collagen Laminin

Answer 88

Lacks H3K27me3- trimethylation of lysine 27 on his tone H3 which repress transcription In about 80% of cases it lacks it

Answer 89

Polyomavirus in 80%

Answer 90

CK20, CK5/6, CK7 - corresponds to the ultrastructural distribution of paranuclear whorls of intermediate filaments Positive staining for various neuro endocrine markers: chromogranin, synaptophysin, somatostatin, calcitonin, vasoactive intestinal peptide Neuron specific enolase, occasionally neural filaments, CD56 S100 negative Thyroid transcription factor 1 negative (helps differentiate from from cutaneous metastasis) Could also do polyomavirus P63 may indicate more aggressive behaviour

Answer 91

``` GLUT1 Lewis Y antigen Meridian Fcgamma RIO Wilms tumour protein ```

Answer 92

Lots of lymphocytes around a single cell

Answer 93

Increased telogen count Swarm of bees Eos Pigment casts

Answer 94

Wade Fite Ziel Nielson Gram Silver

Answer 95

Factor 13a

Answer 96

``` Necrobiotic Sarcoidal Tuberculoid Foreign body Suppurative ```

Answer 97

Hyperplasia not connected to epidermis | Adenoma is

Answer 98

Infundibular

Answer 99

60-90%, but not helpful if it’s alopecia

Answer 100

GA has collagen trapping and mucin

Answer 101

MDM2, CDK4, adipophilin, p16 | CD10 in ~20%

Answer 102

SMA and desmin | Then can do HLRCC: fumarate hydratase to look for Reed syndrome

Answer 103

actin, dermin, h-caldesmon, CD10 | usually negative but can be positive: cytokeratin, S100 -

Answer 104

CD15 positive in apocrine not eccrine

Answer 105

- Fordyce spots or granules: vermillion lip and oral mucosa - Meibomian glands: eyelids - Montgomery tubercles: areolae - Tyson glands: labia minora and prepuce

Answer 106

MSH 2 MSH 6 MLH 1 PMS 2 If MSH 2 is negative - then more likely to have MTS So looking for loss of these - they are micro stability arrays

Answer 107

Crystal violet better | Congo red - shows apple green

Answer 108

MSH 6 MSH 2 MLH1 PMS2

Answer 109

Collagen: blue or green Keratin and muscle: fiber Bone: light red or pink

Answer 110

SMA and actin Myosin may be positive CD 34 and 31 negative

Answer 111

``` 7 Ls: Lupus PMLE Lymphoma Pseudolymphoma Jessners Lues Leprosy ```

Answer 112

Multinucleating Marginación of chromatin Molding of nuclei Ballooning degeneration

Answer 113

Crystal violet metachromasia Positive staining with alkaline Congo red Apple green birefringence under polarised light after Congo red staining Thioflavin T staining: brightly by UV fluorescence microscopy Antibodies to amyloid P Stain against specific precursors like keratin

Answer 114

It’s an AVM mutation that’s more likely to have neuro involvement

Answer 115

20% silver nitrate - crystals appear bland and surrounding tissue yellow De Galantha stain - crystals brown black (normal tissue yellow) Polarized light: brightly refractile brown sheaths of fine needle-like crystals can be seen

Answer 116

CPPD crystals are shorter than urate, and rhomboidal in shape Tophaceous pseudogout: rhomboid crystals as well as foci of calcification are seen within the dermis Stain with non-aqueous alcoholic eosin stain --> CPPD crystals with positive birefringence, as opposed to negative birefringence in gout and tumoral calcinosis

Answer 117

Giemsa | ?CD1a

Answer 118

Oil red O - red Scarlet red - red-brown Schultz- cholesterol and cholesterol esters are blue green, positive in xanthomas except eruptive And IHC CD68

Answer 119

Von Kossa De Galantha more specific for urates Negative birefringence with polarized light

Answer 120

If formalin fixed: amorphous eosinophilic deposits in dermis and s/c tissue Alcohol fixed: brown, needle shaped crystals

Answer 121

SMA Vimentin CD34

Answer 122

S100, C34, PGP9.5, factor 13a, myelin basic protein, neurofilaments Bodian stain rarely performed - reveals axons

Answer 123

``` S100 Vimentin Sox 10 MBP Neurofilament is negative ```

Answer 124

collagen is stained blue, nuclei are stained dark brown, muscle tissue is stained red, and cytoplasm is stained pink

Answer 125

Spindle cells in deep dermis and subcutaneous fat Form herring bone or honeycomb or storiform pattern Spindled or wavy nuclei Pigmented variant: Bednar tumour CD34 positive, Factor 13a negative, stromelysin 3 negative

Answer 126

Lobular Acanthosis with hyperpigmented basal layer (dirty feet) Collagen trapping Variable mixture of spindle fibroblasts and histiocytes (can be xanthomatous) F13a positive, CD34 negative

Answer 127

CD20, CD 79a Follicular: Cd10 positive, BCL-2 negative Leg type: BCL-2 positive (marginal zone also BCL-2 positive) Exclude systemic: MUM-1, CD5, CD23

Answer 128

Grenz zone Follicular: 25% follicular, 75% diffuse, has centrocytes and centroblasts. Positive CD10 (sometimes), CD20, 79a, negative BCL-2, MUM-1, CD5, CD23 Marginal zone: marginal zone cells (pale), plasma cells, eos, Dutcher bodies

Answer 129

BAD Bite/ Bullous (PV/PF, BP/PG,MMP, EBA) ACD /AD Drug eruption Other: Well’s, MF, PEP, IP, Erythema toxicum Neonatorum

Answer 130

Dermal eosinophilia ddx BAD - FUGUE (No vasculitis) Bite/ BP (BP/PG,MMP, EBA) ACD/AD Drug eruption ``` Fungal inf (+Neut) Urticaria (+Neut & edema) GF (+Neut), Eos Granuloma (+ LCH) Unknown? Dermal HSR Eos folliculitis Eos Cellulitis (WELLS) ``` Ps: Angiolymphoid hyperplasia with eosinophilia (if +VESSELS & Plump endothelial cells)

Answer 131

Sharp migration of pale cells: ``` Syphilis Hartnup Acrodermatitis enteropathica Radiodermatitis Pellagra, psoriasis Necrolytic migratory erythema Pagets Clear cell acanthoma, papulosis, SCC ```

Answer 132

``` Sebaceous adenoma/carcinoma Trichilemmoma/cyst Pilomatricoma Clear cell acanthoma/BCC/scc/hidradenoma/syringoma Pagets ```

Answer 133

``` Histiocytoses: JXG, NXG, LCH Xanthomas Sebaceous tumours AFX Leprosy ```

Answer 134

``` Minimal epidermal change Peri-v lymphocytic, can get lymphocytic vasculitis - sup and deep Dermal oedema RCC extravasation Very dermal ```

Answer 135

``` Basketweave stratum corneum (acute) Lichenoid/interface Civatte bodies Mild epidermal spongiosis Dermal oedema Lymphs and eos (latter can be sparse) DIF: non specific, granular deposits of IgM and C3 around BV and at DEJ ```

Answer 136

Melanophages More neuts and eos Lymphocyte exocytosis May have papillary dermal fibrosis

Answer 137

Thickened parakeratosis with retention of keratohyaline granules Thickened eosinophilic stratum corneum

Answer 138

Photoallergic is more eosinophilic | Phototoxic is more neutrophilic

Answer 139

Have more neutrophils

Answer 140

Gram (Brown–Brenn) Bacterial infections Periodic acid Schiff (PAS) (Fungal cell walls Black/Mycotic infections) Grocott (GMS) methenamine silver (Fungal cell walls Black/Mycotic infections)- Black Ziehl–Neelsen  Mycobacterial infections Wade-Fite Mycobacterium TB/ leprae/ MOTT (mycobacteria other than tuberculosis) Warthin–Starry? Spirochetes (Syphilis), Granuloma inguinale (Donovanosis) , Rhinoscleroma, Bacillary angiomatosis Giemsa?  leishmania

Answer 141

Large irregular granulomas with central necrobiosis (palisading macrophages) Appear pink in nature This is from fibrin --> stain positive for Martius Scarlet Blue Will be negative for mucin

Answer 142

``` Solar elastosis Elastophagocytosis Diffuse granulomatous infiltrate Reduction in elastin (van Gieson - stains elastin black) No mucin No necrobiosis ```

Answer 143

Raisin like nuclei with halo

Answer 144

Epidermal spongiosis Intra-epidermal vesiculation Pale keratinocytes Acantholysis Keratinocytes have viral changes: molding, margination, multinucleate, pale grey, enlarged Intra-nuclear eosinophilic inclusions: Cowdry type A or Lipschutz bodies Peri-v lymphs and neuts - sometimes vasculitis

Answer 145

``` Sandwich sign: alternating ortho and parakeratosis with basketweave stratum corneum Neutrophils in the stratum corneum Septate hyphae Can be an invisible dermatosis Spongiosis, peri-follicular neutrophils ```

Answer 146

Central: PAS, methenamine silver, Fontana Masson Capsule: alcian blue, mucinarme, Indian ink

Answer 147

Warthin starry Leishman Giemsa Looking for parasitzed macrophages (Donovan bodies)

Answer 148

JXG NXG Dermatofibroma Sometimes xanthomas

Answer 149

CD68 +ve, Factor 13+ve CD1a and Langerin –ve 10% other cells in lesion S100 +ve

Answer 150

Diffuse dermal infiltrate of Large histocytes with with indented or RENIFORM (“coffee-bean” or Kidney shape) nucleus and abundant eos cytoplasm Often mixed with various inflammatory cells lymph + Eos (esp if eosinophilic granuloma Eos +++) epidermotropism also seen (which differs from mastocytosis) EM = Birbeck granules (“tennis racquet”) within cells Positive  CD1a, S100, Langerin (CD207) Negative CD68, factor XIIIa

Answer 151

Foamy histiocytes (rarely touton giant cell) older lesions have cholesterol clefts neuts in young lesions, particularly eruptive Stain positive for: Oil Red O (cholesterol goes red) , Scarlet Red (goes red), Schultz (goes blue-green) CD68 positive

Answer 152

Crystal violet -> metachromatic Congo red --> apple green birefringence Pagoda red --> specific to amyloid, will be negative for colloid milium Thoflavin T --> green-yellow

Answer 153

Van Gieson stains black

Answer 154

Granulomatous reaction with macrophages and foreign body giant cells acellular bluish material in dermis; negative birefringence with polarized light (unlike pseudogout) Formalin-fixed = amorphous, eosinophilic deposits in dermis and subcutaneous tissue (crystals dissolved) Alcohol-fixed = brown, needle-shaped crystals (doubly refractile) Positive staining with von Kossa, but de Galantha is more specific for urates

Answer 155

Van Gieson - loss of elastin

Answer 156

Keloid has more mucin, no epidermal involvement, decreased vascularity, no incr in fibroblasts Hypertrophic: has vertically oriented capillaries, epidermal involvement, no incr in mucin, parallel oriented collagen and fibroblasts

Answer 157

``` Bx from (affected or normal skin): “Purple-squiggles” or “bramble-bush” disease Fragmented, short, basophilic, calcified elastic tissue fibers in mid-dermis (only elastic disorder you can see with only H & E stain) calcifications -> Calcium salts are deposited on the abnormal elastic fibers (do not confuse with calcinosis cutis) von Kossa method stains calcified elastic fibers black and VVG stains elastic fibers ```

Answer 158

CD31, CD34, podoplanin (lymphatic endothelial), LYVE-1, VEGFR-3, Prox1, D240 ? latter from NSS

Answer 159

MRI (enhances on T2 hyperintense, ill-defined margin that crosses tissue planes), FBC, coagulation studies, platelets, fibrinogen degradation products, biopsy for histopath if safe to do so

Answer 160

CD10 and CD99

Answer 161

Perforin Granzyme TIA-1

Answer 162

``` Parakeratosis/orthokeratosis Loss of granular layer Full thickness atypia Eyeliner sign +/- clear cell change, +/- acantholysis Loss of maturation ```

Answer 163

Sialomucin is positive for PAS and mucopolysaccharide | And then Alcian blue or colloidal iron

Answer 164

Acral skin well-circumscribed dermal accumulation of mucin + stellate fibroblasts Pseudowall is made of dense fibrous tissue Collarette of epidermal RR may clutch the mucin Not considered a true cyst Can have epidermal collarette trying to embrace mucin

Answer 165

``` Pagetoid spread Clear cells - sebocytes Mod-severe atypia Stains: Oil Red O, Sudan Black IHC: EMA, adipophilin Do other pagetoid stains ```

Answer 166

Microcystic adnexal carcinoma Desmoplastic trichoepithelioma Sclerosing BCC

Answer 167

'Tadpole' like structures Proliferation of eccrine ducted structures Horn cysts and milia may be present Stroma fibrotic or sclerotic Ducts are lined with 2 layers of flattened cuboidal epithelium, and ducts are CEA positive Associations: Down Syndrome, Nicolau-Balus

Answer 168

Infiltrate of poroid cells: small, monomorphous nucleus and scant eosinophilic cytoplasm Sharp demarcation between epidermis and tumour Poroid cells may be clear due to accumulation of glycogen - PAS positive Dilated ducts with secretions Stain: EMA and CK7 positive Ducts are CEA positive If deep and loose then call it a dermal duct tumour

Answer 169

Jigsaw puzzle Lobules have 2 cell types: peripheral darker small cells, and larger pale cells in the centre Eosinophilic basement membrane In the tumour there are hyalinized droplets - due to thickened basement membrane, PAS positive Associated with Brooke-Spiegler

Answer 170

``` 'Blue balls in dermis' Not encapsulated Three types of cells: 1. Large cuboidal with eosinophilic cytoplasm 2. Small basaloid with dense hyperchromatic 3. Lymphocytes Peripheral vascular channels prominent Ductal structures may be present CEA positive and PAS negative ```

Answer 171

``` Invaginations Plasma cells Papillomatous, papillary projections Tumour open to surface of skin Apocrine decapitation Check for associated sebaceous naevus ```

Answer 172

Circumscribed tumour No connection to epidermis Maze like granuldar spaces that are apocrine (decapitation) Papillary folds 2 layers: myoepithelial and inner cuboidal Often on vulva

Answer 173

Deep dermal nodular tumour Can be poroid: poroid cells, ductal, keratinous cysts Can be apocrine: multi-lobular, duct like, polyongal, clear, mucinous Association: seb naevus and syringocystadenoma papilliferum

Answer 174

``` Horn cysts Squamous and basaloid epithelium Fibrous stroma PNI is common Bottom heavy Stain: CEA, EMA, keratin ``` Ddx: Syringoma Desmoplastic trichoepithelioma Morphoeaform BCC

Answer 175

Halo inside

Answer 176

A: superficial dermis/DEJ - epithelioid B: mid dermis, lymphocyte like C: deeper - spindle

Answer 177

junctional nests are only small in most cases. It may have a wedge shape on low power, with the apex of the wedge directed toward the deep dermis. The lesion is composed of loosely arranged nests and fascicles of pigmented nevus cells, interspersed with melanophages. Spindle cells are the predominant cell type, but varying numbers of epithelioid cells are also present. The nests extend into the deep reticular dermis and often into the subcutaneous fat They surround hair follicles, sweat glands, and nerves. Pilar muscles are sometimes infiltrated

Answer 178

``` Usually in lower 2/3 of dermis Naevus cells Deep - peri-adnexal, peri-vascular, peri-follicular Single filing / 'indian filing' Seen in arrector pili mm ```

Answer 179

``` Grenz zone Wedge shaped Spindle shaped melanocytes, and dendritic melanocytes Sclerosis - can confuse with DF Melanophages Lack maturation Pigment can be subtle ``` Stain: HMB45 - whole lesion positive Subtype: cellular - more pale

Answer 180

Wedge shaped, symmetric 'Raining down' Kamino bodies in epidermis - eosinophilic globules (PAS positive) Nests of melanocytes, whicha re spindled or epithelioid Clefting/cleavage at junctional zone Maturation preserved Stains: S100, HMB45, Melan-A Pigmented = Reed naevus

Answer 181

Nests of various sizes and shapes with bridging between nests Lentiginous epidermal hyperplasia with nevus cells present in nests and as single cells along the junction “shoulder phenomenon” (peripheral extension of junctional component beyond the dermal component Random cytological cell atypia: occasional cells with enlarged hyperchromatic nuclei +/- prominent nucleoli. (The atypia is usually graded into low grade and severe) fibroplasia of papillary dermis around junctional melanocytes maturation of dermal melanocytes if dermal nests present Some mitosis BUT NO DEEP mitosis (unlike melanoma) Mild to moderate lymph in dermis

Answer 182

LMM: Single (lentiginous melanocytic Hyperplasia) or nested atypical melanocytes, confined to basal layer & with little pagetoid spread epidermal atrophy Solar elastosis (However, not pre-request for dx) The invasive component usually spindled atypical melanocytes often MN melanocytes with prominent dendrites at basal layer (Starburst Giant cells) SSM: Single or nested atypical melanocytes, at all levels within Epidermis, Extensive pagetoid spread (buckshot scatter) Nodular: Dermal atypical melanocytes, often No intraEpid component Acral Lentiginous MM: Acral skin+ Lentiginous elongation of RR with atypical melanocytes in basal layer, some buckshot scatter (pagetoid) not as marked as SSM

Answer 183

Asymmetry of lesion Poor peripheral circumscription (ie single atypical melanocytes trail off at the edges beyond the last nest). Epidermis atrophic hypertrophic or ulceration Proliferation of both single and nested atypical melanocytes within the epidermis and extending into the dermis Nests are: Confluent, variable in size, shape & distribution lack of maturation in depth (as they descend into the dermis) Variability in melanin distribution Single cells: There is confluent lentiginous melanocytic proliferation Pagetoid spread Cytological atypia: variable (sometimes slight) Nuclear Hyperchromatism, pleomorphism Increased mitosis (per mm2), sometimes atypical or deep Often lichenoid dermal lymphocytic infiltrate, less perivascular or sparse +/- lymphatic, vascular or perineural invasion, fibrotic changes of regression or microsatellite deposits

Answer 184

From top of Granular layer (or ulcer base) to deepest point of invasion  most important prognostic indicator

Answer 185

``` if epidermal (Level 1 or insitu) if papillary dermis (2), ablating interface papillary-Reticualr dermis (3) deeper then (level 4), SC (level5) ```

Answer 186

- MAIN: Melan-A (cytoplasmic), SOX-10 (NUCLEAR, red chromogen) - OTHERS: HMB-45, Ki-67 & P 16 lost

Answer 187

CD30 +, CD4 +, TIA-1 + Exclude nodal/systemic ALCL (ALK-1 +ve) Differentiate from ALCL (MUM-1 & TRAF-1 +ve)

Answer 188

CD20+ BCL-6 +, CD10 + (confined to the centre) BCL2 – Lamda or kappa light chain staining

Answer 189

``` CD20, CD79a  +ve bcl-2 +ve bcl-6 & Cd 10 –ve Monoclonal Kappa or lambda (negative staining for CD5, CD10, CD23) ```

Answer 190

``` Grenz zone Tingible body macrophage Eos and plasma cells Polarization: will see dark and light Stains for B and T cells Bcl-6 restricted to lymph follicles Mixed kappa and gamma ```

Answer 191

SMA CD34 Vimentin ** not encapsulated

Answer 192

``` CD34 CD31 HHV8 ERG D240 Perls VEGFR-3, podoplanin, LYVE-1 ```

Answer 193

``` Grenz zone Unencapsulated Spindle cells in dermis - wavy, cigar shaped Mast cells Pale, pink stroma ``` Stains: S100, SOX10, CD34, myelin basic protein Bodian stain will show 1:1

Answer 194

``` Encapsulated Verrocay bodies Alternating hypercellular (Antoni A) and hypocellular (Antoni B) Mucinous stroma Mast cells ``` Stains: S100 protein, vimentin, SOX 10,and myelin basic protein in the tumor cells. Neurofilament -ve

Answer 195

Polyhedral cells, granular Eosinophilic granules: pustulo ovoid pustules of Milian Stains: S100, PGP9.5, Myelin basic protein, CD68

Answer 196

Sheets of blue cells in dermis and down to fat Mitoses and necrosis Tumour cells are small to medium-size with Scanty Cytoplasm + dense round nuclei+ Molding - 'salt and pepper' Stains: Positive for CK20, chromogranin, synaptophysin, CK7?? Negative for TTF-1 --> lung mets Ber-EP4 - BCC S100, melan-a - melanoma CD45/leukocyte common antigen - lymphoma

Answer 197

rounded elevations to raised pedunculated growths The epidermis shows some flattening of rete ridges The dermal component consists of a network of collagen fibers, often oriented perpendicular to the surface in the subepidermal zone and having an onion-skin arrangement around follicles and sometimes blood vessels There is an increase in ‘fibroblastic’ cells, which are plump, spindle shaped, stellate, or even multinucleate. There is often a sparse inflammatory infiltrate that includes mast cells. The blood vessels are increased in number, and some are dilated with an irregular outline

Answer 198

Acanthotic epidermis with hyperpigmented basal layer (Dirty feet) poorly demarcated Sometimes there are aggregates of basaloid cells with follicular differentiation emanating from the epidermis (follicular and basaloid “induction”) Variable admixture of Spindle Fibroblast Histiocytes (some of which may be xanthomatous or multinucleate- foam cells, giant cells) Haemorrhage, haemosiderin and increased vessels Hyalinized stroma/ peripheral “entrapped” collagen bundles Cytologic features unremarkable spindle cells Stains Factor XIIIa +ve CD34 -ve

Answer 199

Poorly circumscribed proliferation of monomorphic spindle cells in deep dermis Storiform or cartwheel arrangement of cells Cells spindled or wavy nuclei and little cytoplasm Extends along fat septa- in a Honey-comb pattern Mild atypia & Few mitoses In < 5% Pigmented variant = Bednar tumour Look for -Fibrosarcomatous degeneration in DFSP (dedifferentiation): foci with more atypia and mitoses, transformation to fibrosarcoma or malignant fibrous histiocytoma with risk of metastasis Stains +ve: CD34 -ve: S100 -ve (exclude spindle cell melanoma), Factor 13a -ve (exclude DF), CD31-ve, (exclude angiosarcoma), SMA -ve (exclude leiomyosarcoma

Answer 200

well-circumscribed, non-encapsulated, highly cellular dermal tumour composed of spindle cell, epithelioid cells or MNG & sometimes foamy cells Tumour cells are Bizarre with prominent pleomorphism, hyperchromatism & many atypical mitosis -Multinucleated tumour giant cells (monster cells) Background Solar elastosis Doesn’t invade the subcutis- is so consider UPS Focal proliferation of atypical epithelioid or spindled cells with pleomorphic nuclei and common mitoses Stain: +ve CD10/CD99 Do spindle cell panel-ve all other spindle cell stains -it’s a DX BY EXCLUSION

Answer 201

well-circumscribed tumours cantered within the superficial subcutis. composed of bland smooth muscle cells compactly arranged into bundles whorls around thick-walled vascular channels spindle cells: cigar like Stains: desmin, actin

Path Flashcards

(237 cards)