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Systemic Pathology I > Pathology of the Integumentary System - Part 1 > Flashcards

Pathology of the Integumentary System - Part 1 Flashcards

(59 cards)

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1
Q

Case example
* 11 y/o, FS, mixed breed dog
* 1 year history of skin disease.
* Lesions are pruritic. Patient has chronic
history of non-seasonal pruritus.
* Partial improvement with short courses of
prednisone and antibiotic.
* Crusting on the muzzle, nasal bridge, and
paw pad
Recognize and describe the
common gross cutaneous lesions.

A

What is the clinical history?
Is it pruritic?
Seasonal? Non-seasonal?
How does the patient respond to treatment?
Responsive to immunosuppressive treatment? Antimicrobial treatment?

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2
Q
  • Cytology:
  • Neutrophils with numerous acantholytic cells.
  • No bacteria seen.
  • Differential diagnosis:
  • Pemphigus foliaceus (most likely), pyoderma
  • Submit skin punch biopsies for a
    definitive diagnosis
A
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3
Q

The skin acts as a protective barrier. Some of its functions are:
* Continuously sheds – ________
* Protect against ____ loss (hydrophobic), _______
agents, chemicals, and physical ____
* Photoprotection: pigmentation (_______) and hair
prevent ____ damage.

A

desquamation, fluid, microbiologic, injury, melanocytes, solar

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4
Q

Additional functions of skin:
Functions of skin
* _______ regulation
* _______ perception
* Storage of _____
* Absorptive surface
* ________-regulation
* ________ action

A

Temperature, Sensory, nutrients, Immuno, Antimicrobial

Immune cells are constantly surveying skin, antimicrobial peptides as well.

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5
Q

Describe how the skin produces vitamin D?

A
  • Vitamin D maintains calcium phosphorus ratio
  • Regulate epidermal differentiation and proliferation
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6
Q

The skin is usually an indicator of ?

A

General health and disease

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7
Q

What can be seen here?

A

Hair coat and skin health can be an indicator of general health.
Neoplasia, diseases affecting visceral organs, can manifest itself as skin disease.

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8
Q

How to describe lesion characteristics?

A
  • Distribution: Anatomic location
  • Focal, multifocal
  • Any mucous membrane involvement (e.g. oral cavity)?
  • Symmetric or Asymmetric
  • Size
  • Shape
  • Configuration
  • Type: Primary (underlying cause of disease) vs Secondary lesion (secondary to
    ?)

Make sure to point out whether lesion(s) is on haired or non-haired skin

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9
Q

What type of lesion distribution pattern can be seen here?

A

Bilaterally symmetric

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10
Q

What type of lesion distribution pattern can be seen here?

A

Asymmetric distribution pattern

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11
Q

Label the image accordingly

A
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12
Q

Primary lesion
* A lesion _______ associated with the _______ process.
* Examples: ?
* Choice for skin biopsy!

A

directly, disease, Macule or patch, papule or plaque, pustule, vesicle or bulla, wheal, nodule, cyst,

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13
Q

List examples of Primary or secondary lesions

A
  • Examples: Alopecia, scale, crust, follicular casts, comedo, and pigmentary abnormalities

All Smart Cute Fairies Can Pick Cute Asses

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14
Q

Secondary lesion
* Modification of a _______ lesion that results from evolution of the _______ lesion, traumatic ______, or other _____ factors.
* Examples: Epidermal collarette, scar, excoriation, erosion or ulcer, fissure, lichenification,
callus

A

primary, primary, injury, , external,

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15
Q

Erythema

A

reddening of the skin

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16
Q

Hyperpigmentation:

A

increase in pigment

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17
Q

Hypopigmentation:

A

decrease in pigment

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18
Q

Macule

A

A flat circumscribed lesion of altered skin color; macule < 1 cm

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19
Q

Patch

A

A flat circumscribed lesion of altered skin color; patch > 1 cm

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20
Q

What type of lesion is pictured here?
Describe its shape, configuration, and size.
Give examples.

A

Macule
flat circumscribed lesion of altered skin color
Examples: Hemorrhage, lentigo, vitiligo

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21
Q

What type of lesion is pictured here?
Describe its shape, configuration, and size.
Give examples.

A

Patch > 1 cm
flat circumsized lesion of altered skin color
Can be erythematous, or hyperpigmented, or hypopogmented.

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22
Q

What type of lesion is pictured here?
Describe its shape, configuration, and size.
Give examples.

A

Papule
Solid elevated lesion; < 1 cm diameter. Inflammatory cells accumulated under the skin.
Examples of where you would see this: Allergic reaction, bacterial folliculitis, etc.

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23
Q

What type of lesion is pictured here?
Describe its shape, configuration, and size.
Give examples.

A

Flat elevation in skin; > 1 cm diameter.
Examples: Calcinosis cutis, eosinophilic plaque
Coyner, 201920
Primary lesion

Called an eosiniphyllic plaque.

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24
Q

What type of lesion is pictured here?
Describe its shape, configuration, and size.
Give examples.

Study These Flashcards
A

Pustule; Circumscribed raised superficial accumulation of purulent
fluid within the epidermis.
Examples: bacterial infection, pemphigus foliaceous.

25
What type of lesion is pictured here? _______ circumscribed elevation of _____ filled with ____ fluid Describe its shape, configuration, and size. Give examples.
Vesicle and Bulla Sharply, epidermis, clear; vesicle < 1 cm; bulla > 1 cm. Examples: viruses, chemicals, burns and autoimmune diseases. Primary lesion
26
What type of lesion is pictured here? _____ circumscribed raised lesion consisting of ____ Describe its shape, configuration, and size. Give examples.
Wheal --> Sharply, edema Examples: Insect bites, urticaria, allergic reaction
27
What type of lesion is pictured here? Describe its shape, configuration, and size. Where does this lesion typically extend into? Give examples.
Nodule --> Circumscribed solid elevation > 1 cm in diameter that usually extends into deeper layers of skin Examples: bacterial or fungal infection, neoplasm etc. 24 Primary lesion
28
What type of lesion is pictured here? What is this lesion lined with? What is it filled with, if anything? Describe its shape, configuration, and size. Give examples.
Epithelium-lined cavity containing fluid or a solid material. It is a smooth, well-circumscribed, fluctuant to solid mass. Examples: follicular cyst and apocrine gland cyst. Miller et al, 201325 Primary lesion
29
What type of lesion is pictured here? Describe its shape, configuration, and size. Give examples.
Alopecia --> Partial to complete loss of hair Examples: endocrine dermatopathy, follicular dysplasia (can not gorw normall)`
30
What type of lesion is pictured here? Sheets of ______ cells that split and ______ from underlying _____ as _____, thick or thin, dry or oily fragments, may adhere to hairs. Describe its shape, configuration, and size. Give examples.
Scale cornified, separate, epidermis as irregular Examples: cornification disorders such as sebaceous adenitis and ichthyosis. Primary or secondary lesion
31
What type of lesion is pictured here? ________ composed of ____ accumulations of ? Describe its shape, configuration, and size. Give examples.
Crust – desquamation, dry accumulations of serum, pus, and epithelial and bacterial debris. Examples: chronic stage of pustular disease (bacterial infection or pemphigus foliaceous). 28 Primary or secondary lesion
32
What type of lesion is pictured here? Accumulation of _____ and ______ material that adheres to ____ _____ extending above surface of ______ ____. Describe its shape, configuration, and size. Give examples.
Follicular cast Accumulation of keratin and follicular material that adheres to hair shaft extending above surface of follicular ostia. Example: sebaceous adenitis
33
What type of lesion is pictured here? Describe its shape, configuration, and size. Give examples.
Follicular cast Yellow is from keratian plugwhich plus tbe hir follcile
34
What type of lesion is pictured here? Describe its shape, configuration, and size. Give examples.
Comedo Dilated hair follicle filled with cornified cells and sebaceous material Examples: solar dermatosis (canine), chin acne and endocrine dermatopath
35
What type of lesion is pictured here? Describe its shape, configuration, and size. Give examples.
Abnormal pigmentation Changes in skin coloration caused by a variety of pigments Examples: * Hypopigmentation – vitiligo * Hyperpigmentation: postinflammatory, chronic, traumatic, and endocrine skin lesions Miller et al, 201331 Primary or secondary lesion
36
What type of lesion is pictured here? A ____ layer of ___ that expands _______ and forms a ___. Describe its shape, configuration, and size. Give examples.
Epidermal collarette A thin layer of scale that expands peripherally and forms a ring. Examples: superficial bacterial infection (pyoderma), insect bite, fungal infection.
37
What type of lesion is pictured here? Describe its shape, configuration, and size. Give examples.
Scar Fibrous tissue that replaces normal skin after dermis injury and/or laceration. On the skin, these areas are oft. Bipsy is a wastge of tiem - do not send ofr pathology Scar: Fibrous tissue that replaces normal skin after dermis injury and/or laceration. On the skin, these areas are often alopecic and depigmented. Examples: healed wound, surgical scar. Do not send to pathologist -> it will give you no information.
38
What type of lesion is pictured here? Describe its shape, configuration, and size. Give examples.
Excoriation Superficial, linear break of the epidermis. Examples: mechanical trauma, the macerating action of secretions, and constant humidity.
39
What type of lesion is pictured here? Describe its shape, configuration, and size. Give examples.
Erosion Partial-thickness loss of epidermis resulting in shallow, moist, glistening depression. Examples: Secondary to vesicle or pustule rupture or secondary to surface trauma, immune-mediated disease
40
What type of lesion is pictured here? Describe its shape, configuration, and size. Give examples.
Ulcer: Full-thickness loss of epidermis and basement membrane, and at least a portion of the dermis with depression of the exposed surface. Examples: ischemic lesions resulting from vasculitis, indolent ulcer, feline herpesvirus dermatitis, feline ulcerative dermatosis syndrome.
41
What type of lesion is pictured here? Describe its shape, configuration, and size. Give examples.
Fisssure A deep, linear break from epidermis into the dermis. Examples: paw pad fissure seen in pemphigus foliaceus, superficial necrolytic dermatitis, or digital hyperkeratosis
42
What type of lesion is pictured here? Describe its shape, configuration, and size. Give examples.
Linchenification Rough, thickened epidermis secondary to persistent rubbing, scratching, or irritation; may have increases pigmentation. Examples: chronic dermatitis. Secondary lesion
43
What type of lesion is pictured here? Describe its shape, configuration, and size. Give examples.
Callus: Thick firm, hyperkeratotic, hairless plaque with increased skin folds, wrinkles or fissures. Examples: trauma over bony prominence such as elbow, sternum, or side of digit Secondary lesion
44
Diagosis ofr skin scrapogng (1)
45
Diagnostics – Skin scraping (2)
46
Diagnostics – Cytology & taping
47
Whenever you hae=ve a noduke, Aspiration.
48
Diagnostics – Microbial culture * Superficial infections: Skin swab for aerobic bacteria Coyner, 201945
49
Diagnostics – Microbial culture
* Panniculitis, draining tracts or nodules: * Tissue culture (sterile procedure) for aerobic and anaerobic bacteria, Mycobacterium, and fungi * Use excisional biopsy or double-punch method
50
Diagnostics – Dermatophyte culture
* Technique: hair pluck, toothbrush technique * Dermatophyte test medium (DTM) * Dermatophyte PCR
51
Can culture dermatophyte after shine lught and brush
52
* Serology or intradermal testing * Only performed when the clinical diagnosis of atopic dermatitis has been made by first ruling out all other causes of pruritus/dermatitis After clincial diagnosi of atopic dermatitis?
53
Diagnostics – Skin biopsy * When?
* The disease that can only be diagnosed by a skin biopsy * Failure to respond to rational therapy * Severe clinical presentations * Persistent ulcers, vesicles, and bullae * Nodular or neoplastic lesions * To guide clinical treatment 49
54
Acute Erythema, papules, pustules
55
Chronic Lichenification, hyperpigmentation
56
Diagnostics – Skin biopsy 1. Which lesions should you use for a skin biopsy? 2. How big should your biopsy sample be for most locations? What are the exceptions?
1. Primary lesions 2. Size: 6-8 mm for most location; 4 mm for paw, nasal planum, periocular region, or eyelid
57
Tips for skin biopsy * Avoid ____-_______ therapy (e.g. steroid) for at least 2 weeks * Treat ____ infections prior to biopsy * Use cytology / scrapings / dermatophyte cultures to identify ______ infections * Submit _____ _____ for nodular or draining tracts * Culture for ? * Don’t ____ the skin or soak in _____ * Include ____ and ____ in your sample * Provide appropriate clinical history and list your clinical differential diagnoses.
anti-inflammatory, secondary, secondary, tissue culture, aerobic, anaerobic bacteria, Mycobacterium, and fungi, scrub, antiseptics, crusts, scales
58
What can be seen here?
Skin punching biopsy
59
Additional testing * ________ stains * Gram: ____ * _______ _____ ____ (PAS): fungi * Acid-fast: ______ * _______ ______ _____ (GMS): fungi, oomyces *_________ stains * Infectious agents * ______ – epithelial, mesenchymal, round cell etc. * ____________ (PCR) * PCR for ? (PARR)
Histochemical, bacteria, Periodic acid–Schiff, mycobacterium, Grocott's Methenamine Silver, Immunohistochemical, Neoplasia, Polymerase chain reaction, Antigen Receptor Rearrangements

Systemic Pathology I (27 decks)

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