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Year 5 Histopath > Skin > Flashcards

Skin Flashcards

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1
Q

What are the 4 layers of the Epidermis

A 
From top to bottom:
S. corneum
S. granulosum
S. spinosum (prickle layer)
S. basaleFrom top to bottom:
S. corneum
S. granulosum
S. spinosum (prickle layer)
S. basaleFrom top to bottom:
S. corneum
S. granulosum
S. spinosum (prickle layer)
S. basaleFrom top to bottom:
S. corneum
S. granulosum
S. spinosum (prickle layer)
S. basaleFrom top to bottom:
S. corneum
S. granulosum
S. spinosum (prickle layer)
S. basaleFrom top to bottom:
S. corneum
S. granulosum
S. spinosum (prickle layer)
S. basale
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2
Q

Describe the S. corneum layer?

A 
non-nucleated
Contains keratinnon-nucleated
Contains keratinnon-nucleated
Contains keratinnon-nucleated
Contains keratinnon-nucleated
Contains keratinnon-nucleated
Contains keratin
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3
Q

Describe the S. granulosum layer?

A

Nuclei disintegrated

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4
Q

Describe the S. spinosum layer?

A

Cells linked by desmosomes

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5
Q

Describe the S. basale layer?

A

mitosis
cells bound to BM by hemidesmosomesmitosis
cells bound to BM by hemidesmosomesmitosis
cells bound to BM by hemidesmosomesmitosis
cells bound to BM by hemidesmosomesmitosis
cells bound to BM by hemidesmosomesmitosis
cells bound to BM by hemidesmosomes

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6
Q

What is the name for increased S.corneum and therefore increased keratin?

A

Hyperkeratosis

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7
Q

What is the name for nuclei in S. corneum

A

Parakeratosis

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8
Q

What is the name for an increase in S. spinosum?

A

Acanthosis

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9
Q

What is the name for a decrease in cohesions between keratinocytes?

A

Acantholysis

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10
Q

What is the name for intercellular oedema?

A

Spongiosis

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11
Q

What is the name for a linear pattern of melanocyte proliferation within epidermal basal cell layer (can be reactive or neoplastic)?

A

Lentiginous

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12
Q

Define dermatitis/eczema:

A

Interchanagable terms for a group of disorders with the same histology
Presents with inflamed, dry, itchy rashesInterchanagable terms for a group of disorders with the same histology
Presents with inflamed, dry, itchy rashesInterchanagable terms for a group of disorders with the same histology
Presents with inflamed, dry, itchy rashesInterchanagable terms for a group of disorders with the same histology
Presents with inflamed, dry, itchy rashesInterchanagable terms for a group of disorders with the same histology
Presents with inflamed, dry, itchy rashesInterchanagable terms for a group of disorders with the same histology
Presents with inflamed, dry, itchy rashes

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13
Q

Where does atopic dermatitis effect infants?

A

Face + scalp

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14
Q

Where does atopic dermatitis effect older than infants?

A

Flexural areas
If chronic - lichenification occurs
persits into adulthood in thouse with a FHx of atopyFlexural areas
If chronic - lichenification occurs
persits into adulthood in thouse with a FHx of atopyFlexural areas
If chronic - lichenification occurs
persits into adulthood in thouse with a FHx of atopyFlexural areas
If chronic - lichenification occurs
persits into adulthood in thouse with a FHx of atopyFlexural areas
If chronic - lichenification occurs
persits into adulthood in thouse with a FHx of atopyFlexural areas
If chronic - lichenification occurs
persits into adulthood in thouse with a FHx of atopy

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15
Q

What hypersensitivity can cause contact dermatitis?

A

Type IV e.g. to nickel or rubber

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16
Q

What are the clinical features of contact dermatitis?

A 
Erythema
Swelling
PruritisErythema
Swelling
PruritisErythema
Swelling
PruritisErythema
Swelling
PruritisErythema
Swelling
PruritisErythema
Swelling
Pruritis
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17
Q

Where does contact dermatitis commonly effect?

A

Ear lobes and neck (jewellery)
Wrist (leather watch straps)
Feet (shoes)Ear lobes and neck (jewellery)
Wrist (leather watch straps)
Feet (shoes)Ear lobes and neck (jewellery)
Wrist (leather watch straps)
Feet (shoes)Ear lobes and neck (jewellery)
Wrist (leather watch straps)
Feet (shoes)Ear lobes and neck (jewellery)
Wrist (leather watch straps)
Feet (shoes)

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18
Q

What is the histology of acute dermatitis?

A 
Spongiosis
Inflammatory infiltrate in dermis
Dilated dermal capillariesSpongiosis
Inflammatory infiltrate in dermis
Dilated dermal capillariesSpongiosis
Inflammatory infiltrate in dermis
Dilated dermal capillariesSpongiosis
Inflammatory infiltrate in dermis
Dilated dermal capillariesSpongiosis
Inflammatory infiltrate in dermis
Dilated dermal capillaries
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19
Q

What is the histology in chronic dermatitis?

A 
Acanthosis
Crusting
ScalingAcanthosis
Crusting
ScalingAcanthosis
Crusting
ScalingAcanthosis
Crusting
ScalingAcanthosis
Crusting
Scaling
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20
Q

What is seborrhoeic dermatitis (dandruff)?

A

Inflammatory reaction to yeast - Malassezia

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21
Q

Where does seborrhoeic dermatitis affect infants?

A

Cradle cap (large yellow scales on scalp)

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22
Q

Where does seborrhoeic dermatitis affect young adults?

A

Mild erythema
Fine scaling
Mildly pruritic

Affects; face, eyebrow, eyelid, anterior chest, external earMild erythema
Fine scaling
Mildly pruritic

Affects; face, eyebrow, eyelid, anterior chest, external earMild erythema
Fine scaling
Mildly pruritic

Affects; face, eyebrow, eyelid, anterior chest, external earMild erythema
Fine scaling
Mildly pruritic

Affects; face, eyebrow, eyelid, anterior chest, external earMild erythema
Fine scaling
Mildly pruritic

Affects; face, eyebrow, eyelid, anterior chest, external ear

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23
Q

Define psoriasis:

A

a skin disease marked by well-demarcated red, itchy, scaly patches.

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24
Q

What is Auspitz’ sign?

A

Rubbing of psoriasis plaques to cause pin-point bleeding

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25
Where does psoriasis effect and what does it look like?
Salmon pink plaques with silver scale Affecting extensor aspects of knees, elbows and scalpSalmon pink plaques with silver scale Affecting extensor aspects of knees, elbows and scalpSalmon pink plaques with silver scale Affecting extensor aspects of knees, elbows and scalpSalmon pink plaques with silver scale Affecting extensor aspects of knees, elbows and scalpSalmon pink plaques with silver scale Affecting extensor aspects of knees, elbows and scalp
26
What is Koebner phenomenon in psoriasis?
Lesions form at the site of trauma
27
Histology of psoriasis:
Parakeratosis Loss of granular layer Clubbing of rete ridges giving "test tubes in a rack" appearance Munro's microabscerssesParakeratosis Loss of granular layer Clubbing of rete ridges giving "test tubes in a rack" appearance Munro's microabscerssesParakeratosis Loss of granular layer Clubbing of rete ridges giving "test tubes in a rack" appearance Munro's microabscerssesParakeratosis Loss of granular layer Clubbing of rete ridges giving "test tubes in a rack" appearance Munro's microabscerssesParakeratosis Loss of granular layer Clubbing of rete ridges giving "test tubes in a rack" appearance Munro's microabscersses
28
Define Munro's microabscesses
Munro's microabscess is an abscess (collection of neutrophils) in the stratum corneum of the epidermis due to the infiltration of neutrophils from papillary dermis into the epidermal stratum corneum.
29
Less common types of psoriasis are:
Flexural psoriasis Guttate psoriasis - raindrop plaque distribution, usually seen 2 weeks post strep throat Erythodermic/pustular psoriasisFlexural psoriasis Guttate psoriasis - raindrop plaque distribution, usually seen 2 weeks post strep throat Erythodermic/pustular psoriasisFlexural psoriasis Guttate psoriasis - raindrop plaque distribution, usually seen 2 weeks post strep throat Erythodermic/pustular psoriasisFlexural psoriasis Guttate psoriasis - raindrop plaque distribution, usually seen 2 weeks post strep throat Erythodermic/pustular psoriasisFlexural psoriasis Guttate psoriasis - raindrop plaque distribution, usually seen 2 weeks post strep throat Erythodermic/pustular psoriasis
30
Psoriasis is associated with:
``` Arthritis (5-10%) Nail changesArthritis (5-10%) Nail changesArthritis (5-10%) Nail changesArthritis (5-10%) Nail changesArthritis (5-10%) Nail changes ```
31
What are the nail changes associated with psoraisis?
Pitting Onycholysis Subungal Hyperkeratosis (POSH)Pitting Onycholysis Subungal Hyperkeratosis (POSH)Pitting Onycholysis Subungal Hyperkeratosis (POSH)Pitting Onycholysis Subungal Hyperkeratosis (POSH)Pitting Onycholysis Subungal Hyperkeratosis (POSH)
32
Define lichin planus
a disease of the skin and/or mucous membranes that resembles lichen. The aetiology is unknowna disease of the skin and/or mucous membranes that resembles lichen. The aetiology is unknowna disease of the skin and/or mucous membranes that resembles lichen. The aetiology is unknowna disease of the skin and/or mucous membranes that resembles lichen. The aetiology is unknowna disease of the skin and/or mucous membranes that resembles lichen. The aetiology is unknown
33
What are the 5 "p's" describing lichen planus lesions?
``` Pruritic Purple Polygonal Papules Plaques ``` ``` They also have a mother of pearl sheenPruritic Purple Polygonal Papules Plaques ``` ``` They also have a mother of pearl sheenPruritic Purple Polygonal Papules Plaques ``` ``` They also have a mother of pearl sheenPruritic Purple Polygonal Papules Plaques ``` They also have a mother of pearl sheen
34
What is Wickam's striae
A fine white network on the surface of lesions in lichen planus
35
Where does lichen plaus occur?
Usually on the inner surfaces of wrists Can also affect oral mucous membranes where the lesions have a lacy appearanceUsually on the inner surfaces of wrists Can also affect oral mucous membranes where the lesions have a lacy appearanceUsually on the inner surfaces of wrists Can also affect oral mucous membranes where the lesions have a lacy appearanceUsually on the inner surfaces of wrists Can also affect oral mucous membranes where the lesions have a lacy appearance
36
What is the histology of lichen planus
Hyperkeratosis with saw-toothing of rete ridges and bvasal cell degeneration
37
Define erythema multiforme
Erythema multiforme is a hypersensitivity reaction usually triggered by infections, most commonly herpes simplex virus (HSV). It presents with a skin eruption characterised by a typical target lesion. There may be mucous membrane involvement.
38
What and where is the classic lesion for erythema multiforme?
Annular target lesions on the hands and feet
39
What causes erythema multiforme?
``` Infections (e.g. herpes simplex, mycoplasma) Drug reactions (e.g. penicillin, salicylates, anti-malarials)Infections (e.g. herpes simplex, mycoplasma) Drug reactions (e.g. penicillin, salicylates, anti-malarials)Infections (e.g. herpes simplex, mycoplasma) Drug reactions (e.g. penicillin, salicylates, anti-malarials)Infections (e.g. herpes simplex, mycoplasma) Drug reactions (e.g. penicillin, salicylates, anti-malarials) ```
40
What can be seen on histology of erythema multiforme?
Subepidermal bullae
41
Define pemphigus
a skin disease in which watery blisters form on the skin.
42
Name 3 types of bullous disease:
``` Dermatitis herpetiformis Pemphigoid PemphigusDermatitis herpetiformis Pemphigoid PemphigusDermatitis herpetiformis Pemphigoid PemphigusDermatitis herpetiformis Pemphigoid Pemphigus ```
43
Define bullous disease:
any disease marked by eruptions of blisters, or bullae, filled with fluid, on the skin or mucous membranes.
44
Describe the pathophys of pemphigus:
IgG Abs binds to desmosomal proteins --> intraepidermal bulla PemphiguS Bullae are SuperficialIgG Abs binds to desmosomal proteins --> intraepidermal bulla PemphiguS Bullae are SuperficialIgG Abs binds to desmosomal proteins --> intraepidermal bulla PemphiguS Bullae are SuperficialIgG Abs binds to desmosomal proteins --> intraepidermal bulla PemphiguS Bullae are Superficial
45
What are the clinical features of pemphigus?
Bullae are easily ruptured Found on skin AND mucosal membranesBullae are easily ruptured Found on skin AND mucosal membranesBullae are easily ruptured Found on skin AND mucosal membranesBullae are easily ruptured Found on skin AND mucosal membranes
46
What is the histology of pemphigus?
Intraepidermal bulla Netlike oattern of intercellular IgG deposits AcantholysisIntraepidermal bulla Netlike oattern of intercellular IgG deposits AcantholysisIntraepidermal bulla Netlike oattern of intercellular IgG deposits AcantholysisIntraepidermal bulla Netlike oattern of intercellular IgG deposits Acantholysis
47
Define pemphigoid:
 is a rare skin condition that causes large, fluid-filled blisters. The blisters develop on areas of skin that often flex — such as the lower abdomen, upper thighs or armpits. Bullous pemphigoid is most common in people older than age 60. is a rare skin condition that causes large, fluid-filled blisters. The blisters develop on areas of skin that often flex — such as the lower abdomen, upper thighs or armpits. Bullous pemphigoid is most common in people older than age 60. is a rare skin condition that causes large, fluid-filled blisters. The blisters develop on areas of skin that often flex — such as the lower abdomen, upper thighs or armpits. Bullous pemphigoid is most common in people older than age 60. is a rare skin condition that causes large, fluid-filled blisters. The blisters develop on areas of skin that often flex — such as the lower abdomen, upper thighs or armpits. Bullous pemphigoid is most common in people older than age 60.
48
Describe the pathophys of pemphigoid:
IgG Abs bind to hemidesmosomes of BM --> subepidermal bulla PemphigoiD bullae are DeepIgG Abs bind to hemidesmosomes of BM --> subepidermal bulla PemphigoiD bullae are DeepIgG Abs bind to hemidesmosomes of BM --> subepidermal bulla PemphigoiD bullae are DeepIgG Abs bind to hemidesmosomes of BM --> subepidermal bulla PemphigoiD bullae are Deep
49
What are the clinical features of pemphigoid?
Large tense bullae on erythmatous base Often on forearms, groin and axillae In the elderly Bullae do not rupture as easily as pemphigusLarge tense bullae on erythmatous base Often on forearms, groin and axillae In the elderly Bullae do not rupture as easily as pemphigusLarge tense bullae on erythmatous base Often on forearms, groin and axillae In the elderly Bullae do not rupture as easily as pemphigus
50
What is the histology of pemphigoid?
Subepidermal bulla with eosinophils Linear deposition of IgG along BMSubepidermal bulla with eosinophils Linear deposition of IgG along BMSubepidermal bulla with eosinophils Linear deposition of IgG along BM
51
Define Dermatitis herpetiformis:
a skin manifestation of celiac disease. Extremely itchy bumps or blisters appear on both sides of the body, most often on the forearms near the elbows, as well as on knees and buttocks.
52
Describe the pathophys of Dermatitis herpetiformis:
Associated with coeliac IgA Abs bind to BM --> subepidermal bullaAssociated with coeliac IgA Abs bind to BM --> subepidermal bullaAssociated with coeliac IgA Abs bind to BM --> subepidermal bulla
53
What are the clinical features of Dermatitis herpetiformis?
Itchy vesicles on extensor surface of elbows and buttocks
54
What is the histology of Dermatitis herpetiformis?
Microabscesses which combine to form subepidermal bullae Neutophil & igA deposits at tips of dermal papillae. Microabscesses which combine to form subepidermal bullae Neutophil & igA deposits at tips of dermal papillae. Microabscesses which combine to form subepidermal bullae Neutophil & igA deposits at tips of dermal papillae. 
55
Epidermal (i.e. from keratinocytes) cutaneous neoplasms can be:
``` Benign Premalignant MalignantBenign Premalignant MalignantBenign Premalignant Malignant ```
56
Name 1 benign epidermal cutaneous neoplasm
Seborrhoeic keratosis
57
Name 3 premalignant epidermal cutaneous neoplasms
Actinic (solar/Senile) keratosis Keratoacanthoma Bowen's diseaseActinic (solar/Senile) keratosis Keratoacanthoma Bowen's diseaseActinic (solar/Senile) keratosis Keratoacanthoma Bowen's disease
58
Name 2 malignant epidermal cutaneous neoplasms
Squamous cell carcinoma Basal cell carcinomaSquamous cell carcinoma Basal cell carcinomaSquamous cell carcinoma Basal cell carcinoma
59
Define seborrhoeic keratosis:
one of the most common noncancerous skin growths in older adults. A seborrheic keratosis usually appears as a brown, black or light tan growth on the face, chest, shoulders or back. The growth has a waxy, scaly, slightly elevated appearance.
60
What are the clinical features of seborrhoeic keratosis:
``` Rough plaques Waxy Stuck on Appear in middle age/elderlyRough plaques Waxy Stuck on Appear in middle age/elderlyRough plaques Waxy Stuck on Appear in middle age/elderly ```
61
Define actinic keratosis:
is a rough, scaly patch on your skin that develops from years of exposure to the sun. It's most commonly found on your face, lips, ears, back of your hands, forearms, scalp or neck.
62
Characteristics of actinic keratosis:
``` Rough Sandpaper like Scaly lesions on sun-exposed areasRough Sandpaper like Scaly lesions on sun-exposed areasRough Sandpaper like Scaly lesions on sun-exposed areas ```
63
Histology of actinic keratosis:
SPAIN ``` Solar elastosis Parakeratosis Atypia/dysplasia Inflammation Not full thicknessSPAIN ``` ``` Solar elastosis Parakeratosis Atypia/dysplasia Inflammation Not full thicknessSPAIN ``` ``` Solar elastosis Parakeratosis Atypia/dysplasia Inflammation Not full thickness ```
64
Define keratoacanthoma:
a low-grade skin cancer tumor that is similar to squamous cell carcinoma (SCC). It originates in the skin's pilosebaceous glands, or hair follicles. This skin cancer tumor grows rapidly, in just a few weeks to a few months.
65
Characteristics of keratoacanthoma:
``` Rapidly growing dome shaped nodule May develop a necrotic, crusted centre Grows over 2-3 weeks Clears spontaneouslyRapidly growing dome shaped nodule May develop a necrotic, crusted centre Grows over 2-3 weeks Clears spontaneously ```
66
Histology of keratoacanthoma:
Hard to differentiate from SCC Atypia/dysplasia throughout epidermis, nuclear crowding and spreading through BM into dermisHard to differentiate from SCC Atypia/dysplasia throughout epidermis, nuclear crowding and spreading through BM into dermis
67
Define Bowen's disease:
a very early form of skin cancer, which is easily curable. The main sign is a red, scaly patch on the skin. The abnormal growth takes place in the squamous cells – the outermost layer of skin – and Bowen's disease is sometimes referred to as "squamous cell carcinoma in situ".
68
Characteristics of Bowen's disease:
Intra-epidermal squamous cell carcinoma in situ Flat Red Scaly patches on sun-exposed areasIntra-epidermal squamous cell carcinoma in situ Flat Red Scaly patches on sun-exposed areas
69
Histology of Bowen's disease:
Full thickness atypia/dysplasia BM intact - i.e. not invading the dermisFull thickness atypia/dysplasia BM intact - i.e. not invading the dermis
70
Define Squamous cell carcinoma (SCC):
the uncontrolled growth of abnormal cells in the skin outer squamous cells of the epidermis. It occurs as a result of keratinization of the epidermal cells and has the potential to metastasize to other regions of the body.
71
Characteristics of Squamous cell carcinoma (SCC):
When Bowens has spread to involve the dermis Similar characteristics to Bowens but may ulcerateWhen Bowens has spread to involve the dermis Similar characteristics to Bowens but may ulcerate
72
Histology of Squamous cell carcinoma (SCC):
Atypia/dysplasia throughout epidermis nuclear crowding and spreading through BM into dermisAtypia/dysplasia throughout epidermis nuclear crowding and spreading through BM into dermis
73
Define Basal cell carcinoma:
Basal cell carcinoma begins in the basal cells — a type of cell within the skin that produces new skin cells as old ones die off. Basal cell carcinoma often appears as a waxy bump, though it can take other forms. Basal cell carcinoma occurs most often on areas of the skin that are often exposed to the sun, such as your face and neck. Most basal cell carcinomas are thought to be caused by long-term exposure to ultraviolet (UV) radiation from sunlight. Avoiding the sun and using sunscreen may help protect against basal cell carcinoma.Basal cell carcinoma begins in the basal cells — a type of cell within the skin that produces new skin cells as old ones die off. Basal cell carcinoma often appears as a waxy bump, though it can take other forms. Basal cell carcinoma occurs most often on areas of the skin that are often exposed to the sun, such as your face and neck. Most basal cell carcinomas are thought to be caused by long-term exposure to ultraviolet (UV) radiation from sunlight. Avoiding the sun and using sunscreen may help protect against basal cell carcinoma.
74
Characteristics of Basal cell carcinoma:
AKA rodent ulcer Slow growing tumour Rarely metastatic but locally destructive Pearly surface, often with telangiectasiaAKA rodent ulcer Slow growing tumour Rarely metastatic but locally destructive Pearly surface, often with telangiectasia
75
Histology of Basal cell carcinoma:
Mass of basal cells pushing down into the dermis Palisading (nuclei align in outermost layer)Mass of basal cells pushing down into the dermis Palisading (nuclei align in outermost layer)
76
Melanocytic (i.e. from melanocytes) cutaneous neoplasms can be:
Benign - melanocytic nevi (=moles). Malignant - melanomaBenign - melanocytic nevi (=moles). Malignant - melanoma
77
How can benign melanocytic nevi (moles) be classified?
``` Junctional Compound IntradermalJunctional Compound Intradermal ```
78
Histology of malignant melanoma is:
atypical melanocytes Initially grow horizontally in epidermis (radial growth phrase) Then grow vertically into dermis (vertical growth phase) Vertical growth produces buckshot appearance (=Pagetoid cells)atypical melanocytes Initially grow horizontally in epidermis (radial growth phrase) Then grow vertically into dermis (vertical growth phase) Vertical growth produces buckshot appearance (=Pagetoid cells)
79
What are pagetoid cells?
buckshock appearance due to vertical growth in malignant melanoma
80
What is the most important prognostic factor in melanoma?
Breslow thickness
81
Subtypes of melanoma are:
Lentigo maligna melanoma - Flat, slowly growing black lesion on sun-exposed caucasians Superficial spreading malignant melanoma - irregular borders with variation in colour Nodular malignant melanoma - can occur on all sites, commoner in young Acral lentiginous melanoma - palms, soles and sublingual areas
82
Define: Stevens Johnson Syndrome (SJS)
a form of toxic epidermal necrolysis, is a life-threatening skin condition, in which cell death causes the epidermis to separate from the dermis. The syndrome is thought to be a hypersensitivity complex that affects the skin and the mucous membranes.
83
Define Toxic Epidermal Necrolysis (TEN)
a potentially life-threatening dermatologic disorder characterized by widespread erythema, necrosis, and bullous detachment of the epidermis and mucous membranes, resulting in exfoliation and possible sepsis and/or death
84
Name two dermatological emergencies and describe why they are dangerous:
Stevens Johnson Syndrome - sheets of skin detachment 30% of body surface area
85
What is Nikolsky sign?
a skin finding in which the top layers of the skin slip away from the lower layers when slightly rubbed. In SJS and TEN this means there is prominent mucosal involvment
86
What can cause SJS and TEN?
Commonly drugs e.g. Sulfonamide Abx and anticonvulsants
87
Define Pityriasis rosea
a mild, noncontagious skin disorder common among children and young adults, and characterized by a single round spot on the body, followed later by a rash of colored spots on the body and upper arms.
88
What distribution does pityriasis rosea have?
Salmon pink rash appears first (=herald patch) followed by oval macules in a christmas tree distribution.
89
When does pityriasis rosea appear and how is it treated?
Appears after a viral illness | Remits spontaneousily

Year 5 Histopath (17 decks)

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