Published on 08/03/2015 by admin
Filed under Dermatology
Last modified 08/03/2015
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Chapter 1
Tammie Ferringer and Christine J. Ko
• Loss of cell–cell adhesion
• Increase in thickness of the epidermis
• Regular (all rete pegs descend to the same level) or irregular (rete pegs descend to different levels in the papillary dermis)
Fig 1-1 Acantholysis, pemphigus vulgaris
Fig 1-2 Acanthosis, psoriasis
Fig 1-3 Anaplasia, Bowen’s disease
Fig 1-4 Apoptosis, outer root sheath, catagen follicle
Fig 1-5 Asteroid body, sarcoidosis
Fig 1-6 Ballooning degeneration, herpes simplex
• Atypical nuclei (abnormal size, shape, staining) and pleomorphism (variation in nuclear characteristics)
• “Programmed cell death”
• “Dead red” keratinocytes with pyknotic nuclei
• Although the term is often applied to any necrotic or dyskeratotic keratinocyte, it is best reserved for physiologic programmed cell death or pathologic processes that produce death through a similar pathway
• Branching, often refers to rete or vasculature
• Collections of eosinophilic material seen in sporotrichosis
• Also refers to star-shaped intracytoplasmic inclusions seen in giant cells of sarcoidosis or berylliosis or other granulomatous processes
• Decrease in thickness of epidermis
• Destruction of epidermis by dissolution of cell attachments and intracellular edema
• Pale pink linear basement membrane material within epidermis, seen in porphyria cutanea tarda
• Represents degenerated type IV collagen
• Pink, globular remnants of keratinocytes
• Collagen fibers surrounded by histiocytes/spindle cells (collagen balls)
• 45° angle parakeratosis in a column above a focus with a diminished granular layer and underlying dyskeratotic cells
• Corps ronds = rounded nucleus with halo of pale to pink dyskeratotic cytoplasm
• Grain = dark blue flattened nucleus surrounded by minimal cytoplasm
• Dyskeratosis = abnormal, individual-cell keratinization
• Also known as the Lipshutz body
• Intranuclear pink inclusions of herpesvirus infection
• Intranuclear pink inclusions of adenovirus and poliovirus infection
• Serum/fluid with inflammatory cells/debris in stratum corneum
• Intracytoplasmic collections of bacteria seen in granuloma inguinale
• Intracytoplasmic pink masses of immunoglobulin that invaginate into the nucleus of plasma cells and appear to be intranuclear
• Loss of normal rete pattern
• Spongiosis with eosinophils in the epidermis
• Coarse, irregular hypergranulosis associated with disruption of cell membranes
• Associated with keratin 1 and 10 mutations
• Lymphocytes in epidermis with relative absence of spongiosis: term usually reserved for mycosis fungoides
• Partial loss of epidermis
• Lymphocytes in the epidermis with associated spongiosis: term usually used when discussing spongiotic dermatitis
• Papillary dermis retains an undulating pattern (often used to describe porphyria cutanea tarda)
• Collagen encrusted with major basic protein from eosinophils
• Lipid-laden histiocyte
• Alteration of hair sheath anatomy by pools of mucin
• Composed of granulomas (collections of histiocytes)
• Uninvolved area of dermis beneath the epidermis or adjacent to a hair follicle (border zone)
• Eosinophilic inclusions of smallpox
• Intracytoplasmic oval, pink inclusions of molluscum infection
• Increased/decreased granular layer
• Increased/decreased melanin pigment
• Generally refers to the dermoepidermal junction
• Dull pink to amphophilic basement membrane material within the epidermis in a Spitz nevus
• Fragmentation of neutrophils (leukocytoclasis). (If neutrophils resemble ants with segmented bodies, then karyorrhexis resembles dismembered ants and scattered ant heads)
• Keratinocytes with clear cytoplasm and shrunken “raisin-like” pyknotic nuclei
• Intracytoplasmic collections of amastigotes in leishmaniasis
• Elongated bulbous rete
• Proliferation predominantly along the dermoepidermal junction
• Fragmentation of neutrophils, also referred to as karyorrhexis
• Interface dermatitis with destruction of the basal layer and Civatte body formation (Figure 1.7)
Fig 1-7 Civatte bodies, lichen planus
Fig 1-8 Collagen entrapment, dermatofibroma
Fig 1-9 Cornoid lamellae, porokeratosis
Fig 1-10 Corps ronds/grains, Darier’s disease
Fig 1-11 Eosinophilic spongiosis, incontinentia pigmenti
Fig 1-12 Epidermolytic hyperkeratosis
Fig 1-13 Epidermotropism, mycosis fungoides
Fig 1-14 Lymphocyte exocytosis, subacute spongiotic dermatitis
Fig 1-15 Flame figure, Wells’ syndrome
Fig 1-16 Foam cells, verruciform xanthoma
Fig 1-17 Follicular mucinosis, alopecia mucinosis
Fig 1-18 Granulomas, sarcoid
Fig 1-19 Hyper-hypogranulosis, lichen planus
Fig 1-20 Kamino bodies, Spitz nevus
Fig 1-21 Karyorrhexis, leukocytoclastic vasculitis
Fig 1-22 Leishman–Donovan bodies, leishmaniasis
Fig 1-23 Medlar bodies, chromomycosis
Fig 1-24 Munro microabscess, psoriasis
Fig 1-25 Necrobiosis, necrobiosis lipoidica
• A band-like infiltrate, generally composed predominantly of lymphocytes, located at the dermoepidermal junction
• Brown, round structure resembling overlapping copper pennies
• Divide by septation, resembling a hot-cross bun
• The property of staining a different color from the stain itself (i.e., the purple color of mast cell granules with the blue stain methylene blue)
• Intra- and extracellular calcified, concentric circular structures, seen in malakoplakia
• Collection of neutrophils in the stratum corneum, as seen in psoriasis
• Pale-staining smudged necrotic collagen
• Inclusions within neurons seen in rabies infection
• Stratum corneum without retained nuclei
• Large cells with abundant cytoplasm within the epidermis
• Buckshot scatter of atypical cells within the epidermis
Fig 1-26 Pagetoid cells and pagetoid scatter, Paget’s disease
• Picket fence-like arrangement at the periphery
• Structure that resembles the whorl of plump mesenchymal cells normally present in the hair papilla (seen in trichoblastoma and trichoepithelioma)
Fig 1-27 Palisading, gout
Fig 1-28 Papillary mesenchymal body, trichoepithelioma
Fig 1-29 (a) PEH, syringosquamous metaplasia following trauma. (b) Elastic fiber trapping in PEH
Fig 1-30 Pseudohorn cyst, seborrheic keratosis
• Exophytic finger-like projections
• Stratum corneum with retained nuclei
• Melanin within dermal macrophages and free within the dermis
• Variation in nuclear size/shape
• Extracellular laminated, calcified structures seen in meningioma, papillary thyroid carcinoma, ovarian carcinoma
• Prominent acanthosis of the adnexal epithelium and epidermis, mimics squamous cell carcinoma
• Often associated with trapping of elastic fibers
• Keratin-filled cystic structure that is the result of cutting through invaginations of the stratum corneum (similar to a horn cyst, but connects to the surface)
• Destruction of epidermis with cell membranes remaining in a net-like pattern
• Network of interconnecting strands (net-like)
• Intracytoplasmic pink collections of immunoglobulins in plasma cells, seen in rhinoscleroma and other conditions with many plasma cells
• Laminated calcified structure seen in sarcoidosis
• Cells with barely visible outlines of nuclei
• Neutrophils in the stratum spinosum, associated with spongiosis at periphery (typical of psoriasis)
• Intercellular edema in epidermis with stretching of cell–cell junctions
• Loss of cuboidal/columnar basal cells, with deepest layer now being polyhedral, pink squamous cells
• Circular whorls of squamous cells
• Cartwheel or basket-weave pattern
Fig 1-31 Reticular degeneration, variola
Fig 1-32 Russell body, rhinoscleroma
Fig 1-33 Shadow cells, pilomatricoma
Fig 1-34 Squamous eddies, irritated seborrheic keratosis
Fig 1-35 Verocay body, schwannoma
• Formation of clear spaces within the basal layer
• Structure composed of two nuclear palisades enclosing pink cytoplasmic processes, seen in schwannoma
• Projection of papillary dermis covered by a layer of epidermal cells into a cavity
Key features
• Numerous follicles that extend down into the panniculus
• Associated sebaceous glands, arrector pili muscles
• Thin epidermis
• Basket-weave stratum corneum
• Hair follicles and sebaceous glands numerous in the dermis
• Demodex mites common
• Eyelid and ear skin have many vellus hair follicles
• In the upper dermis of eyelid skin, skeletal muscle bundles are present
• On the conjunctival surface of the eyelid, stratum corneum and hair follicles are absent, but goblet cells are present
• Very thick dermis, especially in skin from the back
• Scattered hair follicles and sebaceous glands
• Projections of fat extend upward to envelop adnexae
Fig 1-36 Villi, warty dyskeratoma
Fig 1-37 Normal scalp with follicles rooted in the fat
Fig 1-38 Sun-damaged facial skin
Fig 1-39 Sun-damaged skin. Solar elastosis spares papillary dermis
Fig 1-40 Eyelid
• Slight acanthosis of the epidermis with basilar hyperpigmentation
• Sometimes there is a central invagination of the epidermis that leads to a follicle and sebaceous glands
• Smooth muscle bundles in the mid–deep dermis
• Apocrine glands in the reticular dermis
Fig 1-41 Eyelid
Fig 1-42 Ear
Fig 1-43 Areolar skin, smooth muscle bundles
• Compact eosinophilic stratum corneum
• Slight papillomatosis present on dorsal surfaces
• Compact eosinophilic hyperkeratosis with underlying stratum lucidum
• No hair follicles or sebaceous glands
• Eccrine glands numerous
• Meissner and Pacinian corpuscles may be seen
Fig 1-44 Volar skin, thick stratum corneum and deep Pacinian corpuscles
Fig 1-45 Volar skin, stratum lucidum
Fig 1-46 Volar skin, eccrine glands and Pacinian corpuscle
• Absent granular layer
• Keratinocytes are large and pale (filled with glycogen)
• Dilated vessels in the submucosa
• Smooth muscle bundles may be present
Fig 1-47 Mucosa
Fig 1-48 Smooth muscle in submucosa
Fig 1-49 Nasal turbinate mucosa: erectile tissue with mucous glands
Fig 1-50 Fetal mesenchyme
Fig 1-51 Fetal periderm
• Erectile tissue with fibrous septa and vascular sinusoids
• Mucous glands
• Stellate and spindled fibroblasts (mesenchyme)
• Densely cellular
• From epidermis down to insertion of sebaceous gland
• Intraepidermal portion = acrotrichium
• Keratinizes in the pattern of the normal epidermis with a granular layer (keratohyaline granules)
• From the insertion of the sebaceous gland to the insertion of the arrector pili muscle (bulge)
• Keratin is formed in the absence of a granular layer = trichilemmal keratinization
• The inner root sheath is lost at this level and the outer root sheath develops an inner corrugated, dense pink cornified layer; peripheral palisading of the outer root sheath is seen
• From the insertion of the arrector pili muscle (bulge) to Adamson’s fringe
• Only present in anagen hairs
• The point above which hair cornifies
• Dermatophytes only infect cornified hair above Adamson’s fringe
• Above Adamson’s fringe, Huxley’s layer of the inner root sheath no longer has trichohyalin granules
• Hair tends to retract from the inner root sheath above Adamson’s fringe
• The inner root sheath is fused and blue-gray at this level and trichohyalin granules are not seen
• The outer root sheath is composed of pink cells with peripheral palisading
• Below the stem portion of the anagen hair follicle
• From Adamson’s fringe to the base of the follicle
• The bulb has three zones: matrix, supramatrix, keratogenous zone
• Matrix: from base to critical line (widest point of the bulb and papillae)
Dermatopathology
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