Difference between revisions of "Non-malignant skin disease"
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Revision as of 12:25, 23 August 2012
Non-malignant skin disease is relatively common. The pathology may or may not be specific. Some diseases require clinical information to diagnose.
An introduction to dermatopathology is in the dermatopathology article. Nevi (moles) and other melanocytic lesions are dealt with in the article melanocytic lesions. Inflammatory skin conditions are dealt with in inflammatory skin disorders.
Other
Lichen simplex chronicus
General
- May be considered a variant of spongiotic dermatitis.[2]; more specifically, some think it is an atopic dermatitis (which fits in the large spongiotic dermatitis category).[3]
- It is lumped with the psoriasiform dermatitides.
Etiology:[4]
- Pruritus (itchness) -> mechanical trauma -> lichenification (thickened/leathery[5].
Microscopic
Features:[6]
- Acanthosis (epithelial thickening) - irregular.
- Hyperkeratosis.
Other features:[7]
- Spongiosis (epidermal intercellular edema -- cells appear to have a clear halo around 'em).
- Parakeratosis = retention of nuclei in the stratum corneum.
DDx:
- Prurigo nodularis - focal process (nodule or papule).
Images:
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SKIN, PUNCH BIOPSY: - LICHEN SIMPLEX CHRONICUS. - NEGATIVE FOR MALIGNANCY.
Prurigo nodularis
General
- Can be thought of as a localized/focal version of lichen simplex chronicus (LSC).
Gross
- Dome-shaped/raised - papular (<1 cm) or nodular (>1 cm).[8]
Microscopic
DDx:
- Lichen simplex chronicus - more diffuse process.
Very common
Dermatomycosis
General
- Fungal infection of skin.
Note:
- Dermatophytosis (ring worm) is a type of dermatomycosis.
Microscopic
Features:
- Microorganisms - key feature.
- Often hyphae (candida) - like twigs of a tree... branching.
- Perivascular inflammation.
- Exocytosis - blood cell infiltrate the epidermis.
Images:
- Dermatomycosis - intermed. mag. (WC).
- Dermatomycosis - high mag. (WC).
- Dermatomycosis - GMS - low mag. (WC).
- Dermatomycosis - GMS stain - high mag. (WC).
Stains
Cicatrix
- AKA scar, dermal scar.
General
- Previous surgery, biopsy, trauma.
Microscopic
Features:
- Loss of adnexal structures.
- Dense collagen - fibers run parallel to the dermal-epidermal (DE) junction.
- Loss of dermal papilla.
DDx:
- Malignant melanoma, desmoplastic-neurotropic type.
- Dermatofibroma.
- Desmoplastic Spitz nevus.
- Sclerosing blue nevus.
Image:
IHC
- S100 focal/scattered +ve.
- Desmoplastic melanoma strong +ve.
- HMB-45 -ve.
- Sclerosing blue nevus +ve.
Fibroepithelial polyp
- AKA acrochordon, skin tag.
General
- Benign.
- Older people.
- May be associated with pregnancy, diabetes, intestinal polyposis.[9]
- Component of Birt–Hogg–Dubé syndrome - see: Hereditary RCC.
Gross
- Raised skin-coloured lesion.
Image:
Microscopic
Features:
- On a stalk / epithelium on three sides.
- Benign epidermis.
Image:
Actinic keratosis
- Bowenoid actinic keratosis redirects to here.
- Abbreviated AK.
- AKA solar keratosis.[citation needed]
General
Clinical:
- Yellow-brown scaly, patches.
- Sandpaper sensation - on touching.
Risk factors:[11]
- Sun exposure.
- Immune suppression (e.g. organ transplant recipients).
Microscopic
Features:[12]
- Epidermal nuclear atypia:
- Variation is size, shape and staining.
- Nuclear enlargement - key feature.
- Should involve the basal layer.
- Nuclear enlargement - key feature.
- Variation is size, shape and staining.
- Abnormal epidermal architecture:
- Palisading.[citation needed]
- +/-Parakeratosis.
- +/-Irregular acanthosis.
Note:
- May be full thickness - known as bowenoid actinic keratosis.[13]
DDx:
- Bowen's disease - full thickness involvement - with involvement of adnexal epithelium and follicular epithelium.[13]
- Paget disease of the breast.
- Squamous cell carcinoma.
Images:
- Actinic keratosis (WC).
- Actinic keratosis (WC).
- Actinic keartosis (WC).
- Bowenoid actinic keratosis - high mag. (WC).
- Bowenoid actinic keratosis - very high mag. (WC).
Seborrheic keratosis
- Abbreviated SK.
General
- Benign.
- Most common tumour in older people.[14]
- "Large number" of SKs = paraneoplastic syndrome (Leser–Trélat sign).[15]
Epidemiology:
- Old people.
- Usu. in sun exposed area.[16]
Gross
- "Stuck-on" appearance - raised lesion.
Image(s):
Microscopic
Features:[15]
- Raised above skin surface.
- Border sharply demarcated.
- Hyperkeratosis - stratum corneum extra thick.
- Horn cysts - intraepidermal collections of keratin.
- Clusters of cells with brown granular material in the superficial dermis/dermoepidermal junction - pigmented melanocytes.
Images:
- Seborrheic keratosis - low mag. (WC).
- Seborrheic keratosis - high mag. (WC).
- Seborrheic keratosis - high mag. (dermatlas.org).
- Seborrheic keratosis - low mag. (dermatlas.org).
Pilomatricoma
General
- Benign skin tumour.
- Most common solid skin tumour of children.[18]
- CTNNB1 gene mutation important in pathogenesis.[19]
Clinical:
- Hard nodule - calcification.
- +/-Painful.
Treatment:
- Surgical excision.[18]
Microscopic
Features:[20]
- Lower dermis/subcutaneous adipose lesion; thus, usu. surrounded by connective tissue.
- Sharpy demarcated island of cells.
- Calcification in 75% - with calcium staining (von Kossa).
- Cells:[21]
- Basaloid epithelial cells - have prominent nucleoli.
- Anucleate squamous cells ("ghost cells").
- Giant cell foreign body type granulomas (form in reaction to keratin).
Notes:
- Keratin a prominent feature on cytology - lots of orange stuff.
- May ossify.
Images:
- Pilomatrixoma - cytology (bccancer.bc.ca).
- Pilomatrixoma - histology (dermrounds.com).
- Pilomatrixoma - high mag. (WC).
- Pilomatrixoma - intermed. mag. (WC).
DDx:
Dermatofibroma
- Abbreviated DF.
General
- AKA fibrous histiocytoma.
- Reactive process -- it is not a neoplasm.
- Usually associated with previous trauma.
- In women... usually legs.
Microscopic
Features:[22]
- Prominent fibrous bundles, especially at the edge of the lesion.
- Surrounded by spindle cells (fibroblasts).
- Usually thought of as fibroblasts surrounded by fibrous material ("collagen-trapping").
- Surrounded by spindle cells (fibroblasts).
- Lack of adnexal structures, i.e. no sweat glands, no hair.
- +/-Epidermal changes - known as "dirty fingers":[23]
- Acanthosis (thickened epithelial layer - specifically thickened stratum spinosum).
- Basal keratinocyte hyperpigmentation.
Images:
DDx:
- Dermatofibrosarcoma protuberans (DFSP).
- Neurofibroma.
- Blue nevus.
- Melanoma, esp. desmoplastic neurotropic-type.
Subtypes
Like all common things... there are subtypes:[24]
- Cellular.
- Deep penetrating.
- Lipidized - with foamy macrophages, hemorrhage and Touton-like giant cells.
- Epithelioid cell histiocytoma.
- Fibrotic.
- Aneurysmal - large blood filled + features of lipidized.
- Granular cell dermatofibroma.
- Dermatofibroma with monster cells.
Cellular dermatofibroma
Features:
- High cell density in the dermis - "blue" at low power.
- Collagen bundles - key feature.
Images:
IHC
- Factor XIIIa +ve.
- Usually negative in DFSP.
- CD34 -ve.
- Usually positive in DFSP.
- D2-40 +ve.[28]
- Usually negative in DFSP.
Ezcema
General
- A nebulous thingy.
- Very common.
DDx:
- Contact allergy.
- Drug reaction.
- Food allergy.
Microscopic
Features:[29]
- Spongiosis (epidermal edema); keratinocytes spacing increased - key feature.
- +/-Interdermal vesicles.
- +/-Eosinophils (may suggest Rx reaction).
- Perivascular lymphocytes.
Acne vulgaris
General
- Extremely common - esp. among adolescents.
- Very rarely seen by pathologists.
Treatments:
- Antibiotic (minocycline).
- Isotretinoin AKA all-trans retinoic acid (ATRA).
Gross
- Papules, pustules, nodules or cysts.
- White, black or erythematous.
Images:
Microscopic
Features:[30]
- Epidermal invagination or cyst at site of a hair follicle - contains:
- Sebum.
- +/-Bacteria (Propionibacterium acnes) and inflammatory cells - typically neurophils.
Subtyped into:
- Open comedones ("blackheads") - no extension to epidermal surface.
- Closed comedones ("whiteheads") - to epidermal surface have wide opening.
Image:
Very common - viral
Verruca vulgaris
General
Notes:
- Related to condyloma acuminatum.
Microscopic
Features:[31]
- Hyperkeratosis (more keratin - thick stratum corneum).
- Hypergranulosis (thicker stratum granulosum).
- Acanthosis (thickening of the stratum spinosum).
- Rete ridges lengthened (~7-10x normal).
- Large blood vessels at the dermal-epidermal junction.
Memory device: there is more of everything - more s. corneum, s. granulosum, s. spinosum, longer rete ridges, more (larger) blood vessels.
Images:
Verruca plana
General
- Common.
- Usu. hands and face.[32]
Microscopic
Features:[32]
- Orthokeratosis with basketweave pattern.
- Hypergranulosis.
- Viral keratohyaline.
- Koilocytes.
- Acanthosis - yet flat surface and base.
Notes:
- It differs from verruca vulgaris... (1) orthokeratosis, (2) flat surface and base.
Less common
Clear cell acanthoma
General
- Benign.
- Elderly.
- Classically on the leg.[33]
- Rare.
- Clinically not distinct.
- Suspected clinically in only ~3% of cases.[34]
Microscopic
Features:[35]
- Psoriasiform pattern - epidermal thickening (acanthosis).
- Keratinocytes:
- Pale or light pink cytoplasm (when compared to surrounding non-lesional keratinocytes).
- Separated from one another (spongiosis).
- +/-Stratum corneum neutrophils.
DDx:
Images:
Chondrodermatitis nodularis chronica helicis
- AKA chondrodermatitis nodularis helicis.
- Abbreviated CNCH.
General
- Tender/painful - key clinical feature.
- Typically right ear - people more often sleep on this one.[36]
- Usually >40 years old.
Etiology:
- Trauma/mechanical.
Clinical DDx:[36]
Microscopic
Features:[36]
- Dermal inflammation.
- Epithelial hyperlasia.
- Fibrosis.
- Cartilaginous pathology:
- Perichondrial inflammation - key feature.
- Perichondrial disruption.
- +/-Necrosis.
- +/-Hemorrhage.
Images:
Cutaneous calcinosis
- AKA calcinosis cutis.
General
- Benign in itself; underlying cause may not be benign.
- May be a scrotal lesion - known as scrotal calcinosis.[37]
Subtypes:[38]
- Dystrophic - due to death of cells; may be related to a tumour.
- Metastatic - due to chronic renal failure; hyperkalemia; paraneoplastic phenomenon.
- Iatrogenic - post surgical.
- Idiopathic.
Microscopic
Features:
- Dermal calcification:
- Acellular purple blobs on H&E.
- +/-Artefactual tearing of surrounding tissue due to processing (cutting).
- +/-Small artefactual lines ~1-2 micrometers due to processing (cutting).
- Usu. well-circumscribed.
- Acellular purple blobs on H&E.
Images:
Dilated pore of Winer
General
- Benign.
- Looks like zit.
Microscopic
Features:[39]
- Dilated hair follicle with keratin.
- Acanthosis.
- Budding of epidermis (into dermis).
Lichenoid keratosis
- AKA lichen planus-like keratosis.
General
- Caucasians - middle age or older.
Clinical DDx:[40]
Microscopic
Features:[41]
- Hyperkeratosis.
- Parakeratosis.
- Band of inflammatory cells at DE junction (lichenoid inflammation).
- Dead keratinocytes (Civatte bodies).
- Dermal melanophages.
DDx:
- Lichen planus - need clinical correlation (mucosal lesions).
- Drug reaction.
- Cutaneous T-cell lymphoma.
- Regressed melanocytic lesion.
Images:
Granuloma annulare
General
- Benign and self-limited condition.
- Etiology unknown - may be assoc. with trauma.[42]
Gross
- Typically extremities - usu. arms and hands.[42]
Microscopic
Features:[43]
- Dermal palisading granuloma - typically superficial-to-mid dermis - surrounds:
- Necrotic collagen - key feature.
- Nuclei "missing" - have undergone karyolysis.
- Mucin - important.
- Loose/pale, paucicellular, eosinophilic.
- Necrotic collagen - key feature.
- Chronic inflammatory cells.
Notes:
- There may be multiple small foci with intervening normal dermis.[42]
- Granuloma annulare can be subclassified into subcutaneous and interstitial.
- Histomorphologically similar to Rheumatoid nodule.
DDx:
- Necrobiosis lipoidica - little mucin, no normal dermis between foci,[42] plasma cells - common,[44] may involve the fat - tend to be deeper.
- Rheumatoid nodule - has fibrin in the core of the granuloma (instead of mucin).[45]
- Epithelioid sarcoma - esp. if the lesion appears to be mid-to-deep dermis.
Images:
- WC:
- www:
Stains
- Alcian blue +ve (mucin).[42]
Necrobiosis lipoidica
General
Associated with:
- Diabetes mellitus - known as necrobiosis lipoidica diabeticorum.
- Rheumatoid arthritis.
Microscopic
Features:[42]
- Dermal palisading granuloma around:
- Necrotic collagen - key feature.
- Nuclei "missing" - have undergone karyolysis.
- Necrotic collagen - key feature.
- Little mucin, no normal dermis between foci.
- Plasma cells - common.[44]
- May involve adipose tissue.
DDx:
- Granuloma annulare - more mucin, normal dermis between foci,[42] plasma cells uncommon,[44] no fat involvement - usu. more superficial.
- Rheumatoid nodule.
Images:
- Necrobiosis lipoidica (dermatology.cdlib.org).
- Necrobiosis lipoidica (drmihm.com).
- Necrobiosis lipoidica (dermnetnz.org).
Keloid
- Hypertrophic scar redirects to this section.
General
- Sites of previous trauma/surgery, esp. in dark skinned individuals.[22]
Microscopic
Features:[22]
- Thick collagen bundles - surrounded by paler staining fibroblasts - key feature.
- Lesion replaces adnexal structures, e.g. hair, sweat glands.
DDx:
- Hypertrophic scar.
NB:
- Reported as "keloidal-type collagen"; the clinician decides between hypertrophic scar and keloid.
Images:
- WC:
- www:
Angiofibroma
- See also: nasopharyngeal angiofibroma.
- Should not be confused with angiokeratoma.
- Fibrous papule redirects here.
General
- May be seen in the context of tuberous sclerosis - especially "butterfly area of the face".[22]
- Solitary lesions in adults are known as fibrous papules and classically arise on the nose.[46]
Clinical:
- Firm, dome-shaped, flesh coloured.
Microscopic
Features:[22]
- Dome-shaped.
- Fibrotic dermis.
- Enlarged fibroblasts.
- Dilated small vessels.
Image:
Molluscum contagiosum
General
- Etiology: caused by molluscum contagiosum virus.
Microscopic
Features:
- A suprabasilar epidermal lesion consisting of "molluscum bodies", i.e. molluscum bodies are found above the stratum basale.[48]
- Molluscum bodies - key feature:
- Large cells with abundant granular eosinophilic cytoplasm.
- Small peripheral nucleus.
Image(s):
Notes:
- Molluscum bodies very vaguely resemble signet ring cells -- but:
- Cytoplasm eosinophilic and granular.
- Nucleus usually smaller than in signet ring cell.
- Molluscum bodies are only the epidermis - an uncommon place to find SRCs without finding them elsewhere.
- The granular eosinophilic cytoplasm represents accumulated virons.
Superficial dermal infiltrates
Discussed in detail by Alsaad and Ghazarian.[49]
Dermal perivascular lymphoeosinophilic infiltration
- Abbreviated DPLI.
Microscopic appearance is just what it is called:
- Lymphocytes and eosinophils around the vessels in the superficial dermis.
DDx:[49]
- Insect bite - classically wedge-shaped.[50]
- Drug reaction.
- Urticarial reaction.
- Prevesicular early stage of bullous pemphigoid.
- HIV related dermatoses.
Notes:
- May superficially resemble cutaneous lymphoma.[50]
Images:
Congenital dermal melanocytosis
- AKA Mongolian spots.
- Classically seen in asian children.
Gross:
- Brown or blue-grey patch in the lumbosacral area.
Mastocytosis
General
- Abundance of mast cells.
Classification:[51]
- Cutaneous (only) - usually children.
- Urticaria pigmentosa.
- Others.
- Systemic - usually adults.
- Indolent subvariant.
- Aggressive subvariant.
- Leukemic subvariant.
Microscopic
Features:[52]
- Cells in the superficial/mid dermis that are:
- Lymphocyte-like with more cytoplasm that is granular.
- Cells may have spindled or stellate morphology.
- Tend to be more abundant around vessels.
- Lymphocyte-like with more cytoplasm that is granular.
- +/-Eosinophils (common).
- +/-Edema - often prominent; gives cells a white halo.
Notes:
- Lymphocyte vs. mast cell:
- Lymphocytes = round; mast cells = ovoid.
Images:
- www:
- WC:
Stains
- Toluidine blue -- highlights the granules.
IHC
- CD117 +ve.
- Tryptase +ve.[53]
Ichthyosis
General
- Comes in different flavours.
- Usu. inherited... thus a pediatric condition.
Gross
- Fish scale-like appearance.
Image:
Microscopic
Features:[52]
- Thick stratum corneum without basket-weave pattern.
Palmar fibromatosis
General
- AKA Dupuytren's contracture.
Clinical:[54]
- Usually older 60-70s.
- Male > female.
- Associated with:
- Alcohol abuse.
- May be familial.
Microscopic
Features:[55]
- Bland spindle cells in dense collagen.
- No nuclear atypia.
- Giant cells.
- +/-Mitotic figures.
Images:
Angiomyoma
- Do not confuse with angiomyxoma.
General
- Benign.
- Female > male.[57]
Microscopic
Features:
- Well-circumscribed lesion with fascicular architecture.
- Spindle cells/epithelioid cell with moderate eosinophilic (pink) cytoplasm.
- Thick-walled blood vessels. (???)
Images:
Angiokeratoma
General
- Rare.
- May be seen in the context of Fabry disease.[58]
Notes:
- Shouldn't be confused with angiofibroma which is associated tuberous sclerosis.
Microscopic
Features:[58]
- Ectatic superficial dermal vessels.
- Overlying hyperkeratosis
Others: (???)
- Irregular acanthosis.
- Longer rete ridges.
Images:
- WC:
- www:
DDx:
Inverted follicular keratosis
General
- Benign skin lesion.
- Central face - middle age.[59]
- Uncommon.
Microscopic
Features:[59]
- Keratinocyte of cytologically benign proliferation.
- "Squamous eddies" (whorls of keratin).
- Coarse keratohyaline granules.
DDx:
Images:
- Inverted follicular keratosis - low mag. (flickr.com).
- Inverted follicular keratosis - high mag. (flickr.com).
Focal cutaneous mucinosis
General
- Benign.
- May be associated with systemic disease.[61]
Microscopic
Features:
- Light blue whispy material in the dermis - key feature.
DDx:
- Dermal edema.
- Digital mucous cyst.
Panniculitis
This is dealt with in the panniculitis article.
DDx for panniculitis:
- Erythema nodosum.
- Erythema induratum.
- Self-inflicted trauma.
- Systemic lupus erythematosus.
- Weird stuff.
Rare
Necrotizing fasciitis
- Not to be confused with nodular fasciitis.
- AKA flesh-eating disease.
General
- High mortality.
- May be diagnosed at frozen section.[62]
- Classically associated with Group A streptococcus.
Treatment:
- Operative debridement.
Microscopic
Features:
Note:
- Fat lobules between septae may be normal.
DDx:
Images:
Porokeratosis
General
- Genetic.
- Several subtypes.
Notes:
- Not the same as punctate porokeratotic keratoderma.[64]
Microscopic
Features:
- Cornoid lamella (pathognomonic) - key feature:
- Compact keratosis over a hair follicle.
- +/-Rete ridge loss.
Images:
Nevus sebaceous
- AKA nevus sebaceous of Jadassohn.
General
- Congenital.
- Face or scalp.
Microscopic
Features:
- Abundant sebaceous glands.
Nevus lipomatosus superficialis
- Abbreviated NLS.
General
- Rare.
- Congenital.
- Usually lower trunk or gluteal region.[65]
Microscopic
Features:[66]
- Benign adipose tissue in the superficial dermis.
DDx:
Image:
Bullous disease
Cysts
See also
References
- ↑ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1011. ISBN 978-1416031215.
- ↑ Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 296. ISBN 978-0470519035.
- ↑ 3.0 3.1 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 26. ISBN 978-0443066542.
- ↑ URL: http://emedicine.medscape.com/article/1123423-overview. Accessed on: 20 August 2010.
- ↑ URL: http://www.medterms.com/script/main/art.asp?articlekey=10131. Accessed on: 20 August 2010.
- ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1065-6. ISBN 0-7216-0187-1.
- ↑ URL: http://emedicine.medscape.com/article/1123423-diagnosis. Accessed on: 20 August 2010.
- ↑ URL: http://www.pediatrics.wisc.edu/education/derm/text.html. Accessed on: 23 August 2012.
- ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 596. ISBN 978-1416054542.
- ↑ URL: http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=1196583692. Accessed on: 1 September 2011.
- ↑ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1180. ISBN 978-1416031215.
- ↑ URL: http://emedicine.medscape.com/article/1099775-workup#a0723. Accessed on: 1 September 2011.
- ↑ 13.0 13.1 Bagazgoitia, L.; Cuevas, J.; Juarranz, A. (Feb 2010). "Expression of p53 and p16 in actinic keratosis, bowenoid actinic keratosis and Bowen's disease.". J Eur Acad Dermatol Venereol 24 (2): 228-30. doi:10.1111/j.1468-3083.2009.03337.x. PMID 19515076.
- ↑ URL: http://emedicine.medscape.com/article/1059477-overview#a0199. Accessed on: 26 August 2011.
- ↑ 15.0 15.1 Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 595. ISBN 978-1416054542.
- ↑ URL: http://emedicine.medscape.com/article/1059477-overview. Accessed on: 26 August 2011.
- ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 387. ISBN 978-0443066542.
- ↑ 18.0 18.1 URL: http://emedicine.medscape.com/article/1058965-overview. Accessed on: 10 September 2011. Cite error: Invalid
<ref>
tag; name "emed1058965" defined multiple times with different content - ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 597. ISBN 978-1416054542.
- ↑ URL: http://emedicine.medscape.com/article/1058965-diagnosis. Accessed on: 10 September 2011.
- ↑ http://www.bccancer.bc.ca/HPI/CE/cytotechnology/cytosleuthquiz/nongyne/ngcase02d.htm
- ↑ 22.0 22.1 22.2 22.3 22.4 Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 492. ISBN 978-0781765275.
- ↑ BD. 13 April 2011.
- ↑ Mills, Stacey E; Carter, Darryl; Greenson, Joel K; Reuter, Victor E; Stoler, Mark H (2009). Sternberg's Diagnostic Surgical Pathology (5th ed.). Lippincott Williams & Wilkins. pp. 51. ISBN 978-0781779425.
- ↑ URL: http://www.dermpedia.org/case/cellular-dermatofibroma-mimicking-dermatofibrosarcoma-protuberans#. Accessed on: 4 February 2012.
- ↑ Abenoza P, Lillemoe T (October 1993). "CD34 and factor XIIIa in the differential diagnosis of dermatofibroma and dermatofibrosarcoma protuberans". Am J Dermatopathol 15 (5): 429–34. PMID 7694515.
- ↑ Goldblum JR, Tuthill RJ (April 1997). "CD34 and factor-XIIIa immunoreactivity in dermatofibrosarcoma protuberans and dermatofibroma". Am J Dermatopathol 19 (2): 147–53. PMID 9129699.
- ↑ Bandarchi B, Ma L, Marginean C, Hafezi S, Zubovits J, Rasty G (March 2010). "D2-40, a novel immunohistochemical marker in differentiating dermatofibroma from dermatofibrosarcoma protuberans". Mod. Pathol. 23 (3): 434–8. doi:10.1038/modpathol.2009.176. PMID 20062007.
- ↑ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1188. ISBN 978-1416031215.
- ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 76. ISBN 978-0443066542.
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- ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 346. ISBN 978-0443066542.
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