Difference between revisions of "Non-malignant skin disease"
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*[http://www.dermaamin.com/site/images/histo-pic/n/nevus-lipomatosus-superficialis/nevus-lipomatosus-superficialis1.jpg NLS (dermamin.com)].<ref>URL: [http://www.dermaamin.com/site/histopathology-of-the-skin/66-n/1971-nevus-lipomatosus-superficialis----.html http://www.dermaamin.com/site/histopathology-of-the-skin/66-n/1971-nevus-lipomatosus-superficialis----.html]. Accessed on: 7 March 2012.</ref> | *[http://www.dermaamin.com/site/images/histo-pic/n/nevus-lipomatosus-superficialis/nevus-lipomatosus-superficialis1.jpg NLS (dermamin.com)].<ref>URL: [http://www.dermaamin.com/site/histopathology-of-the-skin/66-n/1971-nevus-lipomatosus-superficialis----.html http://www.dermaamin.com/site/histopathology-of-the-skin/66-n/1971-nevus-lipomatosus-superficialis----.html]. Accessed on: 7 March 2012.</ref> | ||
*[http://www.humpath.com/IMG/jpg/nevus_superficialis_lipomatosus_01_1.jpg NLS (humpath.com)].<ref>URL: [http://www.humpath.com/spip.php?article8134 http://www.humpath.com/spip.php?article8134]. Accessed on: 17 December 2012.</ref> | |||
=Bullous disease= | =Bullous disease= |
Revision as of 20:14, 17 December 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).
- Benign alveolar ridge keratosis (AKA oral lichen simplex chronicus[8]) - see oral pathology.
Images:
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SKIN, PUNCH BIOPSY: - LICHEN SIMPLEX CHRONICUS. - NEGATIVE FOR MALIGNANCY.
Oral
RETROMOLAR PAD, RIGHT, PUNCH BIOPSY: - ORAL LICHEN SIMPLEX CHRONICUS. - NEGATIVE FOR MALIGNANCY.
Micro
The sections show a squamous mucosa with irregular psoriasiform change, parakeratosis, and focal hypergranulosis. There is no inflammation at the interface. Epidermal intercellular bridges are easily seen. There is no significant nuclear atypia. Mitoses are not evident.
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).[9]
Microscopic
DDx:
- Lichen simplex chronicus - a more diffuse process, not a raised lesion.
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SKIN LESION, LEFT CHIN, BIOPSY: - PRURIGO NODULARIS.
Micro
The sections show a raised lesion with compact hyperkeratosis and irregular acanthosis. Spongiosis is seen focally. There is minimal hypergranulosis.
There is no thinning of the suprapapillary plate and no dilated superficial blood vessels. There is no interface activity.
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.
- May be very fragmented in section ~ size of a neutrophil.
- Often hyphae (candida) - like twigs of a tree... branching.
- Perivascular inflammation, esp. neutrophils.
- 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
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SKIN, BIOPSY: - SKIN WITH SUPERFICIAL FUNGAL ORGANISMS CONSISTENT WITH CANDIDA. - REACTIVE CHANGES OF THE EPITHELIUM.
Micro
The sections show skin with a neutrophilic infiltrate in the superficial epidermis. PAS-D staining demonstrates fungal organisms with a morphology suggestive of candida.
The epithelium has parakeratosis, acanthosis and spongiosis. No mitotic activity is appreciated. The keratinocytes are moderately enlarged and have evident nucleoli.
Cicatrix
- AKA scar, dermal scar.
General
- Previous surgery, biopsy, trauma.
Microscopic
Features:
- Loss of dermal papilla.
- Dense collagen - fibers run parallel to the dermal-epidermal (DE) junction[10] - key feature.
- Loss of adnexal structures.
Other feature:
- Thin-walled blood vessels.
- Described as running perpendicular to the surface[10] - this may not be apparent.
Note:
- There should not be any nuclear hyperchromasia or pleomorphism.[11]
DDx:
- Malignant melanoma, desmoplastic-neurotropic type - nuclear pleomorphism and/or hyperchromasia; may be focal.[11]
- Dermatofibroma.
- Desmoplastic Spitz nevus.
- Sclerosing blue nevus.
Image:
IHC
- S100 focal/scattered +ve.
- Desmoplastic melanoma strong +ve.
- HMB-45 -ve.
- Sclerosing blue nevus +ve.
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SKIN, LOWER MID BACK, RE-EXCISION: - DERMAL SCAR. - SOLAR ELASTOSIS.
Micro
The sections show skin with a dermis with dense collagen fibres that run parallel to the skin surface without adnexal structures. The overlying dermal-epidermis interface lacks the typical undulation.
Fibroepithelial polyp
- AKA acrochordon, skin tag.
General
- Benign.
- Older people.
- May be associated with pregnancy, diabetes, intestinal polyposis.[12]
- 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.
DDx:
- Pedunculated seborrheic keratosis - typically have epidermal hyperplasia, hyperkeratosis, horn cysts.[13]
- Regressing melanocytic lesions.
Image:
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SKIN ("SKIN TAG"), THIGH, EXCISION: - FIBROEPITHELIAL POLYP.
Micro
The sections show a fragment of skin with epithelium on three sides. The epithelium matures and is not hypertrophic. Orthokeratosis is present. The core of the lesion has fibrofatty tissue. There is no inflammation.
Actinic keratosis
- Bowenoid actinic keratosis redirects to here.
General
- Considered a precursor of squamous cell carcinoma of the skin.[16]
Risk factors:[17]
- Sun exposure.
- Immune suppression (e.g. organ transplant recipients).
Gross
Features:
- Yellow-brown scaly, patches.
- Sandpaper sensation - on touching.
- May be pigmented.[18]
Microscopic
Features:[19]
- Epidermal nuclear atypia:
- Variation is size, shape and staining - must involve basilar layer.
- Nuclear enlargement - key feature.
- Hyperchromasia.
- Variation is size, shape and staining - must involve basilar layer.
- Abnormal epidermal architecture:
- Palisading.[citation needed]
- +/-Parakeratosis - may alternate with orthokeratosis, esp. early lesions.[20]
- +/-Irregular acanthosis.
Note:
- May be full thickness - known as bowenoid actinic keratosis.[21]
DDx:
- Actinic cheilitis - the same lesion on the lip.[22]
- Bowen's disease - full thickness involvement - with involvement of adnexal epithelium and follicular epithelium.[21]
- Paget disease of the breast.
- Squamous cell carcinoma of the skin.
- Lentigo maligna (melanoma in situ on sun damaged skin) - esp. for pigmented AK.[20]
- Seborrheic keratosis - should not have basilar nuclear atypia.
Images:
- Actinic keratosis (WC).
- Actinic keratosis (WC).
- Actinic keartosis (WC).
- Bowenoid actinic keratosis - high mag. (WC).
- Bowenoid actinic keratosis - very high mag. (WC).
Histologic subtypes of actinic keratosis
Like most common things, there are several variants:[20]
- Hypertrophic actinic keratosis.
- Increased thickness of: (1) epidermis and, (2) stratum corneum.[23]
- Acantholytic actinic keratosis.
- Proliferative actinic keratosis - downward finger-like projections of the epidermis.
- Pigmented actinic keratosis.
- DDx: lentigo maligna.
- Lichenoid actinic keratosis.
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SKIN LESION, RIGHT THIGH, BIOPSY: - HYPERTROPHIC ACTINIC KERATOSIS. - SOLAR ELASTOSIS. - NEGATIVE FOR MALIGNANCY.
Bowenoid
SKIN LESION, RIGHT DISTAL FOREARM, BIOPSY: - BOWENOID ACTINIC KERATOSIS, COMPLETELY EXCISED IN PLANE OF SECTION. - EXTENSIVE SOLAR ELASTOSIS. - NEGATIVE FOR MALIGNANCY.
Micro
General
The sections show skin with basilar epidermal nuclear enlargement and hyperchromasia with irregular nuclear palisading. Hyperkeratosis and parakeratosis is present. A granular layer is present. The dermal-epidermal interface is sharply-demarcated. There is focal inflammation at the interface. Extensive solar elastosis is present.
There is no clefting of the lesion from the surrounding stroma. The surrounding stroma does not have a myxoid quality.
Bowenoid
The sections show skin with epidermal nuclear enlargement and hyperchromasia with irregular nuclear palisading. The lesion involves the full thickness of the epidermis; however, it spares adnexal and follicular epithelium. Proliferative activity is present. Hyperkeratosis and parakeratosis is present. A granular layer is present. The dermal-epidermal interface is sharply-demarcated. There is focal inflammation at the interface. Extensive solar elastosis is present.
There is no clefting of the lesion from the surrounding stroma. Intercellular bridges are identified.
Actinic cheilitis
General
- Actinic keratosis of the lip.[22]
Microscopic
- See actinic keratosis.
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LESION, LOWER LIP, BIOPSY: - ACTINIC CHEILITIS. - SOLAR ELASTOSIS.
Micro
The sections show skin with moderate basal nuclear hyperchromasia and atypia, and parakeratosis. The squamous epithelium has maturation to the surface. There is no inflammation at the dermal-epidermal interface. Solar elastosis is present.
Seborrheic keratosis
- Abbreviated SK.
General
- Benign.
- Most common tumour in older people.[24]
- "Large number" of SKs = paraneoplastic syndrome (Leser–Trélat sign).[25]
Epidemiology:
- Old people.
- Usually in sun exposed area.[26]
Gross
- "Stuck-on" appearance - raised lesion.
Image(s):
Microscopic
Features:[25]
- Raised above skin surface.
- Border sharply demarcated.
- Hyperkeratosis - stratum corneum extra thick.
- May be minimal.
- Horn cysts - intraepidermal collections of keratin - key feature.
- Actually invaginations - not true cysts; thus, they may more accurately be called pseudohorn cysts.[27]
- Clusters of cells with brown granular material in the superficial dermis/dermoepidermal junction - pigmented melanocytes.
DDx:[28]
- Actinic keratosis - especially, irritated SKs; have nuclear atypia and parakeratosis.
- Verruca vulgaris - SK may have papillomatous projections.
- Basal cell carcinoma, fibroepitheliomatous pattern - esp. reticulated SK.
- Melanocytic nevus.
- Condyloma acuminatum - may have horn cysts, more probable than SK in the genital area.
Images:
- Seborrheic keratosis - low mag. (WC).
- Seborrheic keratosis - high mag. (WC).
- Seborrheic keratosis - high mag. (dermatlas.org).
- Seborrheic keratosis - low mag. (dermatlas.org).
Histologic subtypes
Like very common lesion, there are subtypes:[28]
- Acanthotic seborrheic keratosis - thickened stratum spinosum; thick epidermis.
- Reticulated seborrheic keratosis - vaguely resembles fibroepithelioma of Pinkus (BCC, fibroepitheliomatous pattern).
- Irritated seborrheic keratosis - spongiosis (epidermal intercellular edema) and inflammation.
- Digitated seborrheic keratosis - papillomatous projections.
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SKIN, MID BACK, SHAVE BIOPSY: - SEBORRHEIC KERATOSIS.
Micro
The sections show skin with acanthosis, pseudohorn cysts, parakeratosis, hyperkeratosis and focal basal epidermal pigmentation. There is no basal nuclear atypia, no mitoses and no melanocytic nests. There is minimal dermal inflammation. There is no solar elastosis.
Without horn pseudocysts
The sections show skin with acanthosis, a thin layer of compact keratin and focal basal epidermal pigmentation. Dilated blood vessels surrounded by collagen are seen in the superficial dermis. No pseudohorn cysts are identified. A granular layer is present.
There is no basal nuclear atypia. There is no mitotic activity and no melanocytic nests. There is no solar elastosis. No koilocytes are apparent.
Pilomatricoma
General
- Benign skin tumour.
- Most common solid skin tumour of children.[30]
- CTNNB1 gene mutation important in pathogenesis.[31]
Clinical:
- Hard nodule - calcification.
- +/-Painful.
Treatment:
- Surgical excision.[30]
Microscopic
Features:[32]
- Nodular circumscribed lower dermis/subcutaneous adipose lesion; thus, usu. surrounded by connective tissue.
- Sharpy demarcated island of cells.
- Calcification in 75%.
- Cells:[33]
- 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:
- Epidermal inclusion cyst.
- Pilomatrix carcinoma - invasive border, cytologic atypia, necrosis.[34]
- Squamous cell carcinoma.
- Basal cell carcinoma.
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SKIN LESION, RIGHT ARM, EXCISION: - PILOMATRICOMA.
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:[35]
- 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":[36]
- Acanthosis (thickened epithelial layer - specifically thickened stratum spinosum).
- Basal keratinocyte hyperpigmentation.
DDx:
- Dermatofibrosarcoma protuberans (DFSP) - usu. deeper, classically has adnexal structures and fat within lesion.
- Neurofibroma.
- Blue nevus.
- Melanoma, esp. desmoplastic neurotropic-type.
- Fibromatosis.
Images:
- Dermatofibroma (ucsf.edu).
- DF - several images (pacificderm.org).
- DF stained with factor XIIIa (biocare.net).
Subtypes
Like all common things... there are subtypes:[37]
- 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.[41]
- Usually negative in DFSP.
Ezcema
General
- A nebulous thingy.
- Very common.
DDx:
- Contact allergy.
- Drug reaction.
- Food allergy.
Microscopic
Features:[42]
- 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:[43]
- Folliculitis:[44]
- Neutrophils around hair follicle and infiltrate into it - including the follicular canal.
- 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.
DDx - acneiform disorder:[44]
- Rosacea.
- Infective folliculitis.
- Perioral dermatitis.
- Acne vulgaris.
Image:
Solar elastosis
- AKA actinic elastosis.
General
- Very common.
- Caused by sun exposure - specifically UV light.[45]
- Severity correlated with cumulative exposure to UV light..[46]
- Often co-localized with skin cancers - as UV light is risk factor for skin cancers.[46]
- Benign.
Microscopic
Features:
- Grey, spaghetti-like material in the superficial dermis.
DDx:
Note:
- It doesn't really look like anything else.
- The DDx above is things to think about that are associated with sun damaged skin.
Images:
- WC:
- www:
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SKIN, RIGHT CHEEK, RE-EXCISION: - DERMAL SCAR. - EXTENSIVE SOLAR ELASTOSIS.
Very common - viral
Verruca vulgaris
- AKA common wart.
General
- Etiology - HPV.
- Very common.
Notes:
- Related to condyloma acuminatum.
Microscopic
Features:[47]
- Hyperkeratosis (more keratin - thick stratum corneum) - in "columns"; keratin in separate towers - not a flat thick sheet.
- Hypergranulosis (thicker stratum granulosum).
- Acanthosis (thickening of the stratum spinosum).
- +/-Rete ridge lengthening (~7-10x normal) and thickening - papillomatous hyperplasia.
- Large blood vessels at the dermal-epidermal junction - between the rete ridges.
- +/-Viral changes - perinuclear halo, nucleus small and hyperchromatic[48] - important when present.
- +/-Binucleation.
Memory device: there is more of everything - more s. corneum, s. granulosum, s. spinosum, longer rete ridges, more (larger) blood vessels.
DDx:
- Squamous cell carcinoma - nuclear atypia full thickness and often more pronounced.
- Hypertrophic actinic keratosis - often accompanied by solar elastosis.
- Actinic keratosis with superimposed lichen simplex chronicus.[20]
- Seborrheic keratosis - may have focal clear cell changes.
Images:
- WC:
- www:
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SKIN LESION, RIGHT LOWER LEG, SHAVE BIOPSY: - VERRUCA VULGARIS.
Micro
The sections show skin with elongated rete ridges, acanthosis, hypergranulosis, hyperkeratosis in vertical columns, focal parakeratosis, dilated blood vessels at the dermal-epidermal junction and koilocytic change. Mild basilar nuclear atypia is present.
Verruca plana
General
- Common.
- Usu. hands and face.[49]
Microscopic
Features:[49]
- 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
Chronic folliculitis
- Folliculitis redirect here.
General
- Common.
- Infrequently biopsied.
Gross
- Erythema.[50]
DDx gross:
Microscopic
Features:
- Inflammation around the hair follicle - key feature.
- Lymphocytes - usu. predominant.
- +/-Chronic changes:
- Acanthosis.
- Hyperkeratosis.
- Hypergranulosis.
DDx:
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SKIN LESION, UPPER ARM, BIOPSY: - CHRONIC FOLLICULITIS WITH SECONDARY SURFACE CHANGES.
Micro
The sections show hair-bearing skin with abundant lymphocytes around and within the hair follicle wall.
The non-hair follicle epidermis has acanthosis, hypergranulosis and compact hyperkeratosis. There is no inflammatory cell infiltrate in the non-hair follicle epidermis or at the non-hair follicle interface.
There are no granulomas.
Clear cell acanthoma
General
- Benign.
- Elderly.
- Classically on the leg.[51]
- Rare.
- Clinically not distinct.
- Suspected clinically in only ~3% of cases.[52]
Microscopic
Features:[53]
- 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.[54]
- Usually >40 years old.
Etiology:
- Trauma/mechanical.
Gross
- Papule on ear.
- +/-Erythematous.
- +/-Crust.
Clinical DDx:[54]
Images:
Microscopic
Features:[54]
- Dermal inflammation.
- Epithelial hyperlasia.
- Fibrosis.
- Cartilaginous pathology:
- Perichondrial inflammation - key feature.
- Perichondrial disruption.
- +/-Necrosis.
- +/-Hemorrhage.
Images:
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Superficial biopsy
SKIN LESION, LEFT ANTIHELIX OF EAR, BIOPSY: - SUPERFICIAL SKIN WITH ACANTHOSIS, HYPERKERATOSIS, MODERATE SOLAR ELASTOSIS, HYPERGRANULOSIS AND A MILD LYMPHOCYTIC PERIVASCULAR INFILTRATE. - NO CARTILAGE IS IDENTIFIED. - NEGATIVE FOR DYSPLASIA AND MALIGNANCY. COMMENT: The findings are non-specific. Chondrodermatitis cannot be excluded.
Cutaneous calcinosis
- AKA calcinosis cutis.
General
- Benign in itself; underlying cause may not be benign.
- May be a scrotal lesion - known as scrotal calcinosis.[55]
Subtypes:[56]
- 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:[57]
- Dilated hair follicle with keratin.
- Acanthosis.
- Budding of epidermis (into dermis).
Lichenoid keratosis
General
- Caucasians - middle age or older.
- May be a variant of seborrheic keratosis (with marked inflammation).[58]
Clinical DDx:[58]
- Basal cell carcinoma, squamous cell carcinoma of the skin, melanocytic neoplasm.
Microscopic
Features:[59]
- 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, esp. malignant melanoma.
- Lichenoid actinic keratosis - has atypical hyperchromatic basal cells - esp. at edge of lesion, usu. in the context of solar elastosis.
Images:
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SKIN LESION, MID-MIDDLE BACK, PUNCH BIOPSY: - LICHENOID KERATOSIS.
Granuloma annulare
General
- Benign and self-limited condition.
- Etiology unknown - may be assoc. with trauma.[60]
Gross
- Typically extremities - usu. arms and hands.[60]
Microscopic
Features:[61]
- 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.[60]
- Granuloma annulare can be subclassified into subcutaneous and interstitial.
- Histomorphologically similar to Rheumatoid nodule.
- Neutrophils may be seen.[62]
DDx:
- Necrobiosis lipoidica - little mucin, no normal dermis between foci,[60] plasma cells - common,[63] may involve the fat - tend to be deeper.
- Rheumatoid nodule - has fibrin in the core of the granuloma (instead of mucin), multinucleated macrophages more common.[64]
- Epithelioid sarcoma - esp. if the lesion appears to be mid-to-deep dermis.
Images:
- WC:
- www:
Stains
- Alcian blue (pH 2.5) +ve (for mucin).[65][60]
Image:
Necrobiosis lipoidica
General
Associated with:
- Diabetes mellitus - known as necrobiosis lipoidica diabeticorum.
- Rheumatoid arthritis.
Microscopic
Features:[60]
- 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.[63]
- May involve adipose tissue.
DDx:
- Granuloma annulare - more mucin, normal dermis between foci,[60] plasma cells uncommon,[63] 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.[35]
Microscopic
Features:[35]
- Thick collagen bundles - surrounded by paler staining fibroblasts - key feature.
- Lesion replaces adnexal structures, e.g. hair, sweat glands.
DDx:
- Hypertrophic scar.[66]
NB:
- Reported as "keloidal-type collagen"; the clinician decides between hypertrophic scar and keloid.
Images:
- WC:
- www:
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SKIN LESION, LEFT SCAPULA, EXCISION: - DERMAL SCAR WITH KELOIDAL-TYPE COLLAGEN, SEE COMMENT. COMMENT: The findings are consistent with a hypetrophic scar and keloid; clinical correlation is required.
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".[35]
- Solitary lesions in adults are known as fibrous papules and classically arise on the nose.[67]
Clinical:
- Firm, dome-shaped, flesh coloured.
Microscopic
Features:[35]
- 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.[69]
- Molluscum bodies - key feature:
- Large cells with abundant granular eosinophilic cytoplasm.
- Small peripheral nucleus.
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.
DDx:
- Nothing really - it is very distinctive.
Image(s):
Superficial dermal infiltrates
Discussed in detail by Alsaad and Ghazarian.[70]
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:[70]
- Insect bite - classically wedge-shaped.[71]
- Drug reaction.
- Urticarial reaction.
- Prevesicular early stage of bullous pemphigoid.
- HIV related dermatoses.
Notes:
- May superficially resemble cutaneous lymphoma.[71]
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:[72]
- Cutaneous (only) - usually children.
- Urticaria pigmentosa.
- Others.
- Systemic - usually adults.
- Indolent subvariant.
- Aggressive subvariant.
- Leukemic subvariant.
Microscopic
Features:[73]
- 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.[74]
Ichthyosis
General
- Comes in different flavours.
- Usu. inherited... thus a pediatric condition.
Gross
- Fish scale-like appearance.
Image:
Microscopic
Features:[73]
- Thick stratum corneum without basket-weave pattern.
Palmar fibromatosis
General
Clinical:[75]
- Usually older - 60s or 70s (years old).
- Male > female.
- Associated with:
- Alcohol abuse.
- May be familial.
Gross
- Ring finger - classic location.[citation needed]
- Nodular.
- Poorly demarcated.
Image:
Microscopic
- Poorly demarcated, usu. multiple lesions/multiple nodules.
- Composed of bland spindle cells in dense collagen.
- Pale grey cytoplasm (moderate quantity).
- Pale ovoid nuclei with small round nucleoli.
- Giant cells - rare.
Note:
- No nuclear atypia.
- Mitotic figures - rarely present, none atypical.
- May see Pacinian corpuscle (AKA lamellar corpuscle) as an incidental finding.
DDx:[77]
- Calcifying aponeurotic fibroma - calcification, chondroid differentiation, usu. < 20 years old.
- Extra-abdominal desmoid fibromatosis - extremely rare on hands and feet, muscle infiltrative.
- Inclusion body fibromatosis.
- Fibrosarcoma - atypia, necrosis, herring-bone pattern.
- Synovial sarcoma - one mass.
- Epithelioid sarcoma - necrosis, atypia.
- Metastatic metaplastic carcinoma, e.g. metaplastic breast carcinoma - extremely uncommon.
Images:
- Palmer fibromatosis (biomedsearch.com).[78]
- Palmar fibromatosis (unibas.ch).
- Pacinian corpuscle (WC).
- Tendon without fibromatosis - intermed. mag. (WC).
IHC
- Beta-catenin +ve (cytoplasmic & nuclear).[79]
Sign out
PALMAR FASCIA, LEFT, FASCIECTOMY: - PALMAR FIBROMATOSIS.
Micro
The sections show multiple poorly-demarcated nodules composed of bland spindle cells with moderate pale grey cytoplasm and pale ellipsoid nuclei with small round nucleoli. The poorly-demarcated nodules are completely surrounded by dense collagen. Calcification is not present. There is no nuclear atypia or necrosis. Mitotic activity is not identified. Benign fibroadipose tissue is present.
Missed fibromatosis
PALMAR FASCIA, LEFT, FASCIECTOMY: - PALMAR FASCIA WITHIN NORMAL LIMITS AND BENIGN FIBROADIPOSE TISSUE -- IN AN INDIVIDUAL WITH A CLINICAL HISTORY OF PALMAR FIBROMATOSIS. - NEGATIVE FOR MALIGNANCY.
Micro
The sections show dense collagen (tendon) without an apparent pathology. Calcification is not present. There is no nuclear atypia or necrosis. Mitotic activity is not identified. Benign fibroadipose tissue is present. Lamellar corpuscles are present. The tissue was submitted in toto and levels were cut.
Straight
PALMAR FASCIA, RIGHT, FASCIECTOMY: - PALMAR FASCIA WITHIN NORMAL LIMITS. - NEGATIVE FOR FIBROMATOSIS. COMMENT: The tissue was submitted in toto and levels were cut.
Micro
The sections show dense collagen (tendon) without an apparent pathology. Calcification is not present. There is no nuclear atypia or necrosis. Mitotic activity is not identified. Benign fibroadipose tissue is present. Lamellar corpuscles are present.
Angiomyoma
- Do not confuse with angiomyxoma.
General
- Benign.
- Female > male.[80]
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.[81]
Notes:
- Shouldn't be confused with angiofibroma which is associated tuberous sclerosis.
Microscopic
Features:[81]
- Ectatic superficial dermal vessels.
- Overlying hyperkeratosis (thick stratum corneum).
Others features:[citation needed]
- Irregular acanthosis.
- Longer rete ridges.
DDx:
Images:
- WC:
- www:
Inverted follicular keratosis
- Abbreviated IFK.[82]
General
- Benign skin lesion.
- Central face - middle age.[83]
- Uncommon.
- May be considered a variant of seborrheic keratosis that is predominantly endophytic.[84]
Microscopic
Features:[83]
- Keratinocyte of cytologically benign proliferation.
- "Squamous eddies" (whorls of keratin).
- Coarse keratohyaline granules.
DDx:
- Squamous cell carcinoma of the skin.
- Trichilemmoma.
- Seborrheic keratosis - has an exophytic component.
Images:
- Inverted follicular keratosis - low mag. (flickr.com).
- Inverted follicular keratosis - high mag. (flickr.com).
Sign out
SKIN LESION, FACE, BIOPSY: - INVERTED FOLLICULAR KERATOSIS.
Focal cutaneous mucinosis
General
- Benign.
- May be associated with systemic disease.[86]
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.[87]
- 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.[89]
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.
Image:
Nevus lipomatosus superficialis
- Abbreviated NLS.
General
- Rare.
- Congenital.
- Usually lower trunk or gluteal region.[90]
Microscopic
Features:[91]
- Benign adipose tissue in the superficial dermis.
DDx:
- Lipoma.
- Fibroepithelial polyp (skin tag).
Images:
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.
- ↑ Natarajan, E.; Woo, SB. (Jan 2008). "Benign alveolar ridge keratosis (oral lichen simplex chronicus): A distinct clinicopathologic entity.". J Am Acad Dermatol 58 (1): 151-7. doi:10.1016/j.jaad.2007.07.011. PMID 18158926.
- ↑ URL: http://www.pediatrics.wisc.edu/education/derm/text.html. Accessed on: 23 August 2012.
- ↑ 10.0 10.1 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 499. ISBN 978-0443066542.
- ↑ 11.0 11.1 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 479. ISBN 978-0443066542.
- ↑ 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.
- ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 342. ISBN 978-0443066542.
- ↑ URL: http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=1196583692. Accessed on: 1 September 2011.
- ↑ Weinberg, JM. (Jan 2006). "Topical therapy for actinic keratoses: current and evolving therapies.". Rev Recent Clin Trials 1 (1): 53-60. PMID 18393780.
- ↑ 16.0 16.1 Roewert-Huber, J.; Stockfleth, E.; Kerl, H. (Dec 2007). "Pathology and pathobiology of actinic (solar) keratosis - an update.". Br J Dermatol 157 Suppl 2: 18-20. doi:10.1111/j.1365-2133.2007.08267.x. PMID 18067626.
- ↑ 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://www.dermoscopy-ids.org/index.php/newest-case/79-lentigo-maligna-vs-pigmented-actinic-keratosis. Accessed on: 23 August 2012.
- ↑ URL: http://emedicine.medscape.com/article/1099775-workup#a0723. Accessed on: 1 September 2011.
- ↑ 20.0 20.1 20.2 20.3 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 353. ISBN 978-0443066542.
- ↑ 21.0 21.1 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.
- ↑ 22.0 22.1 Picascia, DD.; Robinson, JK. (Aug 1987). "Actinic cheilitis: a review of the etiology, differential diagnosis, and treatment.". J Am Acad Dermatol 17 (2 Pt 1): 255-64. PMID 3305604.
- ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 352. ISBN 978-0443066542.
- ↑ URL: http://emedicine.medscape.com/article/1059477-overview#a0199. Accessed on: 26 August 2011.
- ↑ 25.0 25.1 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.
- ↑ URL: http://www.healthcare.uiowa.edu/dermatology/dpt/HornCyst.htm. Accessed on: 13 September 2012.
- ↑ 28.0 28.1 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 338-9. ISBN 978-0443066542.
- ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 387. ISBN 978-0443066542.
- ↑ 30.0 30.1 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
- ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 389. ISBN 978-0443066542.
- ↑ 35.0 35.1 35.2 35.3 35.4 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.
- ↑ 44.0 44.1 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 77. ISBN 978-0443066542.
- ↑ Thomas, NE.; Kricker, A.; From, L.; Busam, K.; Millikan, RC.; Ritchey, ME.; Armstrong, BK.; Lee-Taylor, J. et al. (Nov 2010). "Associations of cumulative sun exposure and phenotypic characteristics with histologic solar elastosis.". Cancer Epidemiol Biomarkers Prev 19 (11): 2932-41. doi:10.1158/1055-9965.EPI-10-0686. PMID 20802019.
- ↑ 46.0 46.1 Karagas, MR.; Zens, MS.; Nelson, HH.; Mabuchi, K.; Perry, AE.; Stukel, TA.; Mott, LA.; Andrew, AS. et al. (Mar 2007). "Measures of cumulative exposure from a standardized sun exposure history questionnaire: a comparison with histologic assessment of solar skin damage.". Am J Epidemiol 165 (6): 719-26. doi:10.1093/aje/kwk055. PMID 17204514.
- ↑ URL: http://missinglink.ucsf.edu/lm/DermatologyGlossary/verruca_vulgaris.html. Accessed on: 14 July 2010.
- ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 106-7. ISBN 978-0443066542.
- ↑ 49.0 49.1 Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 480. ISBN 978-0781765275.
- ↑ URL: http://www.webmd.com/skin-problems-and-treatments/tc/folliculitis-topic-overview. Accessed on: 7 November 2012.
- ↑ Akin, FY.; Ertam, I.; Ceylan, C.; Kazandi, A.; Ozdemir, F.. "Clear cell acanthoma: new observations on dermatoscopy.". Indian J Dermatol Venereol Leprol 74 (3): 285-7. PMID 18583817.
- ↑ Morrison, LK.; Duffey, M.; Janik, M.; Shamma, HN. (Sep 2010). "Clear cell acanthoma: a rare clinical diagnosis prior to biopsy.". Int J Dermatol 49 (9): 1008-11. PMID 20931670.
- ↑ URL: http://www.drmihm.com/cases/case.cfm?CaseID=45. Accessed on: 7 February 2012.
- ↑ 54.0 54.1 54.2 Devani, A.; Barankin, B. (May 2007). "Dermacase. Chondrodermatitis nodularis chronica helicis.". Can Fam Physician 53 (5): 821, 837. PMID 17879469.
- ↑ Dubey, S.; Sharma, R.; Maheshwari, V. (2010). "Scrotal calcinosis: idiopathic or dystrophic?". Dermatol Online J 16 (2): 5. PMID 20178701.
- ↑ URL: http://emedicine.medscape.com/article/1103137-overview. Accessed on: 21 September 2011.
- ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 486. ISBN 978-0781765275.
- ↑ 58.0 58.1 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 346. ISBN 978-0443066542.
- ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 347. ISBN 978-0443066542.
- ↑ 60.0 60.1 60.2 60.3 60.4 60.5 60.6 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 51. ISBN 978-0443066542.
- ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 478. ISBN 978-0781765275.
- ↑ Requena, L.; Fernández-Figueras, MT. (Jun 2007). "Subcutaneous granuloma annulare.". Semin Cutan Med Surg 26 (2): 96-9. doi:10.1016/j.sder.2007.02.006. PMID 17544961.
- ↑ 63.0 63.1 63.2 URL: http://dermnetnz.org/pathology/necrobiosis-lipoidica-path.html. Accessed on: 24 January 2012.
- ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 52-3. ISBN 978-0443066542.
- ↑ 65.0 65.1 Yun, JH.; Lee, JY.; Kim, MK.; Seo, YJ.; Kim, MH.; Cho, KH.; Kim, MB.; Lee, WS. et al. (May 2009). "Clinical and pathological features of generalized granuloma annulare with their correlation: a retrospective multicenter study in Korea.". Ann Dermatol 21 (2): 113-9. doi:10.5021/ad.2009.21.2.113. PMC 2861218. PMID 20523767. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861218/.
- ↑ Gauglitz, GG.; Korting, HC.; Pavicic, T.; Ruzicka, T.; Jeschke, MG.. "Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies.". Mol Med 17 (1-2): 113-25. doi:10.2119/molmed.2009.00153. PMC 3022978. PMID 20927486. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3022978/.
- ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 505. ISBN 978-0443066542.
- ↑ URL: http://www.drdittmar.lu/Services.aspx. Accessed on: 1 September 2011.
- ↑ http://www.missionforvisionusa.org/anatomy/2006/08/what-is-molluscum-contagiosum.html
- ↑ 70.0 70.1 Alsaad, KO.; Ghazarian, D. (Dec 2005). "My approach to superficial inflammatory dermatoses.". J Clin Pathol 58 (12): 1233-41. doi:10.1136/jcp.2005.027151. PMID 16311340.
- ↑ 71.0 71.1 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. 1269. ISBN 0-7216-0187-1.
- ↑ Arock, M.; Valent, P. (Aug 2010). "Pathogenesis, classification and treatment of mastocytosis: state of the art in 2010 and future perspectives.". Expert Rev Hematol 3 (4): 497-516. doi:10.1586/ehm.10.42. PMID 21083038.
- ↑ 73.0 73.1 Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1185. ISBN 978-1416031215.
- ↑ Rudzki, Z.; Sotlar, K.; Kudela, A.; Starzak-Gwóźdź, J.; Horny, HP. (2011). "Systemic mastocytosis (SM) and associated malignant bone marrow histiocytosis - a hitherto undescribed form of SM-AHNMD.". Pol J Pathol 62 (2): 101-4. PMID 21866466.
- ↑ URL: http://www.humpath.com/palmar-fibromatosis. Accessed on: 6 January 2011.
- ↑ URL: http://surgpathcriteria.stanford.edu/softfib/plantar_fibromatosis/printable.html. Accessed on: 6 January 2011.
- ↑ 77.0 77.1 URL: http://surgpathcriteria.stanford.edu/softfib/palmar_fibromatosis/differentialdiagnosis.html. Accessed on: 9 November 2012.
- ↑ Wang L, Zhu H (2006). "Clonal analysis of palmar fibromatosis: a study whether palmar fibromatosis is a real tumor". J Transl Med 4: 21. doi:10.1186/1479-5876-4-21. PMC 1488873. PMID 16696857. http://www.biomedsearch.com/nih/Clonal-analysis-palmar-fibromatosis-study/16696857.html.
- ↑ Degreef, I.; De Smet, L.; Sciot, R.; Cassiman, JJ.; Tejpar, S. (Mar 2009). "Beta-catenin overexpression in Dupuytren's disease is unrelated to disease recurrence.". Clin Orthop Relat Res 467 (3): 838-45. doi:10.1007/s11999-008-0590-z. PMID 18958538.
- ↑ Katenkamp D, Kosmehl H, Langbein L (1988). "[Angiomyoma. A pathologo-anatomic analysis of 229 cases]" (in German). Zentralbl Allg Pathol 134 (4-5): 423–33. PMID 3201831.
- ↑ 81.0 81.1 Karen, JK.; Hale, EK.; Ma, L. (2005). "Angiokeratoma corporis diffusum (Fabry disease).". Dermatol Online J 11 (4): 8. PMID 16403380.
- ↑ Shih, CC.; Yu, HS.; Tung, YC.; Tsai, KB.; Cheng, ST. (Jan 2001). "Inverted follicular keratosis.". Kaohsiung J Med Sci 17 (1): 50-4. PMID 11411260.
- ↑ 83.0 83.1 83.2 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 387. ISBN 978-0443066542.
- ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 341. ISBN 978-0443066542.
- ↑ URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC475744/. Accessed on: 11 May 2010.
- ↑ Gandhi, V.; Dogra, D.; Pandhi, RK.. "Cutaneous focal mucinosis.". Indian J Dermatol Venereol Leprol 62 (4): 260-1. PMID 20948074.
- ↑ Majeski, J.; Majeski, E. (Nov 1997). "Necrotizing fasciitis: improved survival with early recognition by tissue biopsy and aggressive surgical treatment.". South Med J 90 (11): 1065-8. PMID 9386043.
- ↑ Wong, CH.; Wang, YS. (Apr 2005). "The diagnosis of necrotizing fasciitis.". Curr Opin Infect Dis 18 (2): 101-6. PMID 15735411.
- ↑ Alikhan, A.; Burns, T.; Zargari, O. (2010). "Punctate porokeratotic keratoderma.". Dermatol Online J 16 (1): 13. PMID 20137755.
- ↑ Jones, EW.; Marks, R.; Pongsehirun, D. (Aug 1975). "Naevus superficialis lipomatosus. A clinicopathological report of twenty cases.". Br J Dermatol 93 (2): 121-33. PMID 1235780.
- ↑ Yap, FB. (May 2009). "Nevus lipomatosus superficialis.". Singapore Med J 50 (5): e161-2. PMID 19495497.
- ↑ URL: http://www.dermaamin.com/site/histopathology-of-the-skin/66-n/1971-nevus-lipomatosus-superficialis----.html. Accessed on: 7 March 2012.
- ↑ URL: http://www.humpath.com/spip.php?article8134. Accessed on: 17 December 2012.