Difference between revisions of "Non-malignant skin disease"
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===General=== | ===General=== | ||
*An oral pathology. | *An oral pathology. | ||
*May be seen where the sun don't shine - penis,<ref name=pmid20082512>{{Cite journal | last1 = Teichman | first1 = JM. | last2 = Sea | first2 = J. | last3 = Thompson | first3 = IM. | last4 = Elston | first4 = DM. | title = Noninfectious penile lesions. | journal = Am Fam Physician | volume = 81 | issue = 2 | pages = 167-74 | month = Jan | year = 2010 | doi = | PMID = 20082512 }}</ref> vulva and vagina.<ref name=pmid20062629>{{Cite journal | last1 = Gupta | first1 = R. | last2 = Bansal | first2 = B. | last3 = Singh | first3 = S. | last4 = Yadav | first4 = I. | last5 = Gupta | first5 = K. | last6 = Kudesia | first6 = M. | title = Lichen planus of uterine cervix - the first report of a novel site of occurrence: a case report. | journal = Cases J | volume = 2 | issue = | pages = 9306 | month = | year = 2009 | doi = 10.1186/1757-1626-2-9306 | PMID = 20062629 }}</ref> | *May be seen where the sun don't shine - [[penis]],<ref name=pmid20082512>{{Cite journal | last1 = Teichman | first1 = JM. | last2 = Sea | first2 = J. | last3 = Thompson | first3 = IM. | last4 = Elston | first4 = DM. | title = Noninfectious penile lesions. | journal = Am Fam Physician | volume = 81 | issue = 2 | pages = 167-74 | month = Jan | year = 2010 | doi = | PMID = 20082512 }}</ref> [[vulva]] and [[vagina]].<ref name=pmid20062629>{{Cite journal | last1 = Gupta | first1 = R. | last2 = Bansal | first2 = B. | last3 = Singh | first3 = S. | last4 = Yadav | first4 = I. | last5 = Gupta | first5 = K. | last6 = Kudesia | first6 = M. | title = Lichen planus of uterine cervix - the first report of a novel site of occurrence: a case report. | journal = Cases J | volume = 2 | issue = | pages = 9306 | month = | year = 2009 | doi = 10.1186/1757-1626-2-9306 | PMID = 20062629 }}</ref> | ||
Etiology: | Etiology: | ||
Revision as of 19:45, 18 September 2011
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 conditions
Classification
- Bullous.
- Interface.
- Nodular & diffuse.
- Spongiotic.
- Vasculitis.
- Perivascular.
- Panniculitis.
- Psoriasiform.
Tabular comparison of inflammatory skin disease (adapted from Brinster[1]):
| Pattern | Key histologic feature | Subclassifications | Example |
| Bullous | "Empty space" | -Subcorneal -Suprabasillar -Subepidermal |
-Pemphigus foliaceus -Pemphigus vulgaris -Dermatitis herpetiformis |
| Interface | Inflammation at DE junction | -Vacuolar (minimal) -Lichenoid (band-like) |
-Erythema multiforme, SLE -Lichen planus |
| Nodular & diffuse | Nodular & diffuse | ? | |
| Spongiotic | Edema between keratinocytes | -Acute -Subacute -Chronic |
-Poison Ivy -Nummular dermatitis -Atopic dermatitis |
| Vasculitis | Inflammation of vessel wall | ? | ? |
| Perivascular | Inflammation around vessels | ? | ? |
| Panniculitis | Inflamm. of adipose tissue | -Septal -Nodular |
-Erythema nodosum -Erythema induratum |
| Psoriasiform | Epidermal thickening and long rete ridges |
-Regular -Irregular |
-Psoriasis -Lichen simplex chronicus |
Notes:
- DE junction = dermal-epidermal junction.
- The "empty space" in bullous disease in situ is filled with fluid.
Psoriasis
General
- Can be subclassified.
DDx:
- Psoriasis vulgaris (most common).
- Psoriatic arthritis.
- Drug-induced.
- Others.
Microscopic
- Regular epidermal thickening - as very long rete ridges (described as "test tube-morphology") - key feature.
- Epidermis between rete ridges thin ("thinning of suprapapillary plate").
- Parakeratosis.
- Thin/absent granular layer.
- Dilated blood vessels in superficial dermis.
- Neutrophil clusters (Munro microabscess).
Seborrheic dermatitis
General
- Very common.
Microscopic
Features:[3]
- Spongiosis (epidermal edema).
- Acanthosis (epidermal thickening).
- "Follicular lipping" = parakeratosis with neutrophils.
- Perivascular neutrophils and lymphocytes.
Systemic lupus erythematosus
General
- Systemic disease with multi-organ manifestations.
Microscopic
Features:
Dermatomyositis
- For the muscle manifestations see: Neuromuscular_pathology#Dermatomyositis.
General
- Complement mediated disease - membrane attack complex.
- Usually middle age.
- Associated skin rash is common.
- May precede or follow muscle pathology.
- Associated with malignancy in approximately 10% of cases.[6]
Gross
- Have lesions on the knuckles - Gottron's papules.
Microsopic
Features:
- Lymphocytic interface dermatitis (inflammation at the dermal-epidermal junction).
- Loss of rete ridges.
Lichen planus
General
Etiology:
- Autoimmune disease, T-cell–mediated.[9]
Clinical:[10]
- 6 Ps: pruritic (itchy), purple, polygonal, planar papules and plaques.
Gross
- Wickham striae = white lines/dots.
- Due to hypergranulosis.
Microscopic
- Loss of basal cells (stratum basale) -- key feature.
- Loss of rete ridges/formation of pointed rete ridges "sawtoothing".
- Interface dermatitis (lymphocytes at dermal-epidermal junction).
- Hypergranulosis; stratum granulosum thickened (grossly seen as "Wickham stria" = white lines).
- Hyperkeratosis; stratum corneum thickened.
- Necrotic basal cell in dermis = colloid bodies = Civatte bodies.[13]
DDx:
- Bullous disease, subepithelial vesicular.
- Lichenoid keratosis - parakeratosis prominent.
Notes:
- Hyperkeratosis and hypergranulosis are not seen in erythema multiforme.
- Colloid bodies = cytoid bodies = Civatte bodies = hyaline bodies = apoptotic bodies.[14]
- DDx: systemic lupus erythematosus, lichen planus, and graft-versus-host disease.
Images:
Lichen sclerosus
Main article: Lichen sclerosus
Microscopic
Features:[15]
- Subepithelial fibrosis - key feature.
Psoriasis
General
- Chronic skin condition +/- systemic involvement:[16]
- Arthritis.
- Myopathy.
- Enteropathy, e.g. inflammatory bowel disease.
- Syondylitic joint disease (spondylos = vertebrae[17]).
Clinical:
- Auspitz sign = pin-point bleeding on removal of scale.
- Koebner phenomenon = lesions form at site of trauma.
Microscopic
Features:[16]
- Acanthosis + long rete ridges - key feature.
- Parakeratosis.
- Dilated vessels in superficial dermis (give rise to Auspitz sign).
- Spongiform pustules = PMNs in stratum spinosum.
- PMNs in parakeratotic stratum corneum (Munro microabscess).
Other
Squamous cell hyperplasia
General
- Variant of spongiotic dermatitis.[19]
Etiology:[20]
- Pruritus (itchness) -> mechanical trauma -> lichenification (thickened/leathery[21].
Microscopic
Features:[15]
- Acanthosis (epithelial thickening).
- Hyperkeratosis.
Other features:[22]
- Spongiosis (epidermal intercellular edema -- cells appear to have a clear halo around 'em).
- Parakeratosis = retention of nuclei in the stratum corneum.
Images:
Very common
Dermatophytosis
General
- Fungal infection of skin.
Microscopic
Features:
- Microorganisms - key feature.
- Often hyphae (candida) - like twigs of a tree... branching.
- Perivascular inflammation.
- Exocytosis - blood cell infiltrate the epidermis.
Stains
Cicatrix
- AKA 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.
Image:
Fibroepithelial polyp
- AKA acrochordon, skin tag.
General
- Benign.
- Older people.
- May be associated with pregnancy, diabetes, intestinal polyposis.[23]
Gross
- Raised skin-coloured lesion.
Image:
Microscopic
Features:
- On a stalk / epithelium on three sides.
- Benign epidermis.
Image:
Actinic keratosis
- AKA solar keratosis. (???)
General
Clinical: yellow-brown scaly, patches, sandpaper sensation.
Risk factors:[25]
- Sun exposure.
- Immune suppression (e.g. organ transplant recipients).
Microscopic
Features:[26]
- 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:
- Pallisading. (???)
- +/-Parakeratosis.
- +/-Irregular acanthosis.
Image:
Seborrheic keratosis
- Abbreviated SK.
General
- Benign.
- Most common tumour in older people.[27]
- "Large number" of SKs = paraneoplastic syndrome (Leser–Trélat sign).[28]
Epidemiology:
- Old people.
- Usu. in sun exposed area.[29]
Gross
- "Stuck-on" appearance - raised lesion.
Image(s):
Microscopic
Features:[28]
- 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).
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Pilomatricoma
General
- Benign skin tumour.
- Most common solid skin tumour of children.[31]
- CTNNB1 gene mutation important in pathogenesis.[32]
Clinical:
- Hard nodule - calcification.
- +/-Painful.
Treatment:
- Surgical excision.[31]
Microscopic
Features:[33]
- 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:[34]
- 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.
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:[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.
Images:
DDx:
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.
IHC
- Factor XIIIa +ve.
- Usually negative in DFSP.
- CD34 -ve.
- Usually positive in DFSP.
- D2-40 +ve.[40]
- Usually negative in DFSP.
Ezcema
General
- A nebulous thingy.
- Very common.
DDx:
- Contact allergy.
- Drug reaction.
- Food allergy.
Microscopic
Features:[41]
- Spongiosis (epidermal edema); keratinocytes spacing increased - key feature.
- +/-Interdermal vesicles.
- +/-Eosinophils (may suggest Rx reaction).
- Perivascular lymphocytes.
Very common - viral
Verruca vulgaris
General
Notes:
- Related to condyloma acuminatum.
Microscopic
Features:[42]
- 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.[43]
Microscopic
Features:[43]
- 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
Dilated pore of Winer
General
- Benign.
- Looks like zit.
Microscopic
Features:[44]
- Dilated hair follicle with keratin.
- Acanthosis.
- Budding of epidermis (into dermis).
Lichenoid keratosis
General
- Caucasians - middle age or older.
Clinical DDx:[45]
Microscopic
Features:[46]
- 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.[47]
Microscopic
Features:[48]
- Dermal palisading granuloma around:
- Necrotic collagen - key feature.
- Nuclei "missing" - have undergone karyolysis.
- Mucin.
- Loose/pale, paucicellular, eosinophilic.
- Necrotic collagen - key feature.
- Chronic inflammatory cells.
Notes:
- There may be multiple small foci with intervening normal dermis.[47]
- Granuloma annulare can be subclassified into subcutaneous and interstitial.
- Histomorphologically similar to Rheumatoid nodule.
DDx:
- Necrobiosis lipoidica - little mucin, no normal dermis between foci.[47]
- Rheumatoid nodule.
Images:
Keloid
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.
Images:
Angiofibroma
- See also: nasopharyngeal angiofibroma.
General
- May be seen in the context of tuberous sclerosis - esp. "butterfly area of the face".[35]
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.[50]
- 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.
Syringoma
General
- Benign sweat duct tumour.
- Eccrine differentiation.
- Usually close to lower eyelid.[51]
Microscopic
Features:[52]
- Proliferation of benign ducts with lined by a bilayer (as in normal sweat ducts) with abnormal architecture:
- Tadpole like appearing ducts.
Images:
Chondroid syringoma
- Used to be called mixed tumour of skin.[54]
General
- Mixed apocrine & eccrine tumour of skin, usu. in the head & neck[54], esp. nose and cheek.[55]
- May be in major and minor salivary glands.[55]
Microscopic
Features:
- Mix tumour with:[54]
- Epithelial component:
- Nests of cells with:
- Moderate dull eosinophilic cytoplasm.
- Round/ovoid nuclei with nucleoli.
- Nests of cells with:
- Mesenchymal component:
- Chondromyxoid stroma.
- Epithelial component:
Dermal cylindroma
General
- Benign skin lesion.
- Should not be confused with cylindroma (adenoid cystic carcinoma).
Microscopic
Features:
- Nests of cells that are surrounded by hyaline (i.e. glassy, eosinophilic, acellular) material.
DDx:
Images:
Keratoacanthoma
- Abbreviated KA.
- Generally considered to be benign.
- Rare reports of metastases suggesting it may be a form of squamous cell carcinoma.[56]
Clinical
- May grow rapidly (weeks or months) then involute.
- Main DDx is squamous cell carcinoma.
- Exophytic lesion, well-circumscribed.
Microscopic
Features:[57]
- Expansion of stratum spinosum - pushing tongue-like downward growth of epidermis into the dermis.
- Keratin collection (keratin plug) at the center of lesion-superficial aspect.
- Cells have glassy pink cytoplasm.
- Minimal/no nuclear atypia.
Image:
Superficial dermal infiltrates
Discussed in detail by Alsaad and Ghazarian.[58]
Dermal perivascular lymphoeosinophilic infiltration (DPLI)
- Microscopic appearance is just what it is called:
- Lymphocytes and eosinophils around the vessels in the superficial dermis.
DDx:[58]
- Insect bite - classically wedge-shaped.[59]
- Drug reactions.
- Urticarial reactions.
- Prevesicular early stage of bullous pemphigoid.
- HIV related dermatoses.
Notes:
- May superficially resemble cutaneous lymphoma.[59]
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:[60]
- Cutaneous (only) - usually children.
- Urticaria pigmentosa.
- Others.
- Systemic - usually adults.
- Indolent subvariant.
- Aggressive subvariant.
- Leukemic subvariant.
Microscopic
Features:[61]
- 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:
Stains
- Toluidine blue -- highlights the granules.
IHC
- CD117 +ve.
- Tryptase +ve.[62]
Ichthyosis
General
- Comes in different flavours.
- Usu. inherited... thus a pediatric condition.
Clinical:
- Fish scale-like appearance.
Microscopic
Features:[61]
- Thick stratum corneum without basket-weave pattern.
Palmar fibromatosis
General
- AKA Dupuytren's contracture.
Clinical:[63]
- Usually older 60-70s.
- Male > female.
- Associated with:
- Alcohol abuse.
- May be familial.
Microscopic
Features:[64]
- Bland spindle cells in dense collagen.
- No nuclear atypia.
- Giant cells.
- +/-Mitotic figures.
Images:
Angiomyoma
- Do not confuse with angiomyxoma.
General
- Benign.
- Female > male.[66]
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.[67]
Notes:
- Shouldn't be confused with angiofibroma which is associated tuberous sclerosis.
Microscopic
Features:[67]
- 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.[68]
- Uncommon.
Microscopic
Features:[68]
- 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).
Panniculitis
Main article: 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
Porokeratosis
General
- Genetic.
- Several subtypes.
Notes:
- Not the same as punctate porokeratotic keratoderma.[70]
Microscopic
Features:
- Cornoid lamella (pathognomonic) - key feature:
- Compact keratosis over a hair follicle.
- +/-Rete ridge loss.
Nevus sebaceous
- AKA nevus sebaceous of Jadassohn.
General
- Congenital.
- Face or scalp.
Microscopic
Features:
- Abundant sebaceous glands.
Bullous disease
Main article: Bullous disease
Cysts
Main article: Dermal cysts
See also
References
- ↑ 1.0 1.1 Brinster NK (March 2008). "Dermatopathology for the surgical pathologist: a pattern based approach to the diagnosis of inflammatory skin disorders (part I)". Adv Anat Pathol 15 (2): 76–96. doi:10.1097/PAP.0b013e3181664e8d. PMID 18418089.
- ↑ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1191. ISBN 978-1416031215.
- ↑ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1191. ISBN 978-1416031215.
- ↑ JAH. 20 February 2009.
- ↑ Crowson AN, Magro CM, Mihm MC (April 2008). "Interface dermatitis". Arch. Pathol. Lab. Med. 132 (4): 652–66. PMID 18384217. http://www.archivesofpathology.org/doi/full/10.1043/1543-2165%282008%29132%5B652%3AID%5D2.0.CO%3B2.
- ↑ Chen YJ, Wu CY, Huang YL, Wang CB, Shen JL, Chang YT (2010). "Cancer risks of dermatomyositis and polymyositis: a nationwide cohort study in Taiwan". Arthritis Res. Ther. 12 (2): R70. doi:10.1186/ar2987. PMC 2888225. PMID 20398365. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2888225/.
- ↑ Teichman, JM.; Sea, J.; Thompson, IM.; Elston, DM. (Jan 2010). "Noninfectious penile lesions.". Am Fam Physician 81 (2): 167-74. PMID 20082512.
- ↑ Gupta, R.; Bansal, B.; Singh, S.; Yadav, I.; Gupta, K.; Kudesia, M. (2009). "Lichen planus of uterine cervix - the first report of a novel site of occurrence: a case report.". Cases J 2: 9306. doi:10.1186/1757-1626-2-9306. PMID 20062629.
- ↑ URL: http://emedicine.medscape.com/article/1078327-overview. Accessed on: 11 September 2010.
- ↑ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1191. ISBN 978-1416031215.
- ↑ URL: http://emedicine.medscape.com/article/1078327-overview. Accessed on: 11 September 2010.
- ↑ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1192. ISBN 978-1416031215.
- ↑ 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. 604. ISBN 978-1416054542.
- ↑ URL: http://www.careforumwales.org/cell-carcinoma/histopathologic-terminology.html. Accessed on: 28 August 2011.
- ↑ 15.0 15.1 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. 1065-6. ISBN 0-7216-0187-1.
- ↑ 16.0 16.1 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. 603. ISBN 978-1416054542.
- ↑ URL: http://medical-dictionary.thefreedictionary.com/spondylosis. Accessed on: 28 August 2011.
- ↑ 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.
- ↑ 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.
- ↑ URL: http://emedicine.medscape.com/article/1123423-diagnosis. Accessed on: 20 August 2010.
- ↑ 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.
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- ↑ URL: http://emedicine.medscape.com/article/1059477-overview. Accessed on: 26 August 2011.
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- ↑ 31.0 31.1 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.
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- ↑ BD. 13 April 2011.
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- ↑ 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.
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