Difference between revisions of "Dermal cysts"
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==Epidermal inclusion cyst== | ==Epidermal inclusion cyst== | ||
* | *[[AKA]] ''epidermal cyst''. | ||
===General=== | |||
*Very common. | |||
===Microscopic=== | |||
*[http:// | Feature: | ||
*Lining has a granular layer<ref>URL: [http://emedicine.medscape.com/article/1058907-diagnosis http://emedicine.medscape.com/article/1058907-diagnosis]. Accessed on: 18 March 2011.</ref> - '''key feature'''. | |||
*Trapped collagen bundles at edge of lesion with surrounded by fibroblasts. | *Trapped collagen bundles at edge of lesion with surrounded by fibroblasts. | ||
*Red cells. | *Red cells. | ||
*Keratin. | |||
Image: | |||
*[http://missinglink.ucsf.edu/lm/DermatologyGlossary/img/Dermatology%20Glossary/Glossary%20Histo%20Images/epidermal_follicular_cyst.jpg Epidermal follicular cyst (ucsf.edu)]. | |||
DDx: | DDx: | ||
*Dermatofibrosarcoma - if lesion is large. | |||
*Pilar cyst - no granular layer. | |||
==See also== | ==See also== | ||
Revision as of 15:47, 18 March 2011
Dermal cysts happen and are common. Dermatopathologists can diagnose 'em.
Cysts
Common types:[1]
- Epidermal cyst (sebaceous cyst) -- most common.
- Pilar (tricheilemmal) cyst.
- Dermoid cyst.
- Ganglion cyst.
- Milicem.
EM, SJS, TEN
- SJS and TEN are on a spectrum, EM is considered separate.
Erythema multiforme (EM)
Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)
Rx causes of SJS:
- NSAIDs,
- anticonvulsants,
- sulfonamides,
- penicillins.
TEN more severe form SJS.
Definition:
- >30% sheet-like epidermal detachment, diffuse erythema, severe mucous membrane involvement
- most TEN (80%) Rx-related, only 50% of SJS Rx-related
Venous lake
- Dilated vein.
Microscopic
Features:[2]
- Lined by endothelium.
- Blood in lumen.
- +/-Fibrin in lumen.
DDx:
- Angiokeratoma.
- Ectatic superficial dermal vessels.
- Irregular acanthosis.
- Longer rete ridges.
Neurofibromatosis (von Recklinghausen's disease)
Etiology
- Genetic - autosomal dominant disorder.
Management
- Follow for malignant transformation of neurofibroma --> neurofibrosarcoma.
Treatment
- Excise suspicious lesions & lesions that are painful.
Collagenous fibroma
General
- Benign.
- Used to be known as desmoblastic fibroblastoma.
Epidemiology
- May be on the lip.
- acellular stroma with abundant collagen.
- no nuclear atypia.
Dermatomyositis
Gross
- Have lesions on the knuckle - Gottron's papulle
Histology
- Lymphocytic interface dermatitis (inflammation at the dermal-epidermal junction).
- Loss of rete ridges.
Systemic lupus erythematosus
- Lymphocytic interface dermatitis.[5]
Familial benign pemphigus
- AKA Hailey-Hailey disease. Was described by two brothers - that's why it is Hailey-Hailey.[6]
Etiology
- Autosomal dominant with incomplete penetration.[6]
- Desmosomal defect - due to mutation in the gene ATP2C1.[6]
Clinical
- Chest.
- Intriginous regions (?sp).
- Typically presents individual in their 30s and 40s.[6]
Histology
- Hair folicles spared.
- Epidermis thickened.
DDx
- May resemble pemphigus vulgaris.
Epidermal inclusion cyst
- AKA epidermal cyst.
General
- Very common.
Microscopic
Feature:
- Lining has a granular layer[7] - key feature.
- Trapped collagen bundles at edge of lesion with surrounded by fibroblasts.
- Red cells.
- Keratin.
Image:
DDx:
- Dermatofibrosarcoma - if lesion is large.
- Pilar cyst - no granular layer.