Difference between revisions of "Dermatopathology"

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Dermatopathology (view source)

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'''Dermatopathology''' is the pathology of skin.
'''Dermatopathology''' is the pathology of skin.  


Pathology is a significant part of dermatology and dermatologists spend five years in residency. So, it is a huge area.
Pathology is a significant part of dermatology and dermatologists spend five years in residency. So, it is a huge area.


=Specimens=
=Specimens=
*Shave biopsy - done for what is presumed to be benign disease - classically exophytic lesions, e.g. [[seborrheic keratosis]].
*Shave biopsy = done for what is presumed to be benign disease - classically exophytic lesions, e.g. [[seborrheic keratosis]].
*Punch biopsy - usu. epidermis and dermis - suspicious lesions/malignant lesions, e.g. [[basal cell carcinoma]].
*Saucerization = scooped shave biopsy.<ref>{{Cite journal  | last1 = Elston | first1 = D. | title = Practical advice regarding problematic pigmented lesions. | journal = J Am Acad Dermatol | volume = 67 | issue = 1 | pages = 148-55 | month = Jul | year = 2012 | doi = 10.1016/j.jaad.2012.04.006 | PMID = 22703907 }}
*Incisional biopsy - a piece of the lesion for pathologic assessment; lesion not completely removed.
</ref>
*Excision - lesion cut-out with intent for complete removal - usual has a generous margin, e.g. [[malignant melanoma]] excision.
*Punch biopsy = cylindrical piece of skin, usu. epidermis and dermis - suspicious lesions/malignant lesions, e.g. [[basal cell carcinoma]].
*Re-excision - done to get a wider margin ''or'' remove part of a lesion that was incompletely removed in a prior excision.
*Incisional biopsy = a piece of the lesion for pathologic assessment; lesion not completely removed.
*Lymphadenectomy - done for staging.
*Excision = lesion cut-out with intent for complete removal - usual has a generous margin, e.g. [[malignant melanoma]] excision.
*Re-excision = done to get a wider margin ''or'' remove part of a lesion that was incompletely removed in a prior excision.
**Conservative re-excision = cut-out more with a minimal rim of normal tissue.<ref>URL: [http://www.nedermatology.com/skin-cancer-treatments.php http://www.nedermatology.com/skin-cancer-treatments.php]. Accessed on: 26 February 2013.</ref>
*[[Sentinel lymph node]] removal = a special type of lymphadenectomy usu. done for [[cancer staging|staging]], esp. [[malignant melanoma]].


=Histology=
=Histology=
==Layers of the skin==
==Layers of the skin==
[[Image:Skin.png|thumb|Schematic showing the layers and structures of skin. (WC/cancer.gov)]]
*Epidermis - outer most layer, avascular, separated from dermis by a basement membrane, epithelial tissue.
*Epidermis - outer most layer, avascular, separated from dermis by a basement membrane, epithelial tissue.
*Dermis - below the epidermis, vascular, separated from the epidermis by a basement membrane, connective tissue.
*Dermis - below the epidermis, vascular, separated from the epidermis by a basement membrane, connective tissue.
*Subdermis - below the dermis, connective tissue.
 
Note:
*The layer below the skin is the ''subdermis'' ([[AKA]] hypodermis, [[AKA]] subcutaneous tissue).
**It is below the dermis and consists of adipose tissue.<ref>URL: [http://histologyolm.stevegallik.org/node/119 http://histologyolm.stevegallik.org/node/119]. Accessed on: 5 November 2013.</ref>
 
Image:
*[http://histologyolm.stevegallik.org/node/119 Dermis and hypodermis (stevegallik.org)].


===Epidermis===
===Epidermis===
====Layers of the epidermis====
====Layers of the epidermis====
[[Image:Epidermal layers.png|thumb|right|Layers of the epidermis. (WC/Wbensmith)]]
Epidermis layers - from the surface to epidermal-dermal junction:
Epidermis layers - from the surface to epidermal-dermal junction:
*Stratum corneum.  
*Stratum corneum.  
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*Melanocytes.
*Melanocytes.
**Usuallly basal location.
**Usuallly basal location.
**Epithelioid or dentritic morphology.
**Epithelioid or dendritic morphology.
**Pericellular clearing - '''key feature'''.
**Pericellular clearing - '''key feature'''.
**Clear cytoplasm.
**Clear cytoplasm.
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===Adnexal structures===
===Adnexal structures===
The top five structures of the skin:<ref>{{Ref Derm|4-8}}</ref>
The top five structures of the skin:<ref>{{Ref Derm|4-8}}</ref>
{| class="wikitable"
{| class="wikitable sortable"
| '''Structure''' / '''Attribute
! Structure / Attribute
| '''Histomorphology'''
! Histomorphology
| '''Function'''
! Function
| '''[[IHC]]'''
! [[IHC]]
| '''Other'''
! Other
| '''Image'''
! Image
|-
|-
| '''Eccrine gland'''
| '''Eccrine gland'''
| clusters of tubular structures, pale cytoplasm
| clusters of tubular structures, pale cytoplasm
| thermoregulation (cooling) - produce sweat
| thermoregulation (cooling) - produce sweat
| CK7+, CEA+, CAM5.2+, EMA+
| [[CK7]]+, [[CEA]]+, CAM5.2+, [[EMA]]+
| ?
| ?
| ?
| ?
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| '''Nail'''
| '''Nail'''
| epidermal structure
| epidermal structure
| ? look pretty
| weapon (claw-like), look pretty?
| ?
| ?
| ?
| ?
| ?
| [http://histology.osumc.edu/histology/HumanHisto/Integumentary/Img/17B-23_001.html (osumc.edu)], [http://ctrgenpath.net/static/atlas/mousehistology/Windows/integumentary/nail20.html (ctrgenpath.net)]
|-
|-
|}
|}
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| flat + change of colour
| flat + change of colour
| if > 10 mm --> patch
| if > 10 mm --> patch
| [http://commons.wikimedia.org/wiki/File:Macule_and_Patch.svg Macule (WC)]
| [[Image:Macule_and_Patch.svg|thumb|center|150px| Macule (WC)]]
|-
|-
| Patch
| Patch
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| flat + change of colour
| flat + change of colour
| if <= 10 mm --> macule
| if <= 10 mm --> macule
| [http://commons.wikimedia.org/wiki/File:Macule_and_Patch.svg Patch (WC)]
| [[Image:Macule_and_Patch.svg|thumb|center|150px| Patch (WC)]]
|-
|-
| Papule  
| Papule  
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| raised
| raised
| if > 10 mm --> nodule
| if > 10 mm --> nodule
| [http://commons.wikimedia.org/wiki/File:Papule_and_Plaque.svg Papule (WC)]
| [[Image:Papule_and_Plaque.svg|thumb|center|150px| Papule (WC)]]
|-
|-
| Nodule  
| Nodule  
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| raised  
| raised  
| if <= 10 mm --> papule
| if <= 10 mm --> papule
| [http://commons.wikimedia.org/wiki/File:Nodules.svg Nodule (WC)]
| [[Image:Nodules.svg|thumb|center|150px| Nodule (WC)]]
|-
|-
| Plaque  
| Plaque  
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| raised, flat-top
| raised, flat-top
| plateau-like
| plateau-like
| [http://commons.wikimedia.org/wiki/File:Papule_and_Plaque.svg Plaque (WC)]
| [[Image:Papule_and_Plaque.svg|thumb|center|150px| Plaque (WC)]]
|-
|-
| Vesicle  
| Vesicle  
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| raised, fluid filled
| raised, fluid filled
| if > 10 mm --> bulla
| if > 10 mm --> bulla
| [http://commons.wikimedia.org/wiki/File:Vesicles_and_Bulla.svg Vesicle (WC)]
| [[Image:Vesicles_and_Bulla.svg |thumb|center|150px| Vesicle (WC)]]
|-
|-
| Bulla  
| Bulla  
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| raised, fluid filled
| raised, fluid filled
| if <= 10 mm --> vesicle
| if <= 10 mm --> vesicle
| [http://commons.wikimedia.org/wiki/File:Vesicles_and_Bulla.svg Bulla (WC)]
| [[Image:Vesicles_and_Bulla.svg |thumb|center|150px| Bulla (WC)]]
|}
|}
Note:
Note:
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Dermatopathology doesn't have intuitive terms, e.g. thickening of the stratum spinosum isn't ''spinosum hyperplasia''.  The terms have to committed to memory.
Dermatopathology doesn't have intuitive terms, e.g. thickening of the stratum spinosum isn't ''spinosum hyperplasia''.  The terms have to committed to memory.


Common terms:
===Common terms in a table===
{| class="wikitable sortable"  
{| class="wikitable sortable"  
! Term
! Term
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| <ref>{{Ref PBoD|1230}}</ref>
| <ref>{{Ref PBoD|1230}}</ref>
|-
|-
|Basket weave
|Basketweave stratum corneum
| appearance of the normal stratum corneum; presence suggests an acute process
| appearance of the normal stratum corneum; presence in the context of pathology suggests an acute process
|
|
|-
|-
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| <ref>URL: [http://dermnetnz.org/pathology/pathology-glossary.html http://dermnetnz.org/pathology/pathology-glossary.html]. Accessed on: 8 August 2012.</ref>  
| <ref>URL: [http://dermnetnz.org/pathology/pathology-glossary.html http://dermnetnz.org/pathology/pathology-glossary.html]. Accessed on: 8 August 2012.</ref>  
|-
|-
|Epidermotropism
| Hyperkeratosis
| intraepithelial lymphocytes in [[CTCL]]
| thickened stratum  corneum - also see ''compact hyperkeratosis'' and ''basketweave stratum corneum''
|
|-
|Epidermotropism †
| intraepithelial lymphocytes in [[CTCL]]; how to remember: epidermotropis''m'' = ''m''alignant
| <ref name=pmid20132423>{{Cite journal  | last1 = Fung | first1 = MA. | title = 'Epidermotropism' vs. 'exocytosis' of lymphocytes 101: definition of terms. | journal = J Cutan Pathol | volume = 37 | issue = 5 | pages = 525-9 | month = May | year = 2010 | doi = 10.1111/j.1600-0560.2010.01515.x | PMID = 20132423 }}</ref>
| <ref name=pmid20132423>{{Cite journal  | last1 = Fung | first1 = MA. | title = 'Epidermotropism' vs. 'exocytosis' of lymphocytes 101: definition of terms. | journal = J Cutan Pathol | volume = 37 | issue = 5 | pages = 525-9 | month = May | year = 2010 | doi = 10.1111/j.1600-0560.2010.01515.x | PMID = 20132423 }}</ref>
|-
|-
|Exocytosis
|Exocytosis †
| intraepithelial lymphocytes in benign conditions
| intraepithelial lymphocytes in benign conditions
| <ref name=pmid20132423>{{Cite journal  | last1 = Fung | first1 = MA. | title = 'Epidermotropism' vs. 'exocytosis' of lymphocytes 101: definition of terms. | journal = J Cutan Pathol | volume = 37 | issue = 5 | pages = 525-9 | month = May | year = 2010 | doi = 10.1111/j.1600-0560.2010.01515.x | PMID = 20132423 }}</ref>
| <ref name=pmid20132423>{{Cite journal  | last1 = Fung | first1 = MA. | title = 'Epidermotropism' vs. 'exocytosis' of lymphocytes 101: definition of terms. | journal = J Cutan Pathol | volume = 37 | issue = 5 | pages = 525-9 | month = May | year = 2010 | doi = 10.1111/j.1600-0560.2010.01515.x | PMID = 20132423 }}</ref>
|-
|Orthokeratosis
| anuclear keratin layer is present (stratum corneum) - seen in normal skin; ''ortho-'' means ''correct''
| <ref>URL: [http://www.medilexicon.com/medicaldictionary.php?t=63448 http://www.medilexicon.com/medicaldictionary.php?t=63448]. Accessed on: 13 March 2013.</ref><ref>URL: [http://dictionary.reference.com/browse/ortho- http://dictionary.reference.com/browse/ortho-]. Accessed on: 13 March 2013.</ref>
|}  
|}  
Note:
* † These definitions are not universally accepted. ''Epidermotropism'' is sometimes used in the context of benign disease.<ref name=pmid9537476>{{Cite journal  | last1 = Fung | first1 = MA. | last2 = LeBoit | first2 = PE. | title = Light microscopic criteria for the diagnosis of early vulvar lichen sclerosus: a comparison with lichen planus. | journal = Am J Surg Pathol | volume = 22 | issue = 4 | pages = 473-8 | month = Apr | year = 1998 | doi =  | PMID = 9537476 }}</ref>


Image:  
Image:  
*[http://commons.wikimedia.org/wiki/File:Spongiotic_dermatitis_%282%29_Dyshidrotic_.JPG Spongiosis (WC)].
*[http://commons.wikimedia.org/wiki/File:Spongiotic_dermatitis_%282%29_Dyshidrotic_.JPG Spongiosis (WC)].


Others:
===Others terms===
*Crust = epithelial elements, blood.
*Crust = epithelial elements, blood.


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*[[Basal cell carcinoma]] (BCC).
*[[Basal cell carcinoma]] (BCC).
*[[Malignant melanoma]].
*[[Malignant melanoma]].
*Metstases.
*Metastases.


==Non-malignant disease==
==Non-malignant disease==
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| [[fibroepithelial polyp]]
| [[fibroepithelial polyp]]
| Leser–Trélat sign = many SKs in malignancy
| Leser–Trélat sign = many SKs in malignancy
| [http://commons.wikimedia.org/wiki/File:Seborrheic_keratosis_(1).jpg (WC)]
| [[Image:Seborrheic_keratosis_(1).jpg |thumb|center|150px| SK (WC)]]
|-
|-
| [[Dermatofibroma]]
| [[Dermatofibroma]]
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| [[DFSP]]
| [[DFSP]]
| very common
| very common
| [http://www.pacificderm.org/newsflashcpcapril04.html (pacificderm.org)]
| [[Image:SkinTumors-P9280848.jpg|thumb|center|150px|DF (WC)]]
|-
|-
| [[Fibroepithelial polyp]] (skin tag)
| [[Fibroepithelial polyp]] (skin tag)
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| [[seborrheic keratosis]]
| [[seborrheic keratosis]]
| very common
| very common
| [http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=1767547949 (dermatlas.med.jhmi.edu)]
| [[Image:SkinTumors-P9250819.jpg|thumb|center|150px|Skin tag (WC)]]
|-
|-
| [[Lipoma]]
| [[Lipoma]]
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| [[liposarcoma]]
| [[liposarcoma]]
| variants: angiolipoma (blood vessels), myolipoma (muscle)
| variants: angiolipoma (blood vessels), myolipoma (muscle)
| [http://circ.ahajournals.org/content/113/21/e778/F5.expansion.html (ahajournals.org)]
| [[Image: Lipoma -- high mag.jpg|thumb|center|150px|Lipoma (WC)]]
|-
|-
| [[Cicatrix]] (dermal scar)
| [[Cicatrix]] (dermal scar)
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| residual disease, [[hypertrophic scar]], (desmoplastic) [[melanoma]]
| residual disease, [[hypertrophic scar]], (desmoplastic) [[melanoma]]
|  
|  
| [http://commons.wikimedia.org/wiki/File:ScarHistology.JPG (WC)].
| [[Image:ScarHistology.JPG |thumb|center|150px| Scar (WC)]]
|- <!--
|- <!--
| Entity
| Entity
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| [[Neurofibroma]]
| [[Neurofibroma]]
| bland spindle cells
| bland spindle cells
| mixed with collagen (???), assoc. with a nerve
| mast cells, mixed with collagen, assoc. with a nerve
| may be associated with [[neurofibromatosis]], esp. plexiform type
| may be associated with [[neurofibromatosis]], esp. plexiform type
| S100+ (???)
| S100+, GFAP+
| dermal nevus (???)
| neurotized [[melanocytic nevus]]
| may develop into [[MPNST]]
| may develop into [[MPNST]]
| [http://commons.wikimedia.org/wiki/File:Neurofibroma_%281%29.jpg (WC)]
| [[Image:Neurofibroma_%281%29.jpg |thumb|center|150px| Neurofibroma (WC)]]
|-  
|-  
| [[Keratoacanthoma]]
| [[Keratoacanthoma]]
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| [[squamous cell carcinoma]]
| [[squamous cell carcinoma]]
| some don't believe in the entity
| some don't believe in the entity
| [http://commons.wikimedia.org/wiki/File:Skin_keratoacanthoma_whole_slide.jpg (WC)]
| [[Image:Skin_keratoacanthoma_whole_slide.jpg |thumb|center|150px| Keratoacathoma (WC)]]
|-  
|-  
| [[Molluscum contagiosum]]
| [[Molluscum contagiosum]]
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| DDx (?)
| DDx (?)
| favourite exam case
| favourite exam case
| [http://commons.wikimedia.org/wiki/File:Molluscum_contagiosum_high_mag.jpg (WC)]
| [[Image:Molluscum_contagiosum_high_mag.jpg |thumb|center|150px|Molluscum contagiosum (WC)]]
|-  
|-  
| [[Verruca vulgaris]]
| [[Verruca vulgaris]]
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| raised lesions, classically on hand
| raised lesions, classically on hand
| none (p16+?)
| none (p16+?)
| DDx ?
| [[squamous cell carcinoma of the skin|squamous cell carcinoma]]
| caused by [[HPV]]
| caused by [[HPV]]
| [http://commons.wikimedia.org/wiki/File:Verruca_vulgaris_-_very_low_mag.jpg (WC)]
| [[Image:Verruca_vulgaris_-_very_low_mag.jpg |thumb|center|150px| Verruca vulgaris (WC)]]
|-  
|-  
| [[Condyloma acuminatum]]
| [[Condyloma acuminatum]]
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| [[fibroepithelial polyp]]
| [[fibroepithelial polyp]]
| caused by [[HPV]]
| caused by [[HPV]]
| [http://commons.wikimedia.org/wiki/File:Anal_condyloma_%282%29.jpg (WC)]  
| [[Image:Anal_condyloma_%282%29.jpg |thumb|center|150px| Condyloma acuminatum (WC)]]  
|-  
|-  
| [[Granuloma annulare]]
| [[Granuloma annulare]]
| dermal palisading [[granuloma]] around necrotic collagen
| dermal palisading [[granuloma]] around necrotic collagen
| mucin in centre of lesion, (peripheral) lymphocytes
| mucin in centre of lesion, (peripheral) lymphocytes, usu. more superficial than necrobiosis lipoidica
| benign, self-limited
| benign, self-limited
| none (CD68?)
| none (CD68?)
| [[necrobiosis lipoidica]], [[rheumatoid nodule]], [[epithelioid sarcoma]]
| [[necrobiosis lipoidica]], [[rheumatoid nodule]], [[epithelioid sarcoma]]
| Other ?
| Other ?
| [http://commons.wikimedia.org/wiki/File:Granuloma_annulare_-_add_-_intermed_mag.jpg (WC)], [http://commons.wikimedia.org/wiki/File:Granuloma_annulare_-_add_-_high_mag.jpg (WC)]  
| [[Image:Granuloma_annulare_-_add_-_high_mag.jpg |thumb|center|150px| GA (WC)]]  
|-  
|-  
| [[Necrobiosis lipoidica]]
| [[Necrobiosis lipoidica]]
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| DDx
| DDx
| may be associated with [[tuberous sclerosis]]
| may be associated with [[tuberous sclerosis]]
| [http://www.drdittmar.lu/images/sce/angiofibroma-s.jpg Angiofibroma (drdittmar.lu)]
| [[Image:Nasopharyngeal angiofibroma - 2 - high mag.jpg|thumb|150px|Angiofibroma (WC)]]
|-
|-
| [[Keloid]]
| [[Keloid]]
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| [[dermatofibroma]] (???)
| [[dermatofibroma]] (???)
| [[hypertrophic scar]]
| [[hypertrophic scar]]
| [http://missinglink.ucsf.edu/lm/DermatologyGlossary/keloids.html (ucsf.edu)].
| [[Image:Keloid_-_high_mag.jpg|thumb|center|150px|Keloid (WC)]]
|-  
|-  
| [[Eccrine poroma]]
| [[Eccrine poroma]]
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| DDx ?
| DDx ?
| Other ?
| Other ?
| [http://www.flickr.com/photos/40981620@N04/3808316834/in/photostream/ (flickr.com)], [http://www.flickr.com/photos/40981620@N04/3807502071/in/photostream/ (flickr.com)]
| [[Image:SkinTumors-P7150495.JPG|thumb|center|150px|EP (WC)]]
|-  
|-  
| [[Syringoma]]
| [[Syringoma]]
| bilayered ducts, occasionally tadpole like shape
| bilayered ducts, occasionally tadpole like shape
|  
|  
| usu. close to eyelid  
| usu. close to [[eyelid]]
| Stains/IHC ?
| Stains/IHC ?
| DDx ?
| DDx ?
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| may be seen in [[Fabry disease]]
| may be seen in [[Fabry disease]]
| Stains/IHC ?
| Stains/IHC ?
| DDx ?
| [[venous lake]]
| Other ?
| Other ?
| [http://commons.wikimedia.org/wiki/File:Angiokeratoma_-_low_mag.jpg (WC)]
| [[Image:Angiokeratoma_-_low_mag.jpg |thumb|center|150px| Angiokeratoma (WC)]]
|- <!--
|- <!--
| Entity
| Entity
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| [[squamous cell carcinoma of the skin|squamous cell carcinoma]]
| [[squamous cell carcinoma of the skin|squamous cell carcinoma]]
| mutations of CTNNB1 gene
| mutations of CTNNB1 gene
| [http://commons.wikimedia.org/wiki/File:Pilomatrixoma_-_intermed_mag.jpg (WC)]
| [[Image:Pilomatrixoma_-_intermed_mag.jpg |thumb|center|150px| Pilomatrixcoma (WC)]]
|-  
|-  
| [[Juvenile xanthogranuloma]] (JXG)
| [[Juvenile xanthogranuloma]] (JXG)
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| [[Langerhans cell histiocytosis]]
| [[Langerhans cell histiocytosis]]
| may be seen in adults, known as '''adult xanthogranuloma'''
| may be seen in adults, known as '''adult xanthogranuloma'''
| [http://commons.wikimedia.org/wiki/File:Juvenile_xanthogranuloma_-_intermed_mag.jpg (WC)]  
| [[Image:Juvenile_xanthogranuloma_-_high_mag.jpg |thumb|center|150px| JXG (WC)]]  
|}
|}


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| [[pilar cyst]], [[dermoid cyst]]
| [[pilar cyst]], [[dermoid cyst]]
| Other?
| Other?
| [http://missinglink.ucsf.edu/lm/DermatologyGlossary/img/Dermatology%20Glossary/Glossary%20Histo%20Images/epidermal_follicular_cyst.jpg (ucsf.edu)]  
| [[Image:Epidermal inclusion cyst -- high mag.jpg |thumb|center|150px| Epidermal inclusion cyst (WC)]]
|-  
|-  
| [[Pilar cyst]]
| [[Pilar cyst]] (trichilemmal cyst)
| cyst lined by squamous epithelium '''without''' a granular layer
| cyst lined by squamous epithelium '''without''' a granular layer
| keratinous debris
| keratinous debris
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| [[epidermal cyst]]
| [[epidermal cyst]]
| Other?
| Other?
| [http://commons.wikimedia.org/wiki/File:Trichilemmal_cyst_-_intermed_mag.jpg (WC)]
| [[Image:Trichilemmal_cyst_-_very_high_mag.jpg |thumb|center|100px| Pilar cyst (WC)]]
|-  
|-  
| [[Steatocystoma]]
| [[Steatocystoma]]
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| [[dermoid cyst]], follicular cyst
| [[dermoid cyst]], follicular cyst
| Other?
| Other?
| [http://commons.wikimedia.org/wiki/File:Steatocystoma_-_high_mag.jpg (WC)]
| [[Image:Steatocystoma_-_high_mag.jpg |thumb|center|150px| Steatocystoma (WC)]]
|-  
|-  
| [[Dermoid cyst]]
| [[Dermoid cyst]]
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| [[Actinic keratosis]]
| [[Actinic keratosis]]
| epidermal atypia, esp. (basal) nuclear enlargement
| epidermal atypia, esp. (basal) nuclear enlargement
| var. of size, shape and staining
| var. of nuclear size, shape and staining, parakeratosis (important in early lesions); does ''not'' involves adnexal epithelium and follicular epithelium
| yellow-brown scaly
| yellow-brown scaly
| none
| none
| [[squamous carcinoma]], [[Bowen disease]]
| [[squamous carcinoma]], [[Bowen disease]]
| seen with [[solar elastosis]]
| seen with [[solar elastosis]]
| [http://commons.wikimedia.org/wiki/File:Actinic_Keratosis,_H%26E.jpg (WC)]
| [[Image:Actinic_Keratosis,_H%26E.jpg |thumb|center|150px| AK (WC)]]
|-
|-
| [[Bowen disease]] (squamous cell carcinoma in situ)
| [[Bowen disease]] (squamous cell carcinoma in situ)
| epidermal atypia, esp. suprabasal nuclear enlargement
| epidermal atypia, esp. suprabasal nuclear enlargement
| var. of size, shape and staining
| var. of nuclear size, shape and staining; usually full thickness involvement; involve adnexal epithelium and follicular epithelium
|  
|  
| none
| none
| [[squamous carcinoma]], [[actinic keratosis]]
| [[squamous carcinoma]], [[actinic keratosis]]
| typically seen with solar elastosis
| typically seen with solar elastosis
| [http://commons.wikimedia.org/wiki/File:Bowen_disease_%281%29.jpg (WC)]
| [[Image:Bowen_disease_%281%29.jpg |thumb|center|100px| Bowen's disease (WC)]]
|}
|}


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| [[myxoid]] stroma
| [[myxoid]] stroma
| raised, pearly, telangiectasia
| raised, pearly, telangiectasia
| usu. none req., CK5/6+
| usu. none req., [[CK5/6]]+
| [[trichoepithelioma]], [[basaloid squamous cell carcinoma]]
| [[trichoepithelioma]], [[basaloid squamous cell carcinoma]]
| assoc. [[nevoid basal cell carcinoma syndrome]], [[Bazex syndrome]]
| assoc. [[nevoid basal cell carcinoma syndrome]], [[Bazex syndrome]]
| [http://missinglink.ucsf.edu/lm/DermatologyGlossary/img/Dermatology%20Glossary/Glossary%20Histo%20Images/basal_cell_carcinoma_high_power.jpg (ucsf.edu)]   
| [[Image:Basal cell carcinoma - high mag.jpg| thumb| center|150px|BCC (WC)]]   
|-  
|-  
| [[Squamous cell carcinoma]] (SCC)
| [[Squamous cell carcinoma]] (SCC)
Line 593: Line 614:
| [[keratoacanthoma]], [[Paget disease]] ([[EMPD]] & [[PDB]]), [[malignant melanoma]], Toker cell hyperplasia  
| [[keratoacanthoma]], [[Paget disease]] ([[EMPD]] & [[PDB]]), [[malignant melanoma]], Toker cell hyperplasia  
| Other
| Other
| [http://en.wikipedia.org/wiki/File:Oral_cancer_%281%29_squamous_cell_carcinoma_histopathology.jpg (WC)]  
| [[Image:Oral_cancer_%281%29_squamous_cell_carcinoma_histopathology.jpg|thumb|center|150px|SCC (WC)]]  
|-
|-
| [[Malignant melanoma]]
| [[Malignant melanoma]]
Line 602: Line 623:
| [[melanocytic lesions]] esp. [[Spitz nevus]], [[Bowen's disease]]
| [[melanocytic lesions]] esp. [[Spitz nevus]], [[Bowen's disease]]
| may be familial, [[dysplastic nevus]]
| may be familial, [[dysplastic nevus]]
| [http://en.wikipedia.org/wiki/File:Malignant_melanoma_%281%29_at_thigh_Case_01.jpg (WC)]  
| [[Image:Malignant_melanoma_%281%29_at_thigh_Case_01.jpg |thumb|center|150px|Melanoma (WC)]]  
|- <!--
|- <!--
| Entity
| Entity
Line 632: Line 653:
| [[Masson's hemangioma]], [[angiosarcoma]], [[Kaposiform hemangioendothelioma]]
| [[Masson's hemangioma]], [[angiosarcoma]], [[Kaposiform hemangioendothelioma]]
| stages: patch stage, plaque stage, nodular stage, exophytic, infiltrative, lymphadenopathic  
| stages: patch stage, plaque stage, nodular stage, exophytic, infiltrative, lymphadenopathic  
| [http://commons.wikimedia.org/wiki/File:Kaposi_sarcoma_low_intermed_mag.jpg (WC)]  
| [[Image:Kaposi_sarcoma_low_intermed_mag.jpg |thumb|center|150px| Kaposi sarcoma (WC)]]  
|-  
|-  
| [[Cutaneous T-cell lymphoma]] (includes ''mycosis fungoides'')
| [[Cutaneous T-cell lymphoma]] (includes ''mycosis fungoides'')
Line 641: Line 662:
| B cell lymphoma (?)
| B cell lymphoma (?)
| Other
| Other
| [http://commons.wikimedia.org/wiki/File:Cutaneous_T-cell_lymphoma_-_intermed_mag.jpg (WC)]
| [[Image:Cutaneous_T-cell_lymphoma_-_intermed_mag.jpg |thumb|center|150px| CTCL (WC)]]
|-  
|-  
| [[Atypical fibroxanthoma]]
| [[Atypical fibroxanthoma]]
Line 650: Line 671:
| sarcomatoid squamous carcinoma, [[melanoma]], [[leiomyosarcoma]]
| sarcomatoid squamous carcinoma, [[melanoma]], [[leiomyosarcoma]]
| some classify this as '''benign'''; thought to be related to [[undifferentiated pleomorphic sarcoma]]
| some classify this as '''benign'''; thought to be related to [[undifferentiated pleomorphic sarcoma]]
| [http://dermatology.cdlib.org/141/case_reports/afx/1.jpg (cdlib.org)]<ref name=pmid18319023>{{Cite journal  | last1 = Vandergriff | first1 = TW. | last2 = Reed | first2 = JA. | last3 = Orengo | first3 = IF. | title = An unusual presentation of atypical fibroxanthoma. | journal = Dermatol Online J | volume = 14 | issue = 1 | pages = 6 | month =  | year = 2008 | doi =  | PMID = 18319023 }}</ref>
| [[Image:SkinTumors-P9280874.jpg|thumb|center|150px| AFX (WC)]]
|-  
|-  
| [[Merkel cell carcinoma]]
| [[Merkel cell carcinoma]]
Line 659: Line 680:
| cutaneous [[Ewing sarcoma]], [[basal cell carcinoma]], (dermal) [[lymphoma]], metastatic small cell carcinoma (e.g. [[Lung tumours#Small cell carcinoma|lung]])
| cutaneous [[Ewing sarcoma]], [[basal cell carcinoma]], (dermal) [[lymphoma]], metastatic small cell carcinoma (e.g. [[Lung tumours#Small cell carcinoma|lung]])
| rare, aggressive
| rare, aggressive
| [http://www.bccancer.bc.ca/HPI/CE/cytotechnology/cytosleuthquiz/nongyne/ng12hist.htm (bccancer.bc.ca)], [http://commons.wikimedia.org/wiki/File:Merkel_cell_carcinoma_-_high_mag.jpg (WC)]  
| [[Image:Merkel_cell_carcinoma_-_very_high_mag.jpg |thumb|center|100px| MCC (WC)]]  
|-  
|-  
| [[Dermatofibrosarcoma protuberans]] (DFSP)
| [[Dermatofibrosarcoma protuberans]] (DFSP)
Line 668: Line 689:
| [[dermatofibroma]], [[solitary fibrous tumour]] (usu. deeper)
| [[dermatofibroma]], [[solitary fibrous tumour]] (usu. deeper)
| rarely metastases, characteristic [[translocation]]: t(17;22)(q22;q15) COLA1/PDGFB; may transform to [[fibrosarcoma]]
| rarely metastases, characteristic [[translocation]]: t(17;22)(q22;q15) COLA1/PDGFB; may transform to [[fibrosarcoma]]
| [http://commons.wikimedia.org/wiki/File:Storiform_pattern_-_intermed_mag.jpg (WC)]  
| [[Image:Storiform_pattern_-_intermed_mag.jpg |thumb|center|150px| DFSP (WC)]]  
|- <!--
|- <!--
| Entity
| Entity
Line 705: Line 726:
! Image
! Image
|-
|-
| Acanthosis nigricans
| [[Acanthosis nigricans]]
| [[diabetes mellitus]], malignancy
| [[diabetes mellitus]], malignancy
| basal cell hyperpigmentation, hyperkeratosis, prominent rete ridges
| basal cell hyperpigmentation, hyperkeratosis, prominent rete ridges
Line 747: Line 768:


==Acanthosis nigricans==
==Acanthosis nigricans==
Associated with: [[diabetes mellitus]],<ref>URL: [http://www.emedicine.com/derm/topic1.htm http://www.emedicine.com/derm/topic1.htm], URL: [http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=1943559504].</ref> malignancy.<ref name=Ref_PCPBoD8|596>{{Ref PCPBoD8|596}}</ref>
===General===
Associated with:  
*[[Diabetes mellitus]].<ref>URL: [http://www.emedicine.com/derm/topic1.htm http://www.emedicine.com/derm/topic1.htm], URL: [http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=1943559504].</ref>  
*Malignancy.<ref name=Ref_PCPBoD8|596>{{Ref PCPBoD8|596}}</ref>


===Microscopic===
===Microscopic===
Line 754: Line 778:
*Prominent rete ridges.
*Prominent rete ridges.
*Hyperkeratosis.
*Hyperkeratosis.
DDx:
*[[Seborrheic keratosis]] - typically has more hyperkeratosis, pseudohorn cysts.


Images:
Images:
Line 761: Line 788:
*[[Dermatitis herpetiformis]]: gluten enteropathy ([[celiac disease]]), [[thyroid]] disease, intestinal [[lymphoma]].<ref name=Ref_TN2007_D23>{{Ref TN2007|D23}}</ref>
*[[Dermatitis herpetiformis]]: gluten enteropathy ([[celiac disease]]), [[thyroid]] disease, intestinal [[lymphoma]].<ref name=Ref_TN2007_D23>{{Ref TN2007|D23}}</ref>
*[[Pemphigus vulgaris]]: [[thymoma]], myasthenia gravis, malignancy.<ref name=Ref_TN2007_D23>{{Ref TN2007|D23}}</ref>
*[[Pemphigus vulgaris]]: [[thymoma]], myasthenia gravis, malignancy.<ref name=Ref_TN2007_D23>{{Ref TN2007|D23}}</ref>
===Lipoid proteinosis===
<gallery>
File:3767 dp sl 1.png |Lipoid proteinosis (A)
File:3767 dp sl 2.png |Lipoid proteinosis (B)
</gallery>
A. Inner labial biopsy shows subepithelial hyalinized pink/red material, about blood vessels and in general.  B. The particularly glassy appearance of the material in areas is evident at high power.
===Xanthogranuloma in scrotal skin.===
<gallery>
File:DP16MR17 sl 1.png| Xanthogranuloma in scrotal skin. (A)
File:DP16MR17 sl 2.png| Xanthogranuloma in scrotal skin. (B)
File:DP16MR17 sl 3.png| Xanthogranuloma in scrotal skin. (C)
File:DP16MR17 sl 4.png| Xanthogranuloma in scrotal skin. (D)
</gallery>
A. Pseudoepitheliomatous hyperplasia seemingly forms a dermal mass. B. Parakeratosis tops epidermis. C. Neutrophils lie in the center of the apparent mass. D. Diagnostic xanthoma cells lie in dermal papillae.
===Silicone granuloma===
<gallery>
File:DP13AP17 sl1.png| Silicone granuloma (A)
File:DP13AP17 sl2.png| Silicone granuloma (B)
File:DP13AP17 sl3.png| Silicone granuloma (C)
File:DP13AP17 sl4.png| Silicone granuloma (D)
</gallery>
A. The dermis resembles Swiss cheese. B. Macrophages, some with more than one nucleus, accompany empty ovoid spaces. C. Some macrophages resemble Teuton body giant cells. D. An admixture of lymphocytes is not at all unusual.
====Histoplasmosis in skin====
<gallery>
File:DP20AP17 sl 1.png| Dermal histoplasmosis (A)
File:DP20AP17 sl 2.png| Dermal histoplasmosis (B)
File:DP20AP17 sl 3.png| Dermal histoplasmosis (C)
File:DP20AP17 sl 4.png| Dermal histoplasmosis (D)
</gallery>
A. Extending from papillary dermis into dermis is a chronic, blue inflammatory infiltrate. B. The infiltrate comprises lymphocytes, plasma cells, and macrophages. C. At the edge of the biopsy pink strews inflammatory cells; this pink invasion of inflammation, so to speak, is a good place to look for organisms.  D. High power reveals sometimes budding yeast forms in clear spaces.
===Herpes Zoster===
<gallery>
File:5.049889044 sl 1.png| Changes of herpes zoster (A)
File:5.049889044 sl 2.png| Changes of herpes zoster (B)
File:5.049889044 sl 3.png| Changes of herpes zoster (C)
File:5.049889044 sl 4.png| Changes of herpes zoster (D)
</gallery>
Changes of herpes zoster in lower right abdominal skin of a 48 yo Hispanic man. A. Note the edema at the dermoepidermal junction along with a focal separation at the left as well as the inflamed superficial and deep blood vessels. B,C. Careful examination along the junction uncovers smudged chromatin diagnostic of viral infection. D. Vasculitis associated changes include extravasated neutrophils with nuclear dust, as well as pervascular macrophages, lymphocytes and occasional eosinophils.


=References=
=References=
Alessandro
14

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