Difference between revisions of "Non-malignant skin disease"

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==Lichen planus==
==Lichen planus==
*Oral pathology.
===General===
*An oral pathology.
*May be seen where the sun don't shine - penile,<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>


===Microscopy===
===Microscopy===
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Ref.: [http://emedicine.medscape.com/article/1078327-overview http://emedicine.medscape.com/article/1078327-overview].
Ref.: [http://emedicine.medscape.com/article/1078327-overview http://emedicine.medscape.com/article/1078327-overview].
Images:
*[http://commons.wikimedia.org/wiki/File:Lichen_planus_intermed_mag.jpg Lichen planus - intermed. mag. (WC)]
*[http://commons.wikimedia.org/wiki/File:Lichen_planus_low_mag.jpg Lichen planus - low mag. (WC)].


==Lichen sclerosus==  
==Lichen sclerosus==  

Revision as of 00:53, 7 June 2010

Non-malignant skin disease is relatively common. The pathology may or may not be specific. Some diseases require clinical information to diagnose.

General classification (Inflammatory)

  • Bullous.
  • Interface.
  • Nodular & diffuse.
  • Spongiotic.
  • Vasculitis.
  • Perivascular.
  • Panniculitis.
  • Psoriasiform.

Tabular comparison of inflammatory skin disease (adapted from Brister[1]):

Pattern Key histologic feature Subclassifications Example
Bullous "Empty space" -Subcorneal
-Suprabasillar
-Subepidermal
-?
-?
-?
Interface Inflammation at DE junction -Vacuolar (minimal)
-Lichenoid (band-like)
-Erythema multiforme
-Lichen simplex chronicus (LSC)
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 SC tissue -Septal
-Nodular
Psoriasiform Epidermal thickening
and long rete ridges
-Regular
-Irregular

Notes:

  • DE junction = dermal-epidermal junction.
  • The "empty space" in bullous disease in situ is filled with fluid.

Lichen planus

General

  • An oral pathology.
  • May be seen where the sun don't shine - penile,[2], vulva and vagina.[3]

Microscopy

Features:

  • Loss of rete ridges.
  • Loss of basal cells (stratum basale).
  • Interface dermatitis (lymphocytes at dermal-epidermal junction).

Ref.: http://emedicine.medscape.com/article/1078327-overview.

Images:

Lichen sclerosus

  • AKA chronic atrophic vulvitis (when vulvar lesion).

Etiology

  • Scratching due to pruritis.

Histology

Key feature:[4]

  • Subepithelial fibrosis.

Lichen simplex chronicus

Histology

Key features:[5]

  • Acanthosis (epithelial thickening).
  • Hyperkeratosis.

Seborrheic keratosis

General

  • Benign.
  • Common.

Epidemiology

  • Old people.

Gross

  • "Stuck-on" appearance - raised lesion.

Image(s):

Microscopic

Features:

  • Normal appearing epidermis - raised above skin surface.
  • "Horn cysts" - collections of keratin.

Image(s):

Molluscum contagiosum

  • 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.[6]
  • Molluscum bodies:
    • Large cells with abundant granular eosinophilic cytoplasm.
    • Small peripheral nucleus.

Image(s):

Note:

  • Molluscum bodies 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.

Dermal nevus

  • Think melanoma.

Clinical: ABCD = asymmetric, borders (irregular), colour (black), diameter (large).

Microscopic

Features:[7]

  • Symmetrical lesion.
  • "Matures" with depth - less cellular, less atypia.
  • No destruction of surrounding structures.
  • Only in dermis key feature.
    • Otherwise it is something else, e.g. dermal nevus, junctional nevus.

Microscopic

  • Basaloid cells mixed with squamous cells.
  • Keratin-filled invaginations.
  • Horn cysts - intraepidermal, brown globule-like structures.
    • Melanocytes at the dermoepidermal junction.[8]

Pilomatrixoma

General

  • Benign skin tumour.
  • Most common solid skin tumour of children.[9]

Clinical:

  • Hard nodule - calcification.
  • +/-Painful. (???)

Treatment:

  • Surgical excision.[9]

Microscopic

Features:[10]

  • Location: lower dermis/subcutaneous fat; thus, usu. surrounded by connective tissue.
  • Sharpy demarcated island of cells.
  • Calcification in 75% - with calcium staining (von Kossa).
  • Cells:[11]
    • 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:

DDx:

  • Epidermal inclusion cyst.

Syringoma

  • Benign sweat duct tumour. (???)
  • Eccrine differentiation.

Microscopic

Features:[12]

  • Proliferation of benign ducts with lined by a bilayer (as in normal sweat ducts) with abnormal architecture:
    • Tadpole like appearing ducts.

Image:

Inverted follicular keratosis

  • Benign skin lesion.
  • Rare.
  • May mimic squamous cell carcinoma or basal cell carcinoma.[13]

Images:

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.

Images:

Keratoacanthoma

  • Abbreviated KA.
  • Generally considered to be benign.
    • Rare reports of metastases suggesting it may be a form of squamous cell carcinoma.[14]

Clinical

  • May grow rapidly (weeks or months) then involute.
  • Main DDx is squamous cell carcinoma.
  • Exophytic lesion, well-circumscribed.

Microscopic

Features:[15]

  • 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:

Bullous disease

Cysts

See also

References

  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.
  2. Teichman, JM.; Sea, J.; Thompson, IM.; Elston, DM. (Jan 2010). "Noninfectious penile lesions.". Am Fam Physician 81 (2): 167-74. PMID 20082512.
  3. 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.
  4. PBoD P.1065-6
  5. PBoD P.1065-6
  6. http://www.missionforvisionusa.org/anatomy/2006/08/what-is-molluscum-contagiosum.html
  7. need ref
  8. http://emedicine.medscape.com/article/1059477-overview
  9. 9.0 9.1 http://emedicine.medscape.com/article/1058965-overview
  10. http://emedicine.medscape.com/article/1058965-diagnosis
  11. http://www.bccancer.bc.ca/HPI/CE/cytotechnology/cytosleuthquiz/nongyne/ngcase02d.htm
  12. URL: http://emedicine.medscape.com/article/1059871-diagnosis. Accessed on: 12 May 2010.
  13. URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC475744/. Accessed on: 11 May 2010.
  14. Mandrell JC, Santa Cruz D (August 2009). "Keratoacanthoma: hyperplasia, benign neoplasm, or a type of squamous cell carcinoma?". Semin Diagn Pathol 26 (3): 150–63. PMID 20043514.
  15. Klatt. AOP. P. 378.