Difference between revisions of "Non-malignant skin disease"

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Non-malignant skin disease (view source)

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'''Non-malignant skin disease''' is relatively common.  The pathology may or may not be specific.  Some diseases require clinical information to diagnose.
'''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]]''.
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]]''.
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*[[Exocytosis]] - blood cell infiltrate the epidermis.
*[[Exocytosis]] - blood cell infiltrate the epidermis.


Images:
====Images====
*[[WC]]:
<gallery>
**[http://commons.wikimedia.org/wiki/File:Dermatomycosis_-_intermed_mag.jpg Dermatomycosis - intermed. mag. (WC)].
Image:Dermatomycosis_-_intermed_mag.jpg | Dermatomycosis - intermed. mag. (WC)
**[http://commons.wikimedia.org/wiki/File:Dermatomycosis_-_high_mag.jpg Dermatomycosis - high mag. (WC)].
Image:Dermatomycosis_-_high_mag.jpg | Dermatomycosis - high mag. (WC)
**[http://commons.wikimedia.org/wiki/File:Dermatomycosis_-_gms_-_low_mag.jpg Dermatomycosis - GMS stain - low mag. (WC)].
Image:Dermatomycosis_-_gms_-_low_mag.jpg | Dermatomycosis - GMS stain - low mag. (WC)
**[http://commons.wikimedia.org/wiki/File:Dermatomycosis_-_gms_-_high_mag.jpg Dermatomycosis - GMS stain - high mag. (WC)].
Image:Dermatomycosis_-_gms_-_high_mag.jpg | Dermatomycosis - GMS stain - high mag. (WC)
*www:
</gallery>
**[http://missinglink.ucsf.edu/lm/DermatologyGlossary/img/Dermatology%20Glossary/Glossary%20Histo%20Images/tinea_pas.jpg Dermatophytosis (ucsf.edu)].<ref>URL: [http://missinglink.ucsf.edu/lm/DermatologyGlossary/tinea.html http://missinglink.ucsf.edu/lm/DermatologyGlossary/tinea.html]. Accessed on: 25 February 2013.</ref>
www:
*[http://missinglink.ucsf.edu/lm/DermatologyGlossary/img/Dermatology%20Glossary/Glossary%20Histo%20Images/tinea_pas.jpg Dermatophytosis (ucsf.edu)].<ref>URL: [http://missinglink.ucsf.edu/lm/DermatologyGlossary/tinea.html http://missinglink.ucsf.edu/lm/DermatologyGlossary/tinea.html]. Accessed on: 25 February 2013.</ref>


===Stains===
===Stains===
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==Fibroepithelial polyp==
==Fibroepithelial polyp==
*[[AKA]] ''acrochordon''.
{{Main|Fibroepithelial polyp}}
*[[AKA]] ''skin tag''.
===General===
*Benign.
*Older people.
*May be associated with pregnancy, [[diabetes]], [[intestinal polyposis]].<ref name=Ref_PCPBoD8|596>{{Ref PCPBoD8|596}}</ref>
*Can be a component of ''[[Birt–Hogg–Dubé syndrome]]''.
 
===Gross===
*Raised skin-coloured lesion.
 
Image:
*[http://commons.wikimedia.org/wiki/File:Skintagblemish.jpg Skin tag (WC)].
 
===Microscopic===
Features:
*On a stalk / epithelium on three sides.
*Benign epidermis.
 
DDx:
*Pedunculated [[seborrheic keratosis]] - typically have epidermal hyperplasia, hyperkeratosis, horn cysts.<ref name=Ref_Derm342>{{Ref Derm|342}}</ref>
*Regressing [[melanocytic lesions]].
**[[Intradermal melanocytic nevus]].
*[[Nevus lipomatosus superficialis]] - abundant adipocytes in the superficial dermis.
*[[Neurofibroma]].
 
====Images====
<gallery>
Image:SkinTumors-P9250819.jpg | Skin tag. (WC)
</gallery>
www:
*[http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=1767547949 Fibroepithelial polyp (dermatlas.med.jhmi.edu)].<ref>URL: [http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=1196583692 http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=1196583692]. Accessed on: 1 September 2011.</ref>
*[http://www.surgicalpathologyatlas.com/glfusion/mediagallery/media.php?f=0&sort=0&s=20080802171929218 Fibroepithelial polyp (surgicalpathologyatlas.com)].
*[http://dermatology-s10.cdlib.org/143/case_presentations/skintags/3.jpg Inflamed fibroepithelial polyp (cdlib.org)].<ref>URL: [http://dermatology-s10.cdlib.org/143/case_presentations/skintags/allegue.html http://dermatology-s10.cdlib.org/143/case_presentations/skintags/allegue.html]. Accessed on: 9 January 2013.</ref>
===Sign out===
<pre>
EYELID ("TAG"), RIGHT, REMOVAL:
- BENIGN FIBROEPITHELIAL POLYP.
</pre>
<pre>
SKIN ("SKIN TAG"), THIGH, REMOVAL:
- FIBROEPITHELIAL POLYP.
</pre>
 
====Micro====
The sections show a fragment of skin with epithelium on three sides.  The epithelium matures normally and is not hypertrophic.  Orthokeratosis is present. The core of the lesion has fibrous tissue.  There is no significant inflammation. No melanocytic nests are identified.
 
=====Inflamed=====
The sections show a fragment of skin with epithelium on three sides. The epithelium matures
and is acanthotic. Minimal parakeratosis is present. The core of the lesion consists of
fibrous tissue with a mild lymphocyte-predominant dermal infiltrate.  Rare siderophages are
present.
 
There is mild basal nuclear enlargement.  No significant nuclear atypia is apparent. The
dermal-epidermal interface is well-demarcated. Rare basal mitotic activity is identified.


==Actinic keratosis==
==Actinic keratosis==
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Notes:
Notes:
*It differs from verruca vulgaris... (1) orthokeratosis, (2) flat surface and base.
*It differs from [[verruca vulgaris]]... (1) orthokeratosis, (2) flat surface and base.


Images:
====Images====
www:
*[http://www.fujita-hu.ac.jp/~tsutsumi/case/case180.htm Verruca plana - several images (fujita-hu.ac.jp)].
*[http://www.fujita-hu.ac.jp/~tsutsumi/case/case180.htm Verruca plana - several images (fujita-hu.ac.jp)].
*[http://bg.convdocs.org/pars_docs/refs/55/54881/54881_html_m70d4f7e5.jpg Verruca plana (convdocs.org)].<ref>URL: [http://bg.convdocs.org/docs/index-54881.html?page=10 http://bg.convdocs.org/docs/index-54881.html?page=10]. Accessed on: 9 October 2013.</ref>
*[http://www.dermatopathonline.com/verruca%20plana2.html Verruca plana - several good images (dermatopathonline.com)].
*[http://www.dermatopathonline.com/verruca%20plana2.html Verruca plana - several good images (dermatopathonline.com)].


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==Clear cell acanthoma==
==Clear cell acanthoma==
===General===
{{Main|Clear cell acanthoma}}
*Benign.
*Elderly.
*Classically on the leg.<ref name=pmid18583817>{{Cite journal  | last1 = Akin | first1 = FY. | last2 = Ertam | first2 = I. | last3 = Ceylan | first3 = C. | last4 = Kazandi | first4 = A. | last5 = Ozdemir | first5 = F. | title = Clear cell acanthoma: new observations on dermatoscopy. | journal = Indian J Dermatol Venereol Leprol | volume = 74 | issue = 3 | pages = 285-7 | month =  | year =  | doi =  | PMID = 18583817 | URL = http://www.ijdvl.com/text.asp?2008/74/3/285/41396 }}</ref>
*Rare.
*Clinically not distinct.
**Suspected clinically in only ~3% of cases.<ref name=pmid20931670>{{Cite journal  | last1 = Morrison | first1 = LK. | last2 = Duffey | first2 = M. | last3 = Janik | first3 = M. | last4 = Shamma | first4 = HN. | title = Clear cell acanthoma: a rare clinical diagnosis prior to biopsy. | journal = Int J Dermatol | volume = 49 | issue = 9 | pages = 1008-11 | month = Sep | year = 2010 | doi =  | PMID = 20931670 }}</ref>
 
===Microscopic===
Features:<ref>URL: [http://www.drmihm.com/cases/case.cfm?CaseID=45 http://www.drmihm.com/cases/case.cfm?CaseID=45]. Accessed on: 7 February 2012.</ref>
*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 [[neutrophil]]s.
 
DDx:
*[[Psoriasis vulgaris]].
 
Images:
*[http://www.drmihm.com/cases/casefigure.cfm?figID=906&CaseID=45 CCA (drmihm.com)].
*[http://www.dermatlas.com/derm/IndexDisplay.cfm?ImageID=-327718365 CCA - low mag. (dermatlas.com)].
*[http://www.dermatlas.com/derm/IndexDisplay.cfm?ImageID=546460717 CCA - high mag. (dermatlas.com)].


==Chondrodermatitis nodularis chronica helicis==
==Chondrodermatitis nodularis chronica helicis==
*[[AKA]] ''chondrodermatitis nodularis helicis''.
*[[AKA]] ''chondrodermatitis nodularis helicis''.
*Abbreviated ''CNCH''.
*Abbreviated ''CNCH''.
===General===
*[[AKA]] ''Winkler disease''.<ref>URL: [http://www.head-face-med.com/content/4/1/2 http://www.head-face-med.com/content/4/1/2]. Accessed on: 16 January 2014.</ref>
*Tender/painful - '''key clinical feature'''.
{{Main|Chondrodermatitis nodularis chronica helicis}}
*Typically right [[ear]] - people more often sleep on this one.<ref name=pmid17879469>{{Cite journal  | last1 = Devani | first1 = A. | last2 = Barankin | first2 = B. | title = Dermacase. Chondrodermatitis nodularis  chronica helicis. | journal = Can Fam Physician | volume = 53 | issue = 5 | pages = 821, 837 | month = May | year = 2007 | doi =  | PMID = 17879469 }}</ref>
*Usually >40 years old.
 
Etiology:
*Trauma/mechanical.
 
===Gross===
*[[Papule]] on ear.
*+/-Erythematous.
*+/-Crust.
 
Clinical DDx:<ref name=pmid17879469/>
*[[BCC]].
*[[SCC]].
 
Images:
*[http://commons.wikimedia.org/wiki/File:Chondrodermatitis.jpg CNCH (WC)].
*[http://www.dermnetnz.org/lesions/chondrodermatitis.html CNCH (dermnetnz.org)].
 
===Microscopic===
Features:<ref name=pmid17879469/>
*Dermal inflammation.
*Epithelial hyperlasia.
*Fibrosis.
*Cartilaginous pathology:
**Perichondrial inflammation  - '''key feature'''.
**Perichondrial disruption.
**+/-Necrosis.
**+/-Hemorrhage.
 
Images:
*[http://www.dermpedia.org/case/chondrodermatitis-nodularis-chronica-helicis CNCH (dermpedia.org)].
*[http://www.surgicalpathologyatlas.com/glfusion/mediagallery/media.php?s=20080802171837514 CNCH (surgicalpathologyatlas.com)].
*[http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=2140701395 CNCH (dermatlas.med.jhmi.edu)].
 
===Sign out===
====Superficial biopsy====
<pre>
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.
</pre>


==Cutaneous calcinosis==
==Cutaneous calcinosis==
*[[AKA]] ''calcinosis cutis''.
*[[AKA]] ''calcinosis cutis''.
===General===
{{Main|Cutaneous calcinosis}}
*Benign in itself; underlying cause may not be benign.
*May be a [[scrotum|scrotal]] lesion - known as ''scrotal calcinosis''.<ref name=pmid20178701>{{Cite journal  | last1 = Dubey | first1 = S. | last2 = Sharma | first2 = R. | last3 = Maheshwari | first3 = V. | title = Scrotal calcinosis: idiopathic or dystrophic? | journal = Dermatol Online J | volume = 16 | issue = 2 | pages = 5 | month =  | year = 2010 | doi =  | PMID = 20178701 }}</ref>
 
Subtypes:<ref name=emed>URL: [http://emedicine.medscape.com/article/1103137-overview http://emedicine.medscape.com/article/1103137-overview]. Accessed on: 21 September 2011.</ref>
#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).
***+/-Greyish rim of paucicellular material.
**Usu. well-circumscribed.
***May be surrounded by a palisading granuloma & [[giant cell]]s.
 
Images:
*[http://www.dermatopathonline.com/calcinosis%20cutis2.html Calcinosis cutis (dermatopathonline.com)].
 
===Sign out===
<pre>
SKIN AND SUBCUTANEOUS LESION, LEFT HIP, EXCISION:
- SUBCUTANEOUS CALCIFICATION SURROUNDED BY BENIGN FIBROUS TISSUE.
- DERMAL SCAR.
- NEGATIVE FOR MALIGNANCY.
</pre>
 
<pre>
SUBCUTANEOUS MASS, OVER BURSA OF ELBOW, EXCISION:
- CALCINOSIS CUTIS.
</pre>
 
====Micro====
The sections show subcutaneous calcifications surrounded by macrophages and giant cells. No nuclear atypia is apparent. The overlying skin is unremarkable.


==Dilated pore of Winer==
==Dilated pore of Winer==
===General===
===General===
*Benign.
*Benign.
*Looks like zit.
*Looks like a zit.


===Microscopic===
===Microscopic===
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*[[Acanthosis]].
*[[Acanthosis]].
*Budding of epidermis (into dermis).
*Budding of epidermis (into dermis).
==Lichenoid keratosis==
*[[AKA]] ''lichen planus-like keratosis''.
*[[AKA]] ''lichenoid keratosis''.
===General===
*Caucasians - middle age or older.
*May be a variant of [[seborrheic keratosis]] (with marked inflammation).<ref name=Ref_Derm346>{{Ref Derm|346}}</ref>
Clinical DDx:<ref name=Ref_Derm346>{{Ref Derm|346}}</ref>
*[[Basal cell carcinoma]], [[squamous cell carcinoma of the skin]], melanocytic neoplasm.
===Microscopic===
Features:<ref name=Ref_Derm347>{{Ref Derm|347}}</ref>
*Hyperkeratosis.
*Parakeratosis.
*Band of inflammatory cells at DE junction (lichenoid inflammation).
*Dead keratinocytes (Civatte bodies).
*Dermal melanophages.


DDx:
DDx:
*[[Lichen planus]] - need clinical correlation (mucosal lesions).
*[[Pilar sheath acanthoma]].
*[[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:
Image:
*[http://www.dermpathexpert.com/id57.html Lichenoid keratosis (dermpathexpert.com)].
*[http://dermpathexpert.com/id90.html Dilated pore of Winer (dermpathexpert.com)].


===Sign out===
==Lichenoid keratosis==
<pre>
*[[AKA]] ''lichen planus-like keratosis''.
SKIN LESION, MID-MIDDLE BACK, PUNCH BIOPSY:
{{Main|Lichenoid keratosis}}
- LICHENOID KERATOSIS.
</pre>


==Granuloma annulare==
==Granuloma annulare==
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==Necrobiosis lipoidica==
==Necrobiosis lipoidica==
===General===
{{Main|Necrobiosis lipoidica}}
Associated with:
*[[Diabetes mellitus]] - known as ''necrobiosis lipoidica diabeticorum''.
*[[Rheumatoid arthritis]].
 
===Gross===
 
Image:
<gallery>
Image:Necrobiosislipoidica.jpg | Necrobiosis lipoidica. (WC)
</gallery>
 
===Microscopic===
Features:<ref name=Ref_Derm51>{{Ref Derm|51}}</ref>
*Dermal palisading [[granuloma]] around:
**Necrotic collagen - '''key feature'''.
***Nuclei "missing" - have undergone karyolysis.
*Little mucin, no normal dermis between foci.
*Plasma cells - common.<ref name=dermnetnz_nl>URL: [http://dermnetnz.org/pathology/necrobiosis-lipoidica-path.html http://dermnetnz.org/pathology/necrobiosis-lipoidica-path.html]. Accessed on: 24 January 2012.</ref>
*May involve adipose tissue.
 
DDx:
*[[Granuloma annulare|Granuloma a'''nn'''ulare]] - '''m'''ore '''m'''ucin, normal dermis between foci,<ref name=Ref_Derm51>{{Ref Derm|51}}</ref> plasma cells uncommon,<ref name=dermnetnz_nl/> no fat involvement - usu. more superficial.
*[[Rheumatoid nodule]].
 
====Images====
<gallery>
Image:Necrobiosis_lipoidica_-_low_mag.jpg | Necrobiosis lipoidica - low mag. (WC)
</gallery>
www:
*[http://dermatology.cdlib.org/103/NYU/case_presentations/042004n10.html Necrobiosis lipoidica (dermatology.cdlib.org)].
*[http://www.drmihm.com/cases/case.cfm?CaseID=53 Necrobiosis lipoidica (drmihm.com)].
*[http://dermnetnz.org/pathology/necrobiosis-lipoidica-path.html Necrobiosis lipoidica (dermnetnz.org)].


==Keloid==
==Keloid==
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:See also: ''[[nasopharyngeal angiofibroma]]''.
:See also: ''[[nasopharyngeal angiofibroma]]''.
:Should '''not''' be confused with ''[[angiokeratoma]]''.
:Should '''not''' be confused with ''[[angiokeratoma]]''.
===General===
{{Main|Angiofibroma}}
*May be seen in the context of [[tuberous sclerosis]] - especially "butterfly area of the face".<ref name=Ref_WMSP492>{{Ref WMSP|492}}</ref>
*Solitary lesions in adults are known as ''[[fibrous papules]]'' and classically arise on the nose.<ref name=Ref_Derm505>{{Ref Derm|505}}</ref>
 
Clinical:
*Firm, dome-shaped, flesh coloured.
 
===Microscopic===
Features:<ref name=Ref_WMSP492>{{Ref WMSP|492}}</ref>
*Dome-shaped.
*Fibrotic dermis.
**Enlarged fibroblasts.
*Dilated small vessels.
 
DDx:
*[[Benign fibrous papule]] - solitary, nose lesion.
 
Image:
*[http://www.drdittmar.lu/images/sce/angiofibroma-s.jpg Angiofibroma (drdittmar.lu)].<ref>URL: [http://www.drdittmar.lu/Services.aspx http://www.drdittmar.lu/Services.aspx]. Accessed on: 1 September 2011.</ref>


==Benign fibrous papule==
==Benign fibrous papule==
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Note:
Note:
*Several variants exist.<ref name=pmid18032900>{{Cite journal  | last1 = Jacyk | first1 = WK. | last2 = Rütten | first2 = A. | last3 = Requena | first3 = L. | title = Fibrous papule of the face with granular cells. | journal = Dermatology | volume = 216 | issue = 1 | pages = 56-9 | month =  | year = 2008 | doi = 10.1159/000109359 | PMID = 18032900 }}</ref>
*Several variants exist.<ref name=pmid18032900>{{Cite journal  | last1 = Jacyk | first1 = WK. | last2 = Rütten | first2 = A. | last3 = Requena | first3 = L. | title = Fibrous papule of the face with granular cells. | journal = Dermatology | volume = 216 | issue = 1 | pages = 56-9 | month =  | year = 2008 | doi = 10.1159/000109359 | PMID = 18032900 }}</ref>
===Images===
*[http://www.dermaamin.com/site/histopathology-of-the-skin/58-f/1739-fibrous-papule-angiofibroma-.html Fibrous papule (dermaamin.com)].


===Sign out===
===Sign out===
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==Molluscum contagiosum==
==Molluscum contagiosum==
*Abbreviated ''MC''.
{{Main|Molluscum contagiosum}}
===General===
*Etiology: caused by ''molluscum contagiosum virus''.
*May be abundant in immune deficient individuals, e.g. [[HIV]]/AIDS.
 
===Gross===
Features:<ref name=Ref_Derm115>{{Ref Derm|115}}</ref>
*Dome-shaped papules, flesh coloured or pearly.
*Usually face or trunk.
*+/-Central umbilication.
**Central depression.
 
DDx - gross:
*[[Skin tag]].
 
Image:
*[http://commons.wikimedia.org/wiki/File:Molluscaklein.jpg Molluscum contagiosum (WC)].
 
===Microscopic===
Features:<ref name=Ref_Derm115>{{Ref Derm 115}}</ref>
*A suprabasilar epidermal lesion consisting of "molluscum bodies" -- in other words "molluscum bodies" are found above the stratum basale +/- extension to the skin surface.
**Molluscum bodies - '''key feature''':
***Large cells with (granular) eosinophilic cytoplasmic inclusions.
****The inclusions usually fill the cytoplasm.
****Inclusions are usually one per cell... but may be multiple.
***Small peripheral nucleus.
*+/-Lymphocytes.
 
Notes:
*Molluscum bodies very vaguely resemble ''[[signet ring cell]]s'' -- but:
**Cytoplasm is eosinophilic and granular.
**Nucleus usually smaller than in signet ring cells.
**''Molluscum bodies'' are only in the epidermis - an uncommon place to find SRCs without finding them elsewhere.
*The granular eosinophilic cytoplasmic inclusions represents accumulated virons.
*Molluscum bodies "grow" toward the surface
 
DDx:
*Nothing really - it is very distinctive.
 
Images:
*[http://commons.wikimedia.org/wiki/File:Molluscum_contagiosum_high_mag.jpg Molluscum contagiosum - high mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Molluscum_contagiosum_low_mag.jpg Molluscum contagiosum - low magnification (WC)].
*[http://commons.wikimedia.org/wiki/File:Molluscum_contagiosum_1.jpg Molluscum contagiosum (WC)].
 
===Sign out===
<pre>
SKIN LESION ("SKIN TAG"), EXCISION:
- MOLLUSCUM CONTAGIOSUM.
</pre>
 
====Micro====
The section shows fragments of skin with epithelium on three sides. Large suprabasilar cells with eosinophilic intracytoplasmic inclusions (molluscum bodies) and small eccentric nuclei are present, and extend to the skin surface. The epithelium is acanthotic; however, it matures to the surface. There is no significant inflammation.


==Superficial dermal infiltrates==
==Superficial dermal infiltrates==
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==Mastocytosis==
==Mastocytosis==
===General===
{{Main|Mastocytosis}}
*Abundance of [[mast cell]]s.
 
Classification:<ref name=pmid21083038>{{Cite journal  | last1 = Arock | first1 = M. | last2 = Valent | first2 = P. | title = Pathogenesis, classification and treatment of mastocytosis: state of the art in 2010 and future perspectives. | journal = Expert Rev Hematol | volume = 3 | issue = 4 | pages = 497-516 | month = Aug | year = 2010 | doi = 10.1586/ehm.10.42 | PMID = 21083038 }}</ref>
#Cutaneous (only) - usually children.
#*Urticaria pigmentosa.
#*Others.
#Systemic - usually adults.
#*Indolent subvariant.
#*Aggressive subvariant.
#*Leukemic subvariant.
 
===Microscopic===
Features:<ref name=Ref_PBoD8|1185>{{Ref PBoD8|1185}}</ref>
*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.
*+/-Eosinophils (common).
*+/-Edema - often prominent; gives cells a white halo.
 
Notes:
*Lymphocyte vs. mast cell:
**Lymphocytes = round; mast cells = ovoid.
 
Images:
*www:
**[http://www.jameswpattersonmd.com/case_studies/index.cfm?CFID=387434 Mastocytosis - low res. (jameswpattersonmd.com)].
**[http://path.upmc.edu/cases/case366.html Mastocytosis - bone marrow - several images (upmc.edu)].
*[[WC]]:
**[http://commons.wikimedia.org/wiki/File:Mastocytosis_-_high_mag.jpg Mastocytosis - high mag. (WC)].
**[http://commons.wikimedia.org/wiki/File:Mastocytosis_-_cropped_-_very_high_mag.jpg Mastocytosis - very high mag. (WC)].
**[http://path.upmc.edu/cases/case409.html Systemic mastocytosis - several images (upmc.edu)].
 
===Stains===
*[[Toluidine blue stain|Toluidine blue]] -- highlights the granules.
 
===IHC===
*CD117 +ve.
*Tryptase +ve.<ref name=pmid21866466>{{Cite journal  | last1 = Rudzki | first1 = Z. | last2 = Sotlar | first2 = K. | last3 = Kudela | first3 = A. | last4 = Starzak-Gwóźdź | first4 = J. | last5 = Horny | first5 = HP. | title = Systemic mastocytosis (SM) and associated malignant bone marrow histiocytosis - a hitherto undescribed form of SM-AHNMD. | journal = Pol J Pathol | volume = 62 | issue = 2 | pages = 101-4 | month =  | year = 2011 | doi =  | PMID = 21866466 }}
</ref>


==Ichthyosis==
==Ichthyosis==
Line 742: Line 420:


==Palmar fibromatosis==
==Palmar fibromatosis==
{{Main|Fibromatosis}}
*[[AKA]] ''Dupuytren's contracture''.
*[[AKA]] ''Dupuytren's contracture''.
*[[AKA]] ''Dupuytren disease''.
*[[AKA]] ''Dupuytren disease''.
===General===
{{Main|Palmar fibromatosis}}
Clinical:<ref>URL: [http://www.humpath.com/palmar-fibromatosis http://www.humpath.com/palmar-fibromatosis]. Accessed on: 6 January 2011.</ref>
*Usually older - 60s or 70s (years old).
*Male > female.
*Associated with:
**[[Alcohol abuse]].
*May be familial.
 
===Gross===
*Ring finger - classic location.{{fact}}
*Nodular.
*Poorly demarcated.
 
Image:
*[http://commons.wikimedia.org/wiki/File:Morbus_dupuytren_fcm.jpg Palmar fibromatosis (WC)].
 
===Microscopic===
Features:<ref>URL: [http://surgpathcriteria.stanford.edu/softfib/plantar_fibromatosis/printable.html http://surgpathcriteria.stanford.edu/softfib/plantar_fibromatosis/printable.html]. Accessed on: 6 January 2011.</ref><ref name=standford_pf_ddx>URL: [http://surgpathcriteria.stanford.edu/softfib/palmar_fibromatosis/differentialdiagnosis.html http://surgpathcriteria.stanford.edu/softfib/palmar_fibromatosis/differentialdiagnosis.html]. Accessed on: 9 November 2012.</ref>
*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:<ref name=standford_pf_ddx>URL: [http://surgpathcriteria.stanford.edu/softfib/palmar_fibromatosis/differentialdiagnosis.html http://surgpathcriteria.stanford.edu/softfib/palmar_fibromatosis/differentialdiagnosis.html]. Accessed on: 9 November 2012.</ref>
*[[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.
*[[metastasis|Metastatic]] metaplastic carcinoma, e.g. [[metaplastic breast carcinoma]] - extremely uncommon.
 
Images:
*[http://www.biomedsearch.com/attachments/display/00/16/69/68/16696857/1479-5876-4-21-2.jpg Palmer fibromatosis (biomedsearch.com)].<ref name=pmid16696857>{{cite journal |author=Wang L, Zhu H |title=Clonal analysis of palmar fibromatosis: a study whether palmar fibromatosis is a real tumor |journal=J Transl Med |volume=4 |issue= |pages=21 |year=2006 |pmid=16696857 |pmc=1488873 |doi=10.1186/1479-5876-4-21 |url=http://www.biomedsearch.com/nih/Clonal-analysis-palmar-fibromatosis-study/16696857.html}}</ref>
*[http://alf3.urz.unibas.ch/pathopic/e/getpic-fra.cfm?id=8235 Palmar fibromatosis (unibas.ch)].
*[http://commons.wikimedia.org/wiki/File:WVSOM_Pacinian_Corpuscle.JPG Pacinian corpuscle (WC)].
*[http://commons.wikimedia.org/wiki/File:Tendon_-_intermed_mag.jpg Tendon without fibromatosis - intermed. mag. (WC)].
 
===IHC===
*Beta-catenin +ve (cytoplasmic & nuclear).<ref name=pmid18958538>{{Cite journal  | last1 = Degreef | first1 = I. | last2 = De Smet | first2 = L. | last3 = Sciot | first3 = R. | last4 = Cassiman | first4 = JJ. | last5 = Tejpar | first5 = S. | title = Beta-catenin overexpression in Dupuytren's disease is unrelated to disease recurrence. | journal = Clin Orthop Relat Res | volume = 467 | issue = 3 | pages = 838-45 | month = Mar | year = 2009 | doi = 10.1007/s11999-008-0590-z | PMID = 18958538 }}</ref>
 
===Sign out===
====Left====
<pre>
PALMAR FASCIA, LEFT, FASCIECTOMY:
- PALMAR FIBROMATOSIS.
</pre>
 
====Right====
<pre>
PALMAR FASCIA, RIGHT, FASCIECTOMY:
- PALMAR FIBROMATOSIS.
</pre>
 
=====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====
<pre>
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.
</pre>
 
======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=====
<pre>
PALMAR FASCIA, RIGHT, FASCIECTOMY:
- PALMAR FASCIA WITHIN NORMAL LIMITS.
- NEGATIVE FOR FIBROMATOSIS.
 
COMMENT:
The tissue was submitted in toto and levels were cut.
</pre>
 
======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==
==Angiomyoma==
Line 849: Line 441:


==Angiokeratoma==
==Angiokeratoma==
===General===
{{Main|Angiokeratoma}}
*Rare.
*May be seen in the context of [[Fabry disease]].<ref name=pmid16403380/>
 
Notes:
*Shouldn't be confused with ''[[angiofibroma]]'' which is associated [[tuberous sclerosis]].
 
===Gross===
*Dark lesions.
 
Clinical DDx:
*[[Melanocytic lesions]].
====Images====
<gallery>
Image:Angiokeratoma_of_the_Scrotum_7.jpg | Angiokeratoma. (WC)
</gallery>
 
===Microscopic===
Features:<ref name=pmid16403380>{{Cite journal  | last1 = Karen | first1 = JK. | last2 = Hale | first2 = EK. | last3 = Ma | first3 = L. | title = Angiokeratoma corporis diffusum (Fabry disease). | journal = Dermatol Online J | volume = 11 | issue = 4 | pages = 8 | month =  | year = 2005 | doi =  | PMID = 16403380 }}</ref>
#Ectatic superficial dermal vessels.
#Overlying hyperkeratosis (thick stratum corneum).
*Should have "epidermal collarette".<ref name=Ref_Derm548>{{Ref Derm|548}}</ref>
**Vascular space surrounded by epidermis on three sides.
 
Others features:{{fact}}
*Irregular [[acanthosis]].
*Longer rete ridges.
 
DDx:
*[[Venous lake]].
 
====Images====
<gallery>
Image:Angiokeratoma_-_low_mag.jpg | Angiokeratoma - low mag. (WC/Nephron)
Image:Angiokeratoma_-_intermed_mag.jpg | Angiokeratoma - intermed. mag. (WC/Nephron)
</gallery>
www:
*[http://www.pathologyoutlines.com/images/skintumorangiokerat1.jpg Angiokeratoma (pathologyoutlines.com)].
 
===Sign out===
<pre>
SKIN LESION, LEFT POPITEAL FOSSA, PUNCH BIOPSY:
- ANGIOKERATOMA.
</pre>


==Inverted follicular keratosis==
==Inverted follicular keratosis==
Line 959: Line 508:
:'''''Not''' to be confused with [[nodular fasciitis]]''.
:'''''Not''' to be confused with [[nodular fasciitis]]''.
*[[AKA]] ''flesh-eating disease''.
*[[AKA]] ''flesh-eating disease''.
===General===
{{Main|Necrotizing fasciitis}}
*High mortality.
*May be diagnosed at [[frozen section]].<ref name=pmid9386043>{{Cite journal  | last1 = Majeski | first1 = J. | last2 = Majeski | first2 = E. | title = Necrotizing fasciitis: improved survival with early recognition by tissue biopsy and aggressive surgical treatment. | journal = South Med J | volume = 90 | issue = 11 | pages = 1065-8 | month = Nov | year = 1997 | doi =  | PMID = 9386043 }}</ref>
*Classically associated with ''Group A streptococcus''.
 
Treatment:
*Operative debridement.
 
===Microscopic===
Features:
*Necrosis of fascia - '''key feature'''.<ref name=pmid15735411>{{Cite journal  | last1 = Wong | first1 = CH. | last2 = Wang | first2 = YS. | title = The diagnosis of necrotizing fasciitis. | journal = Curr Opin Infect Dis | volume = 18 | issue = 2 | pages = 101-6 | month = Apr | year = 2005 | doi =  | PMID = 15735411 | URL = http://www.sepeap.org/archivos/pdf/9859.pdf }}</ref>
**[[PMN]]s and necrotic debris (amorphous grey or pink material).
 
Note:
*Fat lobules between septae may be normal.
 
DDx:
*[[Cellulitis]].
 
Images:
*[http://commons.wikimedia.org/wiki/File:Necrotizing_fasciitis_-_intermed_mag.jpg Necrotizing fasciitis - intermed. mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Necrotizing_fasciitis_-_high_mag.jpg Necrotizing fasciitis - high mag. (WC)].


==Porokeratosis==
==Porokeratosis==
===General===
{{Main|Porokeratosis}}
*Genetic.
*Several subtypes.
 
Notes:
*Not the same as ''punctate porokeratotic keratoderma''.<ref name=pmid20137755>{{Cite journal  | last1 = Alikhan | first1 = A. | last2 = Burns | first2 = T. | last3 = Zargari | first3 = O. | title = Punctate porokeratotic keratoderma. | journal = Dermatol Online J | volume = 16 | issue = 1 | pages = 13 | month =  | year = 2010 | doi =  | PMID = 20137755 | URL = http://dermatology.cdlib.org/1601/case_presentations/ppk/alikhan.html }}</ref>
 
===Microscopic===
Features:
*Cornoid lamella (pathognomonic) - '''key feature''':
**Compact keratosis over a hair follicle.
*+/-Rete ridge loss.
 
Images:
*[[WC]]:
**[http://commons.wikimedia.org/wiki/File:Porokeratosis_-_intermed_mag.jpg Porokeratosis - intermed. mag. (WC)].
**[http://commons.wikimedia.org/wiki/File:Porokeratosis_-_very_high_mag.jpg Porokeratosis - very high mag. (WC)].


==Nevus sebaceous==
==Nevus sebaceous==
*[[AKA]] ''nevus sebaceous of Jadassohn''.
*[[AKA]] ''nevus sebaceous of Jadassohn''.
===General===
{{Main|Nevus sebaceous}}
*Congenital - considered a [[hamartoma]].<ref name=pmid23217958/>
*Usually sporadic - may be transmitted autosomal dominant.<ref name=pmid23217958/>
*Malignant tumours may arise within a ''nevus sebaceous''.
===Gross===
Features:<ref name=pmid23217958>{{Cite journal  | last1 = West | first1 = C. | last2 = Narahari | first2 = S. | last3 = Kwatra | first3 = S. | last4 = Feldman | first4 = S. | title = Autosomal dominant transmission of nevus sebaceous of Jadassohn. | journal = Dermatol Online J | volume = 18 | issue = 11 | pages = 17 | month = Nov | year = 2012 | doi =  | PMID = 23217958 }}</ref><ref name=pmid19171988>{{Cite journal  | last1 = Simi | first1 = CM. | last2 = Rajalakshmi | first2 = T. | last3 = Correa | first3 = M. | title = Clinicopathologic analysis of 21 cases of nevus sebaceus: a retrospective study. | journal = Indian J Dermatol Venereol Leprol | volume = 74 | issue = 6 | pages = 625-7 | month =  | year =  | doi =  | PMID = 19171988 }}</ref>
*Head and neck [[plaque]] or [[papule]] with:
**Well-circumscribed borders.
**Waxy, yellow appearance.
*Area usu. devoid of hair.<ref name=pmid22148058>{{Cite journal  | last1 = Kim | first1 = JH. | last2 = Park | first2 = HY. | last3 = Ahn | first3 = SK. | title = Nevus sebaceous accompanying secondary neoplasms and unique histopathologic findings. | journal = Ann Dermatol | volume = 23 | issue = Suppl 2 | pages = S231-4 | month = Oct | year = 2011 | doi = 10.5021/ad.2011.23.S2.S231 | PMID = 22148058 }}</ref>
 
DDx - gross:
*[[Seborrheic keratosis]].
 
Image:
*[http://www.dermnet.com/images/Nevus-Sebaceous/picture/17082?imgNumber=14 NS (dermnet.com)].
 
===Microscopic===
Features:<ref name=pmid19171988/>
*Abundant sebaceous glands.
*Immature/abortive hair follicles.
**No normal terminal hair follicles.
*Papillomatous epidermal hyperplasia.
 
Images:
*[http://commons.wikimedia.org/wiki/File:SkinTumors-P6260391.JPG NS (WC)].
*[http://www.dermnet.com/images/Nevus-Sebaceous/picture/17087 NS (dermnet.com)].


==Nevus lipomatosus superficialis==
==Nevus lipomatosus superficialis==
Line 1,036: Line 521:
*[[AKA]] ''nevus lipomatosus cutaneous superficialis'', abbreviated ''NLCS''.
*[[AKA]] ''nevus lipomatosus cutaneous superficialis'', abbreviated ''NLCS''.
*[[AKA]] ''nevus lipomatosus''.<ref name=pmid15677959>{{Cite journal  | last1 = Kaw | first1 = P. | last2 = Carlson | first2 = A. | last3 = Meyer | first3 = DR. | title = Nevus lipomatosus (pedunculated lipofibroma) of the eyelid. | journal = Ophthal Plast Reconstr Surg | volume = 21 | issue = 1 | pages = 74-6 | month = Jan | year = 2005 | doi =  | PMID = 15677959 }}</ref>
*[[AKA]] ''nevus lipomatosus''.<ref name=pmid15677959>{{Cite journal  | last1 = Kaw | first1 = P. | last2 = Carlson | first2 = A. | last3 = Meyer | first3 = DR. | title = Nevus lipomatosus (pedunculated lipofibroma) of the eyelid. | journal = Ophthal Plast Reconstr Surg | volume = 21 | issue = 1 | pages = 74-6 | month = Jan | year = 2005 | doi =  | PMID = 15677959 }}</ref>
===General===
{{Main|Nevus lipomatosus superficialis}}
*Rare.
*Congenital - considered a [[hamartoma]].<ref name=pmid22984661/>
*Usually young adults.<ref>URL: [http://www.dermpedia.org/dermpedia-textbook/nevus-lipomatosus http://www.dermpedia.org/dermpedia-textbook/nevus-lipomatosus]. Accessed on: 8 January 2013.</ref>
 
Clinically separated into:<ref name=pmid17288284>{{Cite journal  | last1 = Triki | first1 = S. | last2 = Mekni | first2 = A. | last3 = Haouet | first3 = S. | last4 = Mokni | first4 = M. | last5 = Kchir | first5 = N. | last6 = Ben Osman Dhahri | first6 = A. | last7 = Zitouna | first7 = M. | title = [Nevus lipomatosus cutaneous superficialis: a clinico-pathological study of 13 cases]. | journal = Tunis Med | volume = 84 | issue = 12 | pages = 800-2 | month = Dec | year = 2006 | doi =  | PMID = 17288284 }}</ref>
*''Solitary'' - one lesion.
*''Multiple'' - more than one lesion.
 
===Gross===
Features:<ref name=pmid22984661>{{Cite journal  | last1 = Goucha | first1 = S. | last2 = Khaled | first2 = A. | last3 = Zéglaoui | first3 = F. | last4 = Rammeh | first4 = S. | last5 = Zermani | first5 = R. | last6 = Fazaa | first6 = B. | title = Nevus lipomatosus cutaneous superficialis: Report of eight cases. | journal = Dermatol Ther (Heidelb) | volume = 1 | issue = 2 | pages = 25-30 | month = Dec | year = 2011 | doi = 10.1007/s13555-011-0006-y | PMID = 22984661  | PMC = 3437641 }}</ref>
*Pedunculated lesion.
*Soft.
*Usually lower trunk or gluteal region.<ref name=pmid1235780>{{Cite journal  | last1 = Jones | first1 = EW. | last2 = Marks | first2 = R. | last3 = Pongsehirun | first3 = D. | title = Naevus superficialis lipomatosus. A clinicopathological report of twenty cases. | journal = Br J Dermatol | volume = 93 | issue = 2 | pages = 121-33 | month = Aug | year = 1975 | doi =  | PMID = 1235780 }}</ref>
 
Image:
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437641/figure/Fig1/ NLS (nih.gov)].<ref name=pmid22984661/>
 
===Microscopic===
Features:<ref name=pmid19495497>{{Cite journal  | last1 = Yap | first1 = FB. | title = Nevus lipomatosus superficialis. | journal = Singapore Med J | volume = 50 | issue = 5 | pages = e161-2 | month = May | year = 2009 | doi =  | PMID = 19495497 | URL = http://smj.sma.org.sg/5005/5005cr3.pdf }}</ref>
*Benign adipose tissue in the dermis.
**Adipocytes in [[reticular dermis]] +/- [[papillary dermis]].<ref name=pmid20673540>{{Cite journal  | last1 = Ghosh | first1 = SK. | last2 = Bandyopadhyay | first2 = D. | last3 = Jamadar | first3 = NS. | title = Nevus lipomatosus cutaneous superficialis: An unusual presentation. | journal = Dermatol Online J | volume = 16 | issue = 7 | pages = 12 | month =  | year = 2010 | doi =  | PMID = 20673540 }}</ref>
 
DDx:
*[[Lipoma]].
*[[Fibroepithelial polyp]] (skin tag).
*[[Intradermal nevus]] with adipocytes.<ref name=pmid9810886>{{Cite journal  | last1 = Eng | first1 = W. | last2 = Cohen | first2 = PR. | title = Nevus with fat: clinical characteristics of 100 nevi containing mature adipose cells. | journal = J Am Acad Dermatol | volume = 39 | issue = 5 Pt 1 | pages = 704-11 | month = Nov | year = 1998 | doi =  | PMID = 9810886 }}</ref>
 
Images:
*[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>
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437641/figure/Fig3/ NLS (nih.gov)].<ref name=pmid22984661/>
*[http://www.dermpedia.org/dermpedia-textbook/nevus-lipomatosus Nevus lipomatosus (dermpedia.org)].
 
===Sign out===
<pre>
SKIN LESION ("SKIN TAG"), LEFT HIP, EXCISION:
- NEVUS LIPOMATOSUS SUPERFICIALIS.
</pre>


=Bullous disease=
=Bullous disease=
Michael
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