Difference between revisions of "Non-malignant skin disease"

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Non-malignant skin disease (view source)

Revision as of 04:46, 28 August 2011

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re-arrange, subdivide
(rm dermal nevus ---> to melanocytic lesions)
(re-arrange, subdivide)
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An introduction to dermatopathology is in the ''[[dermatopathology]]'' article.  [[Nevi]] (moles) and other melanocytic lesions are dealt with in the article ''[[melanocytic lesions]]''.
An introduction to dermatopathology is in the ''[[dermatopathology]]'' article.  [[Nevi]] (moles) and other melanocytic lesions are dealt with in the article ''[[melanocytic lesions]]''.


==General classification (Inflammatory)==
 
=Inflammatory conditions=
==Classification==
*Bullous.
*Bullous.
*Interface.
*Interface.
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*Subepithelial fibrosis - '''key feature'''.
*Subepithelial fibrosis - '''key feature'''.


=Other=
==Squamous cell hyperplasia==
==Squamous cell hyperplasia==
*[[AKA]] ''lichen simplex chronicus''.<ref name=Ref_PBoD1011>{{Ref PBoD8|1011}}</ref>
*[[AKA]] ''lichen simplex chronicus''.<ref name=Ref_PBoD1011>{{Ref PBoD8|1011}}</ref>
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*[http://commons.wikimedia.org/w/index.php?title=File:Lichen_simplex_chronicus_-_high_mag.jpg LSC - high mag. (WC)].
*[http://commons.wikimedia.org/w/index.php?title=File:Lichen_simplex_chronicus_-_high_mag.jpg LSC - high mag. (WC)].


=Very common=
==Seborrheic keratosis==
==Seborrheic keratosis==
*Abbreviated ''SK''.
*Abbreviated ''SK''.
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*[http://commons.wikimedia.org/wiki/File:Verruca_vulgaris_-_very_low_mag.jpg Verruca vulgaris - very low mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Verruca_vulgaris_-_very_low_mag.jpg Verruca vulgaris - very low mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Verruca_vulgaris_-_intermed_mag.jpg Verruca vulgaris - intermed mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Verruca_vulgaris_-_intermed_mag.jpg Verruca vulgaris - intermed mag. (WC)].
==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.<ref>[http://www.missionforvisionusa.org/anatomy/2006/08/what-is-molluscum-contagiosum.html http://www.missionforvisionusa.org/anatomy/2006/08/what-is-molluscum-contagiosum.html]</ref>
*Molluscum bodies - '''key feature''':
**Large cells with abundant granular eosinophilic cytoplasm.
**Small peripheral nucleus.
Image(s):
*[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)].
Note:
*Molluscum bodies vaguely resemble ''[[signet ring cell]]s'' -- 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.


==Pilomatricoma==
==Pilomatricoma==
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DDx:
DDx:
*Epidermal inclusion cyst.
*[[Epidermal inclusion cyst]].
 
==Dermatofibroma==
===General===
*AKA ''fibrous histiocytoma''.
*Reactive process -- it is ''not'' a neoplasm.
*Usually associated with previous trauma.
**In women... usually legs.
 
===Microscopic===
Features:<ref name=Ref_WMSP492>{{Ref WMSP|492}}</ref>
*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").
*Lack of adnexal structures, i.e. no sweat glands, no hair.
*+/-Epidermal changes - known as "dirty fingers":<ref>BD. 13 April 2011.</ref>
**Acanthosis (thickened epithelial layer - specifically thickened ''stratum spinosum'').
**Basal keratinocyte hyperpigmentation.
 
Images:
*[http://missinglink.ucsf.edu/lm/DermatologyGlossary/dermatofibroma.html Dermatofibroma (ucsf.edu)].
*[http://www.pacificderm.org/newsflashcpcapril04.html DF - several images (pacificderm.org)].
 
DDx:
*[[Dermatofibrosarcoma protuberans]] (DFSP).
*[[Neurofibroma]].
*[[Blue nevus]].
*[[Melanoma]].
 
====Subtypes====
Like all common things... there are subtypes:<ref>{{Ref Sternberg5|51}}</ref>
*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===
Features:<ref name=pmid7694515>{{cite journal |author=Abenoza P, Lillemoe T |title=CD34 and factor XIIIa in the differential diagnosis of dermatofibroma and dermatofibrosarcoma protuberans |journal=Am J Dermatopathol |volume=15 |issue=5 |pages=429–34 |year=1993 |month=October |pmid=7694515 |doi= |url=}}</ref><ref name=pmid9129699>{{cite journal |author=Goldblum JR, Tuthill RJ |title=CD34 and factor-XIIIa immunoreactivity in dermatofibrosarcoma protuberans and dermatofibroma |journal=Am J Dermatopathol |volume=19 |issue=2 |pages=147–53 |year=1997 |month=April |pmid=9129699 |doi= |url=}}</ref>
*Factor XIIIa +ve.
**Usually negative in [[DFSP]].
*CD34 -ve.
**Usually positive in DFSP.
*D2-40 +ve.<ref name=pmid20062007>{{cite journal |author=Bandarchi B, Ma L, Marginean C, Hafezi S, Zubovits J, Rasty G |title=D2-40, a novel immunohistochemical marker in differentiating dermatofibroma from dermatofibrosarcoma protuberans |journal=Mod. Pathol. |volume=23 |issue=3 |pages=434–8 |year=2010 |month=March |pmid=20062007 |doi=10.1038/modpathol.2009.176 |url=}}</ref>
**Usually negative in DFSP.
 
==Ezcema==
===General===
*A nebulous thingy.
*Very common.
 
DDx:
*Contact allergy.
*Drug reaction.
*Food allergy.
 
===Microscopic===
Features:<ref>{{Ref PBoD8|1188}}</ref>
*Spongiosis (epidermal edema); keratinocytes spacing increased - '''key feature'''.
*+/-Interdermal vesicles.
*+/-Eosinophils (may suggest Rx reaction).
*Perivascular lymphocytes.
 
=Less common=
==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.<ref>[http://www.missionforvisionusa.org/anatomy/2006/08/what-is-molluscum-contagiosum.html http://www.missionforvisionusa.org/anatomy/2006/08/what-is-molluscum-contagiosum.html]</ref>
*Molluscum bodies - '''key feature''':
**Large cells with abundant granular eosinophilic cytoplasm.
**Small peripheral nucleus.
 
Image(s):
*[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)].
 
Note:
*Molluscum bodies vaguely resemble ''[[signet ring cell]]s'' -- 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==
==Syringoma==
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Image:
Image:
*[http://commons.wikimedia.org/wiki/File:Skin_keratoacanthoma_whole_slide.jpg Keratocanthoma (WC).]
*[http://commons.wikimedia.org/wiki/File:Skin_keratoacanthoma_whole_slide.jpg Keratocanthoma (WC).]
==Dermatofibroma==
===General===
*AKA ''fibrous histiocytoma''.
*Reactive process -- it is ''not'' a neoplasm.
*Usually associated with previous trauma.
**In women... usually legs.
===Microscopic===
Features:<ref name=Ref_WMSP492>{{Ref WMSP|492}}</ref>
*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").
*Lack of adnexal structures, i.e. no sweat glands, no hair.
*+/-Epidermal changes - known as "dirty fingers":<ref>BD. 13 April 2011.</ref>
**Acanthosis (thickened epithelial layer - specifically thickened ''stratum spinosum'').
**Basal keratinocyte hyperpigmentation.
Images:
*[http://missinglink.ucsf.edu/lm/DermatologyGlossary/dermatofibroma.html Dermatofibroma (ucsf.edu)].
*[http://www.pacificderm.org/newsflashcpcapril04.html DF - several images (pacificderm.org)].
DDx:
*[[Dermatofibrosarcoma protuberans]] (DFSP).
*[[Neurofibroma]].
*[[Blue nevus]].
*[[Melanoma]].
====Subtypes====
Like all common things... there are subtypes:<ref>{{Ref Sternberg5|51}}</ref>
*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===
Features:<ref name=pmid7694515>{{cite journal |author=Abenoza P, Lillemoe T |title=CD34 and factor XIIIa in the differential diagnosis of dermatofibroma and dermatofibrosarcoma protuberans |journal=Am J Dermatopathol |volume=15 |issue=5 |pages=429–34 |year=1993 |month=October |pmid=7694515 |doi= |url=}}</ref><ref name=pmid9129699>{{cite journal |author=Goldblum JR, Tuthill RJ |title=CD34 and factor-XIIIa immunoreactivity in dermatofibrosarcoma protuberans and dermatofibroma |journal=Am J Dermatopathol |volume=19 |issue=2 |pages=147–53 |year=1997 |month=April |pmid=9129699 |doi= |url=}}</ref>
*Factor XIIIa +ve.
**Usually negative in [[DFSP]].
*CD34 -ve.
**Usually positive in DFSP.
*D2-40 +ve.<ref name=pmid20062007>{{cite journal |author=Bandarchi B, Ma L, Marginean C, Hafezi S, Zubovits J, Rasty G |title=D2-40, a novel immunohistochemical marker in differentiating dermatofibroma from dermatofibrosarcoma protuberans |journal=Mod. Pathol. |volume=23 |issue=3 |pages=434–8 |year=2010 |month=March |pmid=20062007 |doi=10.1038/modpathol.2009.176 |url=}}</ref>
**Usually negative in DFSP.


==Superficial dermal infiltrates==
==Superficial dermal infiltrates==
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Images:
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://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>
==Ezcema==
===General===
*A nebulous thingy.
*Very common.
DDx:
*Contact allergy.
*Drug reaction.
*Food allergy.
===Microscopic===
Features:<ref>{{Ref PBoD8|1188}}</ref>
*Spongiosis (epidermal edema); keratinocytes spacing increased - '''key feature'''.
*+/-Interdermal vesicles.
*+/-Eosinophils (may suggest Rx reaction).
*Perivascular lymphocytes.


==Angiomyoma==
==Angiomyoma==
*Do '''not''' confuse with ''[[aggressive angiomyxoma|angiomyxoma]]''.
===General===
===General===
*Benign.
*Benign.
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*Infection.
*Infection.


==Bullous disease==
=Bullous disease=
{{main|Bullous disease}}
{{main|Bullous disease}}


==Cysts==
=Cysts=
{{main|Dermal cysts}}
{{main|Dermal cysts}}


==See also==
=See also=
*[[Dermatopathology introduction]].
*[[Dermatopathology introduction]].
*[[Malignant skin disease]].
*[[Malignant skin disease]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


[[Category:Non-malignant skin disease]]
[[Category:Non-malignant skin disease]]
[[Category:Dermatopathology]]
[[Category:Dermatopathology]]
Michael
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