Download - Dermatopathology- We’ve Only Just Begun
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DermatopathologyDermatopathology-- WeWe’’ve Only Just Begunve Only Just Begun
Paul K. Shitabata, M.D.Paul K. Shitabata, M.D.Dermatopathology Dermatopathology InstituteInstitute
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PatternsPatterns
Epidermis
Dermis/Vessels/Hair Follicles
Fat/Vessels
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AcantholysisAcantholysis
Loss of cohesion Loss of cohesion between epidermal or between epidermal or adnexaladnexal keratinacyteskeratinacytesGroverGrover’’s disease, s disease, PemphigusPemphigus, , DarierDarier’’ssdisease, Haileydisease, Hailey--HaileyHailey
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AcanthosisAcanthosis
The increase in the The increase in the thickness of the stratum thickness of the stratum malpighiimalpighiiAcanthosisAcanthosis nigricansnigricans, , Pale cell Pale cell acanthomaacanthoma
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ApoptosisApoptosis
Dropping off of colloid Dropping off of colloid bodies from the epidermis bodies from the epidermis into the dermisinto the dermisOccurs in disorders in which Occurs in disorders in which basal cell damage occurs, basal cell damage occurs, such as such as lichenoidlichenoid tissue tissue reactionsreactionsLichen Lichen planusplanus, LPLK, DLE, LPLK, DLE
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BullaBulla
Cavity of at least 5 mm Cavity of at least 5 mm in diameter forming in diameter forming within or below the within or below the epidermisepidermisBullousBullous pemphigoidpemphigoid, , EBA, DHEBA, DH
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CornoidCornoid
LamellaLamella
The The cornoidcornoid lamella is lamella is tilted toward the center tilted toward the center of such a lesionof such a lesionPeripherally migrating Peripherally migrating clone of abnormal clone of abnormal keratinocyteskeratinocytes forming forming the the cornoidcornoid lamella lamella PorokeratosisPorokeratosis
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EpidermolyticEpidermolytic
HyperkeratosisHyperkeratosis
VacuolationVacuolation of the of the keratohyalinekeratohyaline granular granular layerlayerRule out Congenital Rule out Congenital IchthyosiformIchthyosiformerythrodermaerythrodermaAssociation with Association with dysplasticdysplastic nevinevi
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LichenoidLichenoid
(Interface)(Interface)
Epidermal basal cell Epidermal basal cell damage manifested with damage manifested with cell death or cell death or liquefactiveliquefactivedegeneration (basal degeneration (basal vacuolar change)vacuolar change)Interface sometimes Interface sometimes applied only to applied only to poikilodermatouspoikilodermatousreactions with mild basal reactions with mild basal damage with vacuolar damage with vacuolar changechangeLichen Lichen planusplanus, Fixed drug , Fixed drug eruption, LPLKeruption, LPLK
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ParakeratosisParakeratosis
Retention of nuclei in the Retention of nuclei in the stratum corneumstratum corneumNormal finding on Normal finding on mucous membranesmucous membranesSpongioticSpongiotic dermatitis dermatitis (Eczema)(Eczema)
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PsoriasiformPsoriasiform
Epidermal hyperplasia Epidermal hyperplasia with regular elongation with regular elongation of of reterete ridgesridgesSeveral layers of scale Several layers of scale resulting from bouts of resulting from bouts of activityactivityPsoriasis, PRP, Lichen Psoriasis, PRP, Lichen striatusstriatus, MF, MF
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SpongioticSpongiotic
IntraepidermalIntraepidermalintercellular edema with intercellular edema with widened intercellular widened intercellular spaces and elongation of spaces and elongation of intercellular bridgesintercellular bridgesSubclassifySubclassify by by inflammatory cell typeinflammatory cell typeEczemaEczema
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UlcerUlcer
Obliteration of a Obliteration of a mucosal surfacemucosal surfaceUsually Usually fibrinopurulentfibrinopurulentbasebase
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Epidermal Reaction PatternsEpidermal Reaction Patterns
Orthokeratosis
Spongiosis
AcanthosisParakeratosis
Hyperkeratosis
Modify by Inflammatory Cell
type
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Spongiosis
Parakeratosis Acanthosis Hyperkeratosis
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Orthokeratosis
Hyperkeratosis Acanthosis
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Epidermal/DermalEpidermal/Dermal Reaction PatternsReaction Patterns
Superficial Superficial perivascularperivascularSuperficial and deep Superficial and deep perivascularperivascularNodular and diffuseNodular and diffuseIntraepidermalIntraepidermal vesicular and vesicular and pustularpustularSubepidermalSubepidermal vesicular vesicular
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AbscessAbscess
Obliteration of tissue by Obliteration of tissue by suppurativesuppurative necrosisnecrosisMay have foreign body May have foreign body giant cellsgiant cellsConsider correlation with Consider correlation with culturesculturesConsider special stainsConsider special stains
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CaseationCaseation
NecrosisNecrosis
Identical to coagulation Identical to coagulation necrosis and ischemic necrosis and ischemic necrosisnecrosisAffected tissue has lost its Affected tissue has lost its structural outline and appears structural outline and appears as pale as pale eosinophiliceosinophilic, , amorphous and finely amorphous and finely granulargranularTuberculosis, Tuberculosis, NecrobioticNecrobioticxanthogranulomaxanthogranuloma
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FibrinoidFibrinoid
NecrosisNecrosis
Fibrin deposition in the Fibrin deposition in the wall of small vesselswall of small vesselsCommonly associated Commonly associated with with leukocytoclasticleukocytoclasticvasculitisvasculitis
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Flame FiguresFlame Figures
Encrustation of Encrustation of eosinophiliceosinophilic granules granules around collagenaround collagenFrequent in conditions Frequent in conditions with dermal with dermal eosinophiliaeosinophiliaWellWell’’s syndrome, s syndrome, arthropod, drug reactionsarthropod, drug reactions
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Granulation TissueGranulation Tissue
Newly formed dermis arising Newly formed dermis arising in healing wounds and in healing wounds and characterized by numerous characterized by numerous fibroblasts and new fibroblasts and new capillaries and an infiltrate capillaries and an infiltrate consisting of lymphoid cells, consisting of lymphoid cells, macrophages, and plasma macrophages, and plasma cellscellsDecubitusDecubitus ulcerulcer
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GranulomaGranuloma
Chronic Chronic proliferativeproliferative lesion lesion consisting of mononuclear cells consisting of mononuclear cells and and epithelioidepithelioid cells or cells or multinucleated giant cells or bothmultinucleated giant cells or bothCells lie in groups and are often Cells lie in groups and are often surrounded by lymphoid cellssurrounded by lymphoid cells"Naked" "Naked" granulomasgranulomas have few to have few to none of these surrounding none of these surrounding lymphoid cellslymphoid cellsSarcoidosisSarcoidosis, foreign body, foreign body
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GrenzGrenz
ZoneZone
A narrow area of A narrow area of uninvolved dermis uninvolved dermis between the epidermis between the epidermis and a dermal and a dermal inflammatory or inflammatory or neoplasticneoplastic infiltrate. infiltrate. ““GrenzGrenz”” is German for is German for ““borderborder””Some lymphomas, Some lymphomas, granulomagranuloma facialefaciale
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NecrobiosisNecrobiosis
Altered collagen that Altered collagen that loses its normal loses its normal eosinophiliceosinophilic coloration coloration and and fibrillarfibrillar appearance, appearance, becoming slightly bluish becoming slightly bluish and "smudgedand "smudged““NecrobiosisNecrobiosis lipoidicalipoidica, , some infectionssome infections
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Nuclear DustNuclear Dust
Fragmented nuclei Fragmented nuclei scattered in the dermis, scattered in the dermis, predominantly around predominantly around blood vesselsblood vesselsLeukocytoclasticLeukocytoclasticvasculitisvasculitis, , granulomagranulomafacialefaciale, Sweet, Sweet’’s syndromes syndrome
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Epidermal ChangesSpongioticBallooning
Psoriasiform/Lichenoid
Epidermal Changes Interface
No Epidermal ChangesPerivascularIntestitial
Superficial/Deep
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Lichenoid/Interface
Psoriasiform
Psoriasiform Lichenoid
Spongiotic
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Superficial Superficial PerivascularPerivascular No Epidermal ChangesNo Epidermal Changes
TineaTinea versicolorversicolorDermatophytosisDermatophytosisErythrasmaErythrasmaPitted Pitted keratolysiskeratolysisVitiligoVitiligoSchamberg'sSchamberg's disease disease Viral Viral exanthemsexanthemsDrug eruption (one type)Drug eruption (one type)UrticariaUrticaria, late, lateErythemaErythema figuratumfiguratum, , superficial superficial
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Superficial Superficial PerivascularPerivascular/Interstitial /Interstitial No Epidermal ChangesNo Epidermal Changes
Schamberg'sSchamberg's diseasediseasePUPPP PUPPP Dermatitis Dermatitis herpetiformisherpetiformisLinear Linear IgAIgA dermatosisdermatosisDermatitis Dermatitis herpetiformisherpetiformis--like like drug eruptionsdrug eruptionsAcute discoid lupus Acute discoid lupus erythematosuserythematosus/SLE/SLELeukocytoclasticLeukocytoclastic vasculitisvasculitisErythemaErythema marginatummarginatum
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Superficial Superficial PerivascularPerivascular/Interstitial /Interstitial No Epidermal ChangesNo Epidermal Changes
BullousBullous pemphigoidpemphigoid/Herpes /Herpes gestationisgestationis, , urticarialurticarialPemphigusPemphigus vulgarisvulgaris, , urticarialurticarialArthropodArthropodPUPPP PUPPP UrticariaUrticariaPostinflammatoryPostinflammatory pigmentarypigmentaryalterationalterationMacular Macular amyloidosisamyloidosisUrticariaUrticaria pigmentosapigmentosaBrachioradialBrachioradial pruritispruritis
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Superficial Superficial PerivascularPerivascular PsoriasiformPsoriasiform
PsoriasisPsoriasisAllergic contact dermatitisAllergic contact dermatitisNummular dermatitisNummular dermatitisDyshidroticDyshidrotic dermatitis dermatitis PityriasisPityriasis rubrarubra pilarispilarisSeborrheicSeborrheic dermatitis dermatitis
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Superficial Superficial PerivascularPerivascular PsoriasiformPsoriasiform
DermatophytosisDermatophytosisCandidiasisCandidiasisLichen simplex Lichen simplex chronicuschronicusPrurigoPrurigo nodularisnodularisAcanthomaAcanthoma fissuratumfissuratumPressure papule from Pressure papule from prosthesisprosthesisSurfer's nodulesSurfer's nodulesChondrodermatitisChondrodermatitisnodularisnodularis helicishelicis
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Superficial Superficial PerivascularPerivascular SpongioticSpongiotic
PsoriasiformPsoriasiform
Allergic contact Allergic contact dermatitisdermatitisNummular dermatitisNummular dermatitisDyshidroticDyshidrotic dermatitisdermatitisId reactionId reactionSeborrheicSeborrheic dermatitisdermatitisNonbullousNonbullous congenital congenital ichthyosiformichthyosiformerythrodermaerythrodermaLichen Lichen striatusstriatus
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Superficial Superficial PerivascularPerivascular LichenoidLichenoid/Interface/Interface
Lichen Lichen planusplanusLichenoidLichenoid drugdrugPityriasisPityriasis lichenoideslichenoideschronicachronicaDLEDLEDermatomyositisDermatomyositisGVHGVHEMEM
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Superficial Superficial PerivascularPerivascular Psoriasiform/LichenoidPsoriasiform/Lichenoid
Lichen Lichen striatusstriatusBullousBullous pemphigoidpemphigoidHerpes Herpes gestationisgestationis, , urticarialurticarialMycosis Mycosis fungoidesfungoides
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Superficial/DeepSuperficial/Deep No Epidermal ChangesNo Epidermal Changes
Polymorphous light eruption, Polymorphous light eruption, earlyearlyErythemaErythema figuratumfiguratumErythemaErythema chronicumchronicum migransmigransPernioPernioErythemaErythema nodosumnodosumPMLE PMLE DLE, tumid DLE, tumid CLLCLLBB--cell lymphoma cell lymphoma
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Superficial/DeepSuperficial/Deep No Epidermal ChangesNo Epidermal Changes
Arthropod insult Arthropod insult ErythemaErythema chronicumchronicum migransmigransScleroderma Scleroderma Leprosy, indeterminateLeprosy, indeterminate
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Superficial/Deep Superficial/Deep PerivascularPerivascular
and Interstitialand Interstitial
SuppurativeSuppurative folliculitisfolliculitis, periphery, peripheryNeutrophilicNeutrophilic eccrineeccrine hidradenitishidradenitisFlea biteFlea biteCellulitisCellulitisErythropoieticErythropoietic protoporphyriaprotoporphyriaArthropodArthropodErythemaErythema chronicumchronicum migransmigransWell's syndrome Well's syndrome
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Superficial/Deep Superficial/Deep PerivascularPerivascular
and Interstitialand Interstitial
GranulomaGranuloma annulareannulareNecrobiosisNecrobiosis lipoidicalipoidicaInterstitial Interstitial granulomatousgranulomatousdermatitis with arthritis dermatitis with arthritis Mycosis Mycosis fungoidesfungoides, , granulomatousgranulomatous
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Superficial/Deep Superficial/Deep Epidermal Epidermal LichenoidLichenoid--InterfaceInterface
PLEVAPLEVAFixed drug eruptionFixed drug eruptionDermatophytosisDermatophytosisLyPLyPGVHGVHDLEDLEAcrodermatitisAcrodermatitis chronicachronicaatrophicansatrophicansMycosis Mycosis fungoidesfungoides, , plaque plaque
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Nodular/Diffuse DermatitisNodular/Diffuse Dermatitis
Lymphocytes
Histiocytes(Granulomas)
EosinophilsPlasma cells
Neutrophils
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Nodular/Diffuse DermatitisNodular/Diffuse Dermatitis
HistiocytesHistiocytes((GranulomasGranulomas))
SarcoidalSarcoidalTuberculoidTuberculoidPalisadedPalisadedSuppurativeSuppurative
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Nodular/Diffuse DermatitisNodular/Diffuse Dermatitis
HistiocytesHistiocytes((GranulomasGranulomas))
TuberculoidTuberculoidSuppurativeSuppurative
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Nodular/Diffuse DermatitisNodular/Diffuse Dermatitis
Cell TypeCell Type DiagnosisDiagnosis
NeutrophilsNeutrophils SweetsSweets
EosinophilsEosinophils WellWell’’s, Hypersensitivitys, Hypersensitivity
Plasma cellsPlasma cells LymeLyme
diseasedisease
HistiocytesHistiocytes GranulomatousGranulomatous
diseasesdiseases
MixedMixed GranulomaGranuloma
facialefaciale
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IntraepidermalIntraepidermal Vesicular Vesicular and and PustularPustular DermatitisDermatitis
Vesicular Pustular
Ballooning Spongiosis Acantholysis Cleaving Intracorneal Subcorneal
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IntraepidermalIntraepidermal
Vesicular Vesicular DermatosisDermatosis
Spongiosis
Intraepidermal vesicle
Intraepidermal bullae
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IntraepidermalIntraepidermal
SpongiosisSpongiosis
Allergic contact dermatitisAllergic contact dermatitisNummular dermatitisNummular dermatitisDyshidroticDyshidrotic dermatitisdermatitisId reactionId reactionPhotoallergicPhotoallergic dermatitis, earlydermatitis, earlyDermatophytosisDermatophytosisMiliariaMiliaria rubrarubraGianottiGianotti--CrostiCrosti syndrome syndrome PityriasisPityriasis rosearoseaErythemaErythema annulareannulare centrifugumcentrifugumSeborrheicSeborrheic dermatitis dermatitis Lichen Lichen striatusstriatusPityriasisPityriasis alba alba Mycosis Mycosis fungoidesfungoides, , maculemacule/patch /patch
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IntraepidermalIntraepidermal
SpongiosisSpongiosis
PUPPPPUPPPAllergic contact dermatitisAllergic contact dermatitisNummular dermatitisNummular dermatitisDyshidroticDyshidrotic dermatitisdermatitisId reaction Id reaction BullousBullous pemphigoidpemphigoidHerpes Herpes gestationisgestationisPemphigusPemphigus vulgarisvulgaris, , urticarialurticarialIncontinentiaIncontinentia pigmentipigmentiToxic Toxic erythemaerythema of newborn of newborn Arthropod assault Arthropod assault
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IntraepidermalIntraepidermal
BallooningBallooning
HerpesHerpesOrfOrfParapoxParapox infectioninfectionMeaslesMeaslesHydroaHydroa aestivale/Hydroaaestivale/Hydroavacciniformevacciniforme
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IntraepidermalIntraepidermal
with with AcantholysisAcantholysis
PemphigusPemphigus vulgarisvulgarisPemphigusPemphigus vegetansvegetansPemphigusPemphiguserythematosuserythematosusPemphigusPemphigus foliaceusfoliaceusFogoFogo selvagemselvagemGroverGrover’’s diseases disease
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IntraepidermalIntraepidermal SpongioticSpongiotic
Psoriasiform/LichenoidPsoriasiform/Lichenoid
Allergic contact dermatitisAllergic contact dermatitisNummular dermatitisNummular dermatitisDyshidroticDyshidrotic dermatitisdermatitisId reactionId reactionSeborrheicSeborrheic dermatitisdermatitisNonbullousNonbullous congenital congenital ichthyosiformichthyosiform erythrodermaerythrodermaLichen Lichen striatusstriatus
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IntraepidermalIntraepidermal SpongioticSpongiotic
Psoriasiform/LichenoidPsoriasiform/Lichenoid
Lichen Lichen striatusstriatusBullousBullous pemphigoidpemphigoidHerpes Herpes gestationisgestationis, , urticarialurticarialMFMF
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SubepidermalSubepidermal
Vesicular Vesicular DermatosisDermatosis
Subepidermal
Minimal Mixed Lymphocytes
Neutrophils Neuts/Eos Mast Cells
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SubepidermalSubepidermal
Vesicular Vesicular DermatosisDermatosis
BullousBullous pemphigoidpemphigoid/Herpes /Herpes gestationisgestationisCicatricialCicatricial pemphigoidpemphigoidDermatitis Dermatitis herpetiformisherpetiformis/Linear /Linear IgAIgA diseasedisease
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SubepidermalSubepidermal
Vesicular Vesicular DermatosisDermatosis
EBAEBABullousBullous LELEBullousBullous mastocytosismastocytosisBullousBullous amyloidosisamyloidosisDrug reactionsDrug reactionsLPLP
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Special CategoriesSpecial Categories
VasculitisVasculitisAlopeciaAlopeciaFolliculitis/PerifolliculitisFolliculitis/PerifolliculitisFibrosingFibrosing dermatitisdermatitisPanniculitisPanniculitis
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VasculitisVasculitis
Mixed
Large Vessel
Small Vessel
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VasculitisVasculitis
LeukocytoclasticLeukocytoclasticvasculitisvasculitisMicroscopic Microscopic arteritisarteritisPolyarteritisPolyarteritis nodosanodosaErythemaErythema induratuminduratum
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Alopecia
Non-Inflammatory Inflammatory
Follicle density normal Follicle density decreased Lymphocytes Mixed
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AlopeciaAlopecia NonNon--InflammatoryInflammatory
Follicle density normalFollicle density normalAndrogenic alopecia Androgenic alopecia TelogenTelogen effluviumeffluviumTrichotillomaniaTrichotillomania
Follicle density decreasedFollicle density decreasedTraction alopecia Traction alopecia
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AlopeciaAlopecia InflammatoryInflammatory
Alopecia Alopecia areataareataLichen Lichen planopilarisplanopilarisDLEDLESclerodermaSclerodermaFolliculitisFolliculitis decalvansdecalvansTineaTinea capitiscapitisMajocchi'sMajocchi's granulomagranulomaBurns/RadiationBurns/RadiationSyphilis Syphilis ScarScar
LPPLPPSclerodermaSclerodermaDLEDLE
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Spongiotic
PerifolliculitisSuppurative
Folliculitis
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Granulomatous Fibrosing
Lymphocytes
Perifolliculitis
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Folliculitis/PerifolliculitisFolliculitis/Perifolliculitis
Infectious (Infectious (StaphStaph, Strep, , Strep, DermatophytosisDermatophytosisEndothrix/EctothrixEndothrix/Ectothrix))Acne Acne vulgarisvulgarisAcne Acne rosacearosaceaPerforating disordersPerforating disorders
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Folliculitis/PerifolliculitisFolliculitis/Perifolliculitis
InfundibulofolliculitisInfundibulofolliculitisAlopecia Alopecia mucinosamucinosaPerifolliculitisPerifolliculitis
ScurvyScurvyLichen Lichen planopilarisplanopilarisDLEDLERosaceaRosaceaKeratosisKeratosis pilarispilaris
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FibrosingFibrosing
DermatitisDermatitis
Fibrosing Dermatitis
Fibrocytes Increased Fibrocytes Decreased
SclerosisRadiation
ScarScleroderma/Morphea
Antecedents to Fibrosis
UlcerGranulation tissue
Granulomas
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Sclerosis
Fibrosis
Antecedent to Fibrosis
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FibrosingFibrosing
DermatitisDermatitis
ScarScarChronic Chronic lymphedemalymphedemaKeloidKeloidDermatofibromaDermatofibromaAnetodermaAnetodermaAcrodermatitisAcrodermatitis chronicachronicaatrophicansatrophicansLSEA/LSEA/MorpheaMorpheaRadiation sclerosisRadiation sclerosis
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PanniculitisPanniculitis
LobularWith or without Vasculitis
SeptalWith or without vasculitis
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PanniculitisPanniculitis
ErythemaErythema nodosumnodosumErythemaErythema induratuminduratumLupus Lupus panniculitispanniculitisInfectiousInfectiousPancreatic fat necrosisPancreatic fat necrosisLympohmaLympohmaSubQSubQ fat necrosisfat necrosisPoststeroidPoststeroid panniculitispanniculitis
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QuestionsQuestions
People talk fundamentals People talk fundamentals and superlatives and then and superlatives and then make some changes of make some changes of detail. detail.
Oliver Wendell Holmes Jr.Oliver Wendell Holmes Jr.
(1841 (1841 --
1935)1935)