Dermatopathology Quiz 2.

8/9/2019 Dermatopathology Quiz 2.

1/13

Dermatopathology QuizDermatopathology Quiz--22

Deba P Sarma, MDDeba P Sarma, MD

OmahaOmaha


2/13

M 80, right eyebrowM 80, right eyebrowCase 1

What is your diagnosis?

Apocrine hidrocystoma


3/13

Apocrine hydrocystomaApocrine hydrocystoma

(Hidrocystoma, apocrine type)(Hidrocystoma, apocrine type)

Uncommon, solitary cyst derived from apocrine duct occurringUncommon, solitary cyst derived from apocrine duct occurringon the head and neck.on the head and neck.

Unilocular or multilocular dermal cyst lined by two layers ofUnilocular or multilocular dermal cyst lined by two layers ofcells: an outer layer of flattened myoepithelial cells and ancells: an outer layer of flattened myoepithelial cells and aninner layer of tall columnar cells with red cytoplasm and basallyinner layer of tall columnar cells with red cytoplasm and basally

placed nuclei.placed nuclei.Decapitation secretion is present. If significant papillaryDecapitation secretion is present. If significant papillaryepithelial projections are seen within the cyst, the lesion isepithelial projections are seen within the cyst, the lesion iscalled an apocrine cystadenoma.called an apocrine cystadenoma.


4/13

M 66, ulcerated papule, left upper eyelidM 66, ulcerated papule, left upper eyelid

Case 2


Blastomycosis


5/13

-- Cutaneous blastomycosisCutaneous blastomycosis

-- A deep fungal disease, usually primary in the lung with spread toA deep fungal disease, usually primary in the lung with spread toother organs including skin.other organs including skin.

-- Caused by fungus Blastomyces dermatitidis.Caused by fungus Blastomyces dermatitidis.

-- Skin shows ulceration and granulomatous inflammation, sometimesSkin shows ulceration and granulomatous inflammation, sometimespseudoepithelial epidermal hyperplasia.pseudoepithelial epidermal hyperplasia.

-- Organisms appear in tissues as thickOrganisms appear in tissues as thick--walled sporeswalled spores

(some with single buds) averaging 10 micron in diameter.(some with single buds) averaging 10 micron in diameter.

-- They are seen in H&E stain. Also positive with PAS and GMS stain.They are seen in H&E stain. Also positive with PAS and GMS stain.


6/13

F 31, left chest wallF 31, left chest wallCase 3

AFB and PAS stain: Negative

CD 68: Positive

Factor XIIIa: Positive


7/13

What is your diagnosis?What is your diagnosis?

XanthogranulomaXanthogranuloma


8/13

XanthogranulomaXanthogranuloma

Intact epidermis with a diffuse dermal proliferation ofIntact epidermis with a diffuse dermal proliferation of

large cells with angulated nuclei, abundant foamylarge cells with angulated nuclei, abundant foamy

cytoplasm, and well defined cell borders.cytoplasm, and well defined cell borders.

The nuclei show inconspicuous nucleoli. SeveralThe nuclei show inconspicuous nucleoli. Severalmultinucleated Toutonmultinucleated Touton--type giant cells ase seen.type giant cells ase seen.

The cytoplasm of the cells stain for CD 68 and FactorThe cytoplasm of the cells stain for CD 68 and Factor

XIIIa, but not with SXIIIa, but not with S--100 and CD 1a.100 and CD 1a.

The lesion is most commonly seen in children, but itThe lesion is most commonly seen in children, but itcan occur at any age.can occur at any age.


9/13

F 70, left elbowF 70, left elbowCase 4


Verruca vulgaris


10/13

Verruca vulgarisVerruca vulgaris

Commonly caused by Human papilloma virus: HPVCommonly caused by Human papilloma virus: HPV--2 and2 and --4.4.

Verruca vulgaris is a mature squamous cell lesion.Verruca vulgaris is a mature squamous cell lesion.

Verruciform or acanthotic squamous cell proliferation.Verruciform or acanthotic squamous cell proliferation.

Rete ridges at the periphery of the lesion point to the center.Rete ridges at the periphery of the lesion point to the center.

Base of the lesion shows normal basal cuboidal keratinocytes.Base of the lesion shows normal basal cuboidal keratinocytes.

Keratin on the top of the lesion is compact type.Keratin on the top of the lesion is compact type.


11/13

F 56, scalpF 56, scalpCase 5


Syringocystadenoma papilliferum


12/13

Syringocystadenoma papilliferumSyringocystadenoma papilliferum

Syringocystadenoma papilliferum (SP) is a benign adnexalSyringocystadenoma papilliferum (SP) is a benign adnexal

tumor, probably from apocrine glands most commonly locatedtumor, probably from apocrine glands most commonly located

on the scalp or face, which frequently arises from a nevuson the scalp or face, which frequently arises from a nevus

sebaceus (NS).sebaceus (NS).

Epidermis shows acanthosis and papillomatosis.Cystic invaginations with papillary projections extend downward

from the epidermis.

The papillary projections are lined by two layers of cuboidal and

columnar epithelial cells. Luminal cells may show decapitation

secretion.

The stroma is infiltrated by a numerous plasma cells.Malformed sebaceous glands and hair structures may be

present.


13/13

END

Dermatopathology Quiz 2.

Documents

Transcript of Dermatopathology Quiz 2.