Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully...
Transcript of Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully...
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Invisible or nearly invisible dermatopathologic diagnoses
Hafeez Diwan, MD, PhDBaylor College of Medicine
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Disclosures
Nothing to discloseNo conflicts of interest
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Categorization of invisibility
Invisible because it is there but subtleInvisible because it is something else
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Epidermis/Stratum corneum
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Epidermis/Stratum Corneum
Fungus – Tinea
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SANDWICH SIGN
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PAS POSITIVE FUNGI
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44 year-old female with mole on right foot
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Epidermis/Stratum Corneum
Fungus – TineaErythrasma – Corynebacterium minutissimumGranular parakeratosis
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HISTORY
The patient is 43-year-old pregnant female who presented with a few deeply pigmented macules on the left sole.
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ADDITIONAL HISTORYPatient had been tarring driveway with her husband but didn’t think she had been exposed to the material.
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Epidermis/Stratum Corneum
Fungus – TineaErythrasma – Corynebacterium minutissimumGranular parakeratosisExogenous pigment
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Epidermis/Stratum Corneum
Fungus – TineaErythrasma – Corynebacterium minutissimumGranular parakeratosisExogenous pigmentCD8-positive (hypopigmented) mycosis fungoides
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Mid-back biopsy from a baby
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The quality of the keratin
Ichthyosis
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Epidermis/Stratum corneum
Look carefullyIf you don’t see anything, do a GMS or PAS stainLook for the sandwich signLook at the granular layer (especially if the biopsy is from the axilla)Look at the quality of the keratin
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Dermis
Lichen amyloid
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Dermis
Lichen amyloidMacular amyloid
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Dermis
Lichen amyloidUrticaria
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Dermis
Lichen amyloidUrticariaUrticaria pigmentosa (mastocytosis)
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Telangiectasia macularis eruptiva perstans (TMEP) – another mastocytosis
Stains for mast cells: Giemsa, Toluidine blue, CD117, mast cell tryptase
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Dermis
Lichen amyloidUrticariaUrticaria pigmentosa (mastocytosis)Nodular amyloid
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Dermis
Lichen amyloidUrticariaUrticaria pigmentosa (mastocytosis)Nodular amyloidNevus of Ota
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Dermis
Lichen amyloidUrticariaUrticaria pigmentosa (mastocytosis)Nodular amyloidNevus of OtaScleredema
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Scleredema
Diabetics, post-infectious, or ?blood dyscrasiaIll-defined plaquesHistology – square biopsy, edemaMucin stain may be helpful
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Dermis
Lichen amyloidUrticariaUrticaria pigmentosa (mastocytosis)Nodular amyloidNevus of OtaScleredemaAnetoderma
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Dermis
Lichen amyloidUrticariaUrticaria pigmentosa (mastocytosis)Nodular amyloidNevus of OtaScleredemaAnetodermaConnective tissue nevus
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Dermis
Lichen amyloidUrticariaUrticaria pigmentosa (mastocytosis)Nodular amyloidNevus of OtaScleredemaAnetodermaConnective tissue nevus/White fibrous papulosis of neck
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Invisible because it is something else
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CK7
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Cam 5.2
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Extramammary Paget disease
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“Dark” Paget’s
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Metastatic renal cell carcinoma
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Keratin
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Leishmaniasis mimicking squamous cell carcinoma
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Kaposi sarcoma mimicking dermatofibroma
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Kaposi sarcoma mimicking stasis
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HISTORY
38 year-old female with lesions on tongue, foot and hands.Clinical impression: Lichen planus
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