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8/3/2019 7 CPC Cases Final
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Case 1Case 1
5858 yoyo AAM with new lesions on arms AAM with new lesions on armsfor 6 weeksfor 6 weeks
Worse with sun exposureWorse with sun exposure
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PAS Colloidal Iron
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Discoid Lupus ErythematosusDiscoid Lupus Erythematosus
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Discoid Lupus ErythematosusDiscoid Lupus Erythematosus
Dense superficial and deepDense superficial and deep periadnexalperiadnexal,,perivascularperivascular mononuclear infiltratemononuclear infiltrate
Interface dermatitisInterface dermatitis
– – Vacuolar changes, pigment incontinence, Vacuolar changes, pigment incontinence,necrotic keratinocytesnecrotic keratinocytes
Follicular pluggingFollicular plugging
Basement membrane thickeningBasement membrane thickening
Increased dermalIncreased dermal mucinmucin
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“ “
LL” ” ss
of Dense Dermal Lymphocytic Infiltratesof Dense Dermal Lymphocytic Infiltrates
LLupus erythematosusupus erythematosus
LLymphocytic lymphomaymphocytic lymphoma
– – Atypical lymphocytes, not usually Atypical lymphocytes, not usually periadnexalperiadnexal
LLymphocytomaymphocytoma cutiscutis
– – Larger lymphocytes, often mimics germinal center formationLarger lymphocytes, often mimics germinal center formation
PolymorphousPolymorphous LL ight Eruptionight Eruption
– – Significant papillary dermal edema, notSignificant papillary dermal edema, not periadnexalperiadnexal
LLymphocytic infiltrates of ymphocytic infiltrates of JessnerJessner
– – Similar to LE, increased numbers of B cellsSimilar to LE, increased numbers of B cells
LLuesues
– – Many plasma cells, no increase inMany plasma cells, no increase in mucinmucin;; TpTp stains,stains, serologiesserologies
LLyme diseaseyme disease
– – LymphoplasmacyticLymphoplasmacytic infiltrates, silver stains for spirochetesinfiltrates, silver stains for spirochetes
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Case 2Case 2
7373 yoyo man with itchyman with itchy “ “bumpsbumps” ” on legson legs
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Hypertrophic Lichen PlanusHypertrophic Lichen Planus
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Hypertrophic Lichen PlanusHypertrophic Lichen Planus
Prominent hyperplasia of epidermis with overlyingProminent hyperplasia of epidermis with overlying
orthokeratosisorthokeratosis
Psoriasiform hyperplasia at margins (secondary toPsoriasiform hyperplasia at margins (secondary to
rubbing)rubbing)
Basal cell damage usually confined to the tips of Basal cell damage usually confined to the tips of
reterete ridgesridges
Typically infiltrate is not as dense or bandTypically infiltrate is not as dense or band--likelike
Can seeCan see eoseos and plasma cells (and plasma cells (ββ
blockers)blockers)
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Case 3Case 3
5656 yoyo WM with new onset of tenderWM with new onset of tendersores on upper bodysores on upper body
Multiple sclerosis, on mycophenolateMultiple sclerosis, on mycophenolate
mofetil and prednisonemofetil and prednisone
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Disseminated Necrot ic Herpes ZosterDisseminated Necrotic Herpes Zoster
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Herpes Virus InfectionHerpes Virus Infection
Epidermal nuclei: peripheral clumping of chromatin,Epidermal nuclei: peripheral clumping of chromatin,homogeneous groundhomogeneous ground--glass appearance, ballooning,glass appearance, ballooning,
eosinophilic intranuclear inclusion bodieseosinophilic intranuclear inclusion bodies
Cytoplasm: vacuolization initially along the basalCytoplasm: vacuolization initially along the basallayer, then entire epidermislayer, then entire epidermis
Ballooning degeneration & reticular degenerationBallooning degeneration & reticular degeneration
Perineural and some intraneural inflammationPerineural and some intraneural inflammation
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Case 4Case 4
New rash on face of pregnant womanNew rash on face of pregnant woman
Growing for 2 weeksGrowing for 2 weeks
ItchyItchy
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DermatophytosisDermatophytosis
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DermatophytosisDermatophytosis
BasketBasket--weave aboveweave abovecompact stratum corneumcompact stratum corneum
Collection of neutrophilsCollection of neutrophils
Non pigmentedNon pigmented hyphaehyphae inin
stratum corneumstratum corneum
PAS diagnosticPAS diagnostic
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NeutrophilicNeutrophilic SpongiosisSpongiosis
PustularPustular psoriasispsoriasis
Reactive arthritisReactive arthritis
IgA pemphigusIgA pemphigus
PalmoplantarPalmoplantar pustulosispustulosis
DermatophytosisDermatophytosis andand candidiasiscandidiasis
Acute generalized Acute generalized exanthematousexanthematous pustulosispustulosis
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Case 5Case 5
Routine annual full body skin check onRoutine annual full body skin check on7272--yearyear--oldold
Small scaly reddish brown papule onSmall scaly reddish brown papule on
back back
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Retrospective study of 342 cases of invasive MM and MIS fromRetrospective study of 342 cases of invasive MM and MIS fromhead, neck, chest, back head, neck, chest, back
23 (6.7%) had a lichenoid tissue reaction obscuring a portion of 23 (6.7%) had a lichenoid tissue reaction obscuring a portion of the lesionthe lesion
Only rarely were melanocytic nests evident within the lichenoidOnly rarely were melanocytic nests evident within the lichenoidarea uponarea upon immunostainingimmunostaining lichenoid regressionlichenoid regression
Melanoma in SituMelanoma in Situ
Anatomic Pathology / LICHENOID TISSUE REACTION IN MALIGNANT MELANOMA 766 Am J Clin
Pathol 2002;117:766-770 © American Society for Clinical Pathology
Lichenoid Tissue Reaction in Malignant Melanoma A Potential Diagnostic Pitfall
CPT Scott R. Dalton, MC, USA,1,3 Capt Matt A. Baptista, USAF, MC,1,3COL Lester F. Libow, MC, USA,2 and COL Dirk M. Elston, MC, USA2
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Case 6Case 6
4343--yearyear--old with ESRD on HD for 10old with ESRD on HD for 10yearsyears
Skin tightening started a few monthsSkin tightening started a few months
ago and is getting worseago and is getting worse
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NephrogenicNephrogenic Systemic FibrosisSystemic Fibrosis
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NephrogenicNephrogenic
Systemic FibrosisSystemic Fibrosis
IncreasedIncreased cellularitycellularity of dermis and subcutaneous fatof dermis and subcutaneous fat
Spindled andSpindled and dendriticdendritic cells interspersed betweencells interspersed between
thickened collagen bundlesthickened collagen bundles
EpitheloidEpitheloid and multinucleated giant cellsand multinucleated giant cells
Variable increase in dermal Variable increase in dermal mucinmucin and elastic fibersand elastic fibers
Immunohistochemistry:Immunohistochemistry: – – CD34:CD34: fibrocytesfibrocytes
– – FactorFactor XIIIaXIIIa and CDand CD--68: mono68: mono-- and multinucleated cellsand multinucleated cells
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Case 7Case 7
New growths on leg of 53New growths on leg of 53 yoyo manman
Similar lesions in mother and sisterSimilar lesions in mother and sister
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PorokeratosisPorokeratosis
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PorokeratosisPorokeratosis
Clonal disorder of keratinization withClonal disorder of keratinization with
hyperproliferation of atypical keratinocyteshyperproliferation of atypical keratinocytes
CornoidCornoid lamella: narrow column of lamella: narrow column of hyperparakeratosishyperparakeratosis
above a cluster of above a cluster of dyskeratoticdyskeratotic keratinocyteskeratinocytes
Typically 2Typically 2 cornoidcornoid lamellae lean towards each otherlamellae lean towards each other
Epidermis in between is thin, sometimesEpidermis in between is thin, sometimes dyskeratoticdyskeratotic
Patchy lichenoid inflammationPatchy lichenoid inflammation
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Case 8Case 8
Painful boils on the legs of a 60Painful boils on the legs of a 60 yoyowoman hospitalized for acutewoman hospitalized for acute
pancreatitispancreatitis
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Pancreatic PanniculitisPancreatic Panniculitis
Mixed lobular and septal panniculitisMixed lobular and septal panniculitis
“ “Ghost cellsGhost cells” ” : necrotic, partially calcified: necrotic, partially calcifiedadipocytesadipocytes
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Case 9Case 9
1616 y/oy/o M with 3 wk M with 3 wk h/oh/o reddishreddish--brownbrown
papules on arms and legspapules on arms and legs
R/oR/o xanthomasxanthomas, guttate psoriasis or GA , guttate psoriasis or GA
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Pityriasis Lichenoides etPityriasis Lichenoides et Varioliformis Varioliformis Acuta Acuta
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Pityriasis Lichenoides etP ityriasis Lichenoides et
Varioliformis Varioliformis Acuta Acuta (PLEVA)(PLEVA)
Superficial and deep, wedge shapedSuperficial and deep, wedge shapedperivascularperivascular infiltrateinfiltrate
Mounds of parakeratosis with neutrophilsMounds of parakeratosis with neutrophils
Vacuolar degeneration of basal layer Vacuolar degeneration of basal layer
Papillary dermal hemorrhagePapillary dermal hemorrhage
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Case 10Case 10
4949 yoyo WM with 2 monthWM with 2 month h/oh/o rashrash
PreviousPrevious bxbx: lymphoma cutis: lymphoma cutis
Lymphoma cutisLymphoma cutis vsvs drug reactiondrug reaction
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Secondary SyphilisSecondary Syphilis
Psoriasiform hyperplasia of the epidermisPsoriasiform hyperplasia of the epidermis
Superficial and deepSuperficial and deep perivascularperivascular infiltrateinfiltrate
Plasma cellsPlasma cells