HISTOLOGICAL DIAGNOSTIC CLUES
Daniel J. Santa CruzSt Louis, MO, USA
PATHOGNOMONIC
(Gr. Pathos- disease + -Gnomonikos fit to give judgement)
1. Specifically distinctive or characteristic of a disease or pathological condition.
2. A sign or symptom on which a diagnosis can be made.
DORLAND’S Illustrated Medical Dictionary
BLUE CUTICLE IN THE HORNY LAYER
Scabies
Norwegian scabies
Scabies Demodex
ABSENCE OF EPIDERMAL GRANULAR CELL LAYER
Ichthyosis vulgaris
ICHTHYOSIS VULGARIS
ICHTHYOSIS VULGARIS
ICHTHYOSIS VULGARIS
ICHTHYOSIS NORMAL SKIN
GRANULAR PARAKERATOSIS
“Axillary” granular parakeratosis
Courtesy of Omar Sangueza, MD
CLINICAL FEATURES
Red or hyperpigmented areas in one or both axilla.
Also described in the submammary fold. Suspected to be a reaction to antiperspirants.
REFERENCES
Northcut AD, Nelson DM and Tschen JA. Axillary granular parakeratosis.J Am Acad Dermatol 1991; 24:541-4.
Barnes CJ, Lesher JL, and Sangueza OP. Axillary granular parakeratosis.Int J Dermatol 2001; 40:439-41
ALTERNATING ORTHO AND PARAKERATOSIS
Actinic keratosis
EPIDERMAL SQUAMOUS EDDIES
Incontinentia pigmenti
SQUAMOUS EDDIES
Irritated seborrheic keratosis Verrucae Squamous cell carcinoma Benign follicular neoplasms
THE VASE SIGN
Spongiotic dermatitis
SPONGIOTIC DERMATITIS
SPONGIOTIC DERMATITIS
CD1a
Mycosis fungoides Langerhans cell histiocytosis
Spongiotic folliculitis
LeBoit, P E and Epstein, B AA vase-like shape characterizes the epidermal-mononuclear cell collections seen in spongiotic dermatitis.Am J Dermatopathol 1990, 12: 612-6
GRANULAR KERATINOCYTIC NECROSIS
Herpetic infection
HERPES
HERPES
HERPES
HERPES
HERPES
EPIDERMAL DYSTROPHY
Chemotherapy effect
EPIDERMAL DYSTROPHY
Pronounced dysmaturation of the epidermis Keratinocytes with large nuclei alternating with
very small ones Multiple nucleoli Apoptosis at all levels of the epidermis High level mitoses Abnormal mitoses
EPIDERMAL DYSTROPHYDifferential diagnosis
Carcinoma in situ Actinic keratosis Erythema ab igne Viral cytopathic effect Post radiation changes
BASEMENT MEMBRANE THICKENING
Discoid lupus erythematosus
DISCOID LUPUS ERYTHEMATOSUS
DISCOID LUPUS ERYTHEMATOSUS
DISCOID LUPUS ERYTHEMATOSUS
DISCOID LUPUS ERYTHEMATOSUS
PAS
DISCOID LUPUS ERYTHEMATOSUS
Ig G
THICKENING OF THE BASEMENT MEMBRANE
Although very characteristic of DLE, basement membrane tickening can be see in: Inflammed seborrheic keratosis Lichen sclerosus et atrophicus
CATERPILLAR BODIES
Porphyria cutanea tarda
CATERPILLAR BODIES
CATERPILLAR BODIES
PAS
PAS
Egbert, B M, LeBoit, P E, McCalmont, T, Hu, C H and Austin, CCaterpillar bodies: distinctive, basement membrane-containing structures in blisters of porphyria.Am J Dermatopathol 1993, 15: 199-202
PUNCHED OUT HOLES IN SEBACEOUS GLANDS
Nevus sebaceus of Jadasshon
NEVUS SEBACEUS
NEVUS SEBACEUS
Wilson Jones, E and Heyl, TNaevus sebaceus. A report of 140 cases with special regard to the development of secondary malignant tumours.Br J Dermatol 1970, 82: 99-117
PAPILLARY MESENCHYMAL BODIES
Tumors of the hair germ
TRICHOEPITHELIOMA
TRICHOEPITHELIOMA
FOLLICULAR BULB AND PAPILLA
ADULT ANAGEN
TRICHOBLASTOMA
PAPILLARY MESENCHYMAL BODIES
Brooke, J D,Fitzpatrick, J E and Golitz, L EPapillary mesenchymal bodies: a histologic finding useful in differentiating trichoepitheliomas from basal cell carcinomas.J Am Acad Dermatol 1989, 21: 523-8
TRICHOMALACIA
Traction alopecia
TRACTION ALOPECIA
TRACTION ALOPECIA
TRACTION ALOPECIA
CHOLESTEROL CRYSTALS IN DERMAL ARTERIES
Atheromatous emboli
ATHEROMATOUS EMBOLI
ATHEROMATOUS EMBOLI
Malakoplakia
MICHAELIS-GUTMAN BODIES
MALAKOPLAKIA
MALAKOPLAKIA
MALAKOPLAKIA
PAS Von Kossa