DERMATOPATHOLOGY(FOR DENTISTRY STUDENT)Prateep WarnnissornDepartment of Medicine, Naresuan University

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Overview

Definition of terms

Infectious diseases -wart, molluscum contagiousum

Inflammatory diseases -acne, urticaria, eczema, arthropod bites, psoriasis, seborrheic dermatitis, vesiculobullous disease

Neoplastic diseases -SCC, BCC & MM

Principles of therapy of skin change and pathology

OVERVIEW

Normal skin

Wound healing

NORMAL SKIN

Epidermis

Dermis

Subcutaneous

Adnexal structures

EPIDERMIS

http://headandneckcancerguide.org/wp-content/uploads/2013/02/61_epidermis2.jpg

http://missinglink.ucsf.edu/lm/dermatologyglossary/img/Dermatology%20Glossary/Glossary%20Histo%20Images/Epidermis_40x-211.jpg

EPIDERMIS -MUCOUS MEMBRANE

S.spinosum

larger cells

pale cytoplasm-more glycogen

Granular layer -none

Keratinization with parakeratosis (retain nucleus)

http://www.lab.anhb.uwa.edu.au/mb140/corepages/oral/oral.htm

DERMIS

http://kreativestudios.com/Tooltip/05Integument/images/03Dermis.jpg

DERMIS

http://www.lab.anhb.uwa.edu.au/mb140/corepages/connective/Images/skk040evg.jpg

http://www.google.com/imgres?client=safari&rls=en&biw=1135&bih=669&tbm=isch&tbnid=n1dYl8VhB3YE1M%3A&imgrefurl=http%3A%2F%2Fwww.studyblue.com%2Fnotes%2Fnote%2Fn%2Funit-4-histology--connective-tissue-proper%2Fdeck%2F1989056&docid=5yd0dxzL1qRYPM&imgurl=http%3A%2F%2Fclassconnection.s3.amazonaws.com%2F844%2Fflashcards%2F1132844%2Fjpg%2Fcardimage_1989056_01327949756872.jpg&w=1000&h=688&ei=ab4nU4DdO4WFrAfghYCgDA&zoom=1&ved=0COABEIQcMC0&iact=rc&dur=509&page=3&start=30&ndsp=18

HYPODERMIS & ADNEXAL STRUCTURES

http://apbrwww5.apsu.edu/thompsonj/Anatomy%20&%20Physiology/2010/2010%20Exam%20Reviews/Exam%202%20Review/dermis_diagram.gif

WOUND HEALING

Coagulation

Inflammatory

Proliferative & migration

Remodeling

http://img.medscape.com/article/782/469/782469-fig2.jpg

DEFINITION OF TERMS

S.corneum/keratin -orthokeratosis, parakeratosis

S.malphigii -atrophy, acanthosis, papillomatosis

S.granular -hypergranulosis, hypogranulosis

S.spinusum -ballooning, spongiosis, acantholysis, dyskeratosis

Terms in viral infections

Exocytosis -white blood cells in epidermis

ORTHOKERATOSIS

Thickening of the s.corneum

http://escholarship.org/uc/item/1qg46424/111902-3b.jpg

PARAKERATOSIS

Flattened keratinocyte nuclei in S.corneum

http://www.skinpathology.org/psoriasis/

ATROPHY

Thining of epidermis

http://www.globalskinatlas.com/upload/lg259_8.jpg

ACANTHOSIS

hypertrophy of s.spinosum

http://classconnection.s3.amazonaws.com/866/flashcards/880334/png/acanthosis.png

PAPILLOMATOSIS

nipplelike growths

http://www.ijdvl.com/articles/2013/79/3/images/ijdvl_2013_79_3_338_110769_f6.jpg

HYPERGRANULOSIS

thickened granular layer

http://www.dermaamin.com/site/images/histo-pic/h/hypertrophic-lichen-planus/hypertrophic-lichen-planus1.jpg

HYPOGRANULOSIS

decrease thickness of granular layer

http://openi.nlm.nih.gov/detailedresult.php?img=3276782_ad-23-S303-g002&req=4

INTRACELLULAR EDEMA

ballooning

intracellular clear round spaces

pale, large cells

https://web.duke.edu/pathology/Week19/Week19.html#answer

INTERCELLULAR EDEMA

spongiosis

widening of intercellular bridge

http://1.bp.blogspot.com/_51yzVOvZWEc/SzxAJJVLbiI/AAAAAAAAFjg/0PpWqE3_Pq0/s400/Eczema%20nummular2.jpg

ACANTHOLYSIS

separation and rounding up of cells

loss of intercellular adhesions

http://missinglink.ucsf.edu/lm/dermatologyglossary/img/Dermatology%20Glossary/Glossary%20Histo%20Images/acantholysis.jpg

DYSKERATOSIS

necrosis, apoptosis

prematurely keratinised

prominent eosinophilic cytoplasm

TERMS IN VIRAL INFECTIONS

Coarse clumping keratohyaline granules

Intranuclear inclusion body

Intracytoplasmic inclusion body

multinucleated giant cells

Koilocyte

COARSE CLUMPING KERATOHYALINE GRANULES

large keratohyaline granules in s.granular layer

http://forum.mckeedermpath.com/uploads/88ca6edbc0492119d1735034a98b55a8.jpg

INTRANUCLEAR INCLUSION BODY

large intranuclear inclusion body

eccentric, crescent bluish nucleus

http://upload.wikimedia.org/wikipedia/commons/d/d3/Molluscum_contagiosum_1.jpg

INTRACYTOPLASMIC INCLUSION BODY

http://cai.md.chula.ac.th/chulapatho/chulapatho/lecturenote/infection/Pathology%20of%20infection/inclusion%20bodies/verruca_vulgaris/verruca4.gif

MULTINUCLEATED GIANT CELL

http://cai.md.chula.ac.th/chulapatho/chulapatho/lecturenote/infection/Pathology%20of%20infection/inclusion%20bodies/herpesimplex_files/SKIN085.jpg

VACUOLATED CELL /KOILOCYTE

perinuclear halo or clear cytoplasm

http://jcwl.glmc.edu.cn/glblnet/severbj1/bl/JPEG3/SKIN036.JPG

INFECTIOUS DISEASES

Warts

Molluscum contagiosum

WARTS / VERRUCA VULGARIS

acanthosis

“church spire papillomatosis

ortho-and parakeratosis

hypergranulosis

koilocytosis

inward bending of tete

http://cai.md.chula.ac.th/chulapatho/chulapatho/lecturenote/infection/Pathology%20of%20infection/inclusion%20bodies/verrusca_vulgaris.html

MOLLUSCUM CONTAGIOSUM

intracytoplasmic inclusion body

crescentric nucleus

http://www.webpathology.com/slides/slides/ExtGenitalia_Molluscum1.jpg

INFLAMMATORY DISEASES

acne

urticaria

eczema

arthropod bites

psoriasis

seborrheic dermatitis

vesiculobullous disease -pemphigus, pemphigoid

http://accessmedicine.mhmedical.com/content.aspx?bookid=392&sectionid=41138785

ACNE VULGARIS

http://dermaamin.com/site/images/histo-pic/a/acne-vulgaris/acne-vulgaris1.jpg

URTICARIA

dermal edema

vascular dilatation & endothelial swelling

scant perivascular infiltration

http://www.dermpedia.org/files/images/Urticaria_4.jpg

ECZEMA

spongiosis (acute > subacute)

spongiotic vesicle (acute > subacute)

exocytosis (acute > subacute)

parakeratosis (subacute)

http://upload.wikimedia.org/wikipedia/commons/9/9d/Spongiotic_dermatitis_(2)_Dyshidrotic_.JPG

ECZEMA (CHRONIC)

vertical collagen streak

compact orthokeratosis

acanthosis (chronic > subacute)

http://missinglink.ucsf.edu/lm/dermatologyglossary/img/Dermatology%20Glossary/Glossary%20Histo%20Images/lichen_simplex_chronicus_from_normal_skin_mid_power.jpg

http://missinglink.ucsf.edu/lm/dermatologyglossary/img/Dermatology%20Glossary/Glossary%20Histo%20Images/lichen_simplex_chronicus_from_normal_skin_mid_power.jpg

ARTHROPOD BITE

edema epidermis & dermis

wedge shape inflammation

infiltration superficial & deep

mainly eosinophils

http://classconnection.s3.amazonaws.com/352/flashcards/717352/png/untitled1319594530915.png

PSORIASIS

parakeratosis & orthokeratosis

neutrophils

in s.corneum (Munro microabscess)

in upper epidermis (spongioform pustule of Kogoj)

thin suprapapillary plate (Auspitz sign)

dilate vessels close to the epidermis

elongation of rete ridge (camel foot)

http://www.dermweb.com/pathology/graphics/annotations/psoriasis1ann.jpg

http://www.ijdvl.com/articles/2013/79/3/images/ijdvl_2013_79_3_338_110769_f4.jpg

http://www.ijdvl.com/articles/2013/79/3/images/ijdvl_2013_79_3_338_110769_f4.jpg

SEBORRHEIC DERMATITIS

eczema + psoriasis

spongiosis without spongiotic vesicle

shoulder parakeratosis (follicular ostia), neutrophilic parakeratosis

sebaceous gland -large & numerous

http://dermaamin.com/site/images/histo-pic/s/seborrheic-dermatitis/seborrheic-dermatitis4.jpg

PEMPHIGUS VULGARIS

suprabasal separation “raw of tomb stone”

Direct immunoflourescence -IgG on surface of keratinocytes

http://dermaamin.com/site/images/histo-pic/p/pemphigus-histopathology/pemphigus-histopathology25.jpg

http://www.ijdvl.com/articles/2013/79/3/images/

ijdvl_2013_79_3_338_110769_f27.jpg

http://www.google.com/url?sa=i&source=images&cd=&docid=durhjvZDMNVQ8M&tb

nid=7F2_20A-gcmTcM:&ved=0CAUQjBw4Og&url=http%3A%2F%2Fimg.medscape.com%2Fpi%2Femed%2Fckb

%2Fdermatology%2F1048885-1064187-3368.jpg&ei=qSctU4XFOMbXrQfVp4CAAg&psig=AFQjCNF

5H0fq_2qRG6pU9RqeDU9pd-Qx7w&ust=1395554602033805

BULLOUS PEMPHIGOID

subepidermal separation

eosinophil

DIF -linear C3 & IgG at basement membrane zone

http://plaza.umin.ac.jp/pathol2/photo-library/system/data/image_data/

11348999517711.jpg

http://eso-cdn.bestpractice.bmj.com/best-practice/images/bp/en-gb/453-

8_default.jpg

NEOPLASM

Basal cell carcinoma

Squamous cell carcinoma

Malignant melanoma

BASAL CELL CARCINOMA

large uniform nuclei and scant cytoplasm

retraction of the stroma around the tumor islands -clefts

aggregations of basaloid keratinocytes extend from epidermis to dermis

peripheral palisading

http://plaza.umin.ac.jp/pathol2/photo-library/system/data/

image_data/11349004874921.jpg

SQUAMOUS CELL CARCINOMA

normal & atypical squamous cells -nuclear pleomorphism, apoptosis, mitosis

horn pearls -foci of keratinization in concentric rings of squamous cells

extension of atypical keratinocyte beyond the basement membrane (invasive SCC)

http://missinglink.ucsf.edu/lm/dermatologyglossary/

img/Dermatology%20Glossary/Glossary%20Histo%20Images/

squamous_cell_carcinoma_invasive_high_power.jpg

MALIGNANT MELANOMA

architectural

asymmetry

poor lateral circumscription (single, scattered cells)

large size >5 mm)

epidermal nest larger than dermal nest

pagetoid spreading -spread to upper epidermis and later to dermis

http://melanocytepathology.com/

uploads/editor/Malignant_melanoma_12_a.

jpg

MM

cytologic atypia

large nuclear & cytoplasm (with dusty pigment)

nuclear pleomorphism, hyperchromasia & variability

mitosis & necrotic

https://secure.health.utas.edu.au/intranet/cds/pathprac/Files/

Cases/Skin/Case96/Case96.htm

PRINCIPLES OF THERAPY OF SKIN CHANGE AND PATHOLOGY

Corticosteroids

Retinoids

Immunomodulators

Keratolytics

Antiperspiration

Psoriasis therapies

CORTICOSTEROIDS

Anti-proliferative

inhibit DNA synthesis

reduce keratinocyte size and proliferation

Anti-inflammatory

inhibit phospholiapse A2 release & transcription factors -activator protein-1 & nuclear factor kappa B

Immunosuppressive

suppress leukocyte migration, mast cells, Langerhans cells & T-cell proliferation

Vasoconstrictive

RETINOIDS

Increase

differential markers -involucrin, loricrin, filaggrin & transglutaminase

proliferation of basal keratinocytes

IMMUNOMODULATORS

Calcineurin inhibitor

tacrolimus

interact FK-506 binding protein, inhibit nuclear translocation

anti-inflammatory -decrease T-cell proliferation and pro inflammatory cytokines

Imidazoquinoline amine

imiquimod -TLR-7 & TLR-8 agonist

enhances immune response -proinflammatory cytokines

antiviral (wart, molluscum), antitumoral (actinic keratosis, basal cell carcinoma)

KERATOLYTICS

Salicylic acid

loosening corneocytes connections

soften s.corneum

Urea

Lactic acid

ANTIPERSPIRATION

Aluminium chloride

formation of an obstruction of sweat gland

PSORIASIS THERAPIES

Coal tar

inhibit DNA synthesis and mitosis

Calcipotriene

inhibit epidermal proliferation

induce epidermal differentiation

calcipotriol