7 CPC Cases Final

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







PAS Colloidal Iron



Discoid Lupus ErythematosusDiscoid Lupus Erythematosus



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



“ “

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



Case 2Case 2

7373 yoyo man with itchyman with itchy “ “bumpsbumps” ” on legson legs











Hypertrophic Lichen PlanusHypertrophic Lichen Planus



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)



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











Disseminated Necrot ic Herpes ZosterDisseminated Necrotic Herpes Zoster



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



Case 4Case 4

New rash on face of pregnant womanNew rash on face of pregnant woman

Growing for 2 weeksGrowing for 2 weeks

ItchyItchy











DermatophytosisDermatophytosis



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



NeutrophilicNeutrophilic SpongiosisSpongiosis

PustularPustular psoriasispsoriasis

Reactive arthritisReactive arthritis

IgA pemphigusIgA pemphigus

PalmoplantarPalmoplantar pustulosispustulosis

DermatophytosisDermatophytosis andand candidiasiscandidiasis

Acute generalized Acute generalized exanthematousexanthematous pustulosispustulosis



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









Melan-A



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



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









CD34



FXIIIa CD68



NephrogenicNephrogenic Systemic FibrosisSystemic Fibrosis



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



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









PorokeratosisPorokeratosis



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



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











Pancreatic PanniculitisPancreatic Panniculitis

Mixed lobular and septal panniculitisMixed lobular and septal panniculitis

“ “Ghost cellsGhost cells” ” : necrotic, partially calcified: necrotic, partially calcifiedadipocytesadipocytes



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











Pityriasis Lichenoides etPityriasis Lichenoides et Varioliformis Varioliformis Acuta Acuta



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



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















Secondary SyphilisSecondary Syphilis

Psoriasiform hyperplasia of the epidermisPsoriasiform hyperplasia of the epidermis

Superficial and deepSuperficial and deep perivascularperivascular infiltrateinfiltrate

Plasma cellsPlasma cells



Thank youThank you

7 CPC Cases Final

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