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Dms146 Slide Dermatopathology
Dms146 Slide Dermatopathology
Dr. H
Dr
H. Soekimin
Soekimin, SpPA
Dr. T. Ibnu Alferraly, SpPA
Departemen
p
Patologi
g Anatomi
FK USU
Makula ( Macule ) : ruam bulat pada kulit, ukuran bervariasi, datar, perbedaan warna dgn
kulit sekitar
Papula ( Papule ) : daerah kulit dgn elevasi solid 5 mm
Nodul ( Nodule )
Plak ( Plaque )
: vesikel besar
besar, 5 mm
Blister
Likenifikasi
f
( Lichenification
f
)
Ekskoriasi ( Excoriation )
Papule: Raised dome shaped lesion less than 0.5 cm. (Common Nevi,
Moles, Cherryy angioma,
g
Sarcoidosis
Plaque: A slightly raised area which is not very deep with a flat top and
Patch:
atc Macule larger
g than 1 cm in size. Monocytic
y Leukemia
Rash
Desquamation
(
)
cm . (Psoriasis)
>0.5
(Hives)
(freckles) bluish
(freckles),
Scale: Flake of flat horny cells which is loosened from the cells below
(Psoriasis)
Atrophy:
p y Loss of substance of Skin. Thinningg of epidermis,
p
, dermis or
subcutaneous tissue. Ehler's Danlos syndrome
Vescicle: Dome shaped, thin wall, less than 05.cm in diameter, filled with fluid
Pustule: Vescicle filled with pus. Less than 0.5 cm in size. (Acne pustule)
Ulcer: Hole in skin. Heals with scar when it is not malignant. (Squamous cell
E ti
Erotion:
L
Less
d
deeper than
h ulcer
l
(Leukemia cutis)
Fluctuation present.
cancer)
Vesicle/ Bullae
Clinical findings of the proband. (a) Confluent vesicles and bullae on the palms
and
d llateral
t l aspects
t on th
the fifingers. (b) D
Desquamation
ti on th
the palms.
l
((c)) Confluent
C fl
t
vesicles on the sole. (d) Histological results showing spongiosis and spongiotic
vesicles (hematoxylin and eosin staining).
Purpura
Fisure
Fi
Macula
Telengiectasi
g
Ulcer
AKANTOLISIS :
The loss of cohesion between epidermal or adnexal keratinocytes
AKANTOSIS
The increase in the thickness of the stratum malpighii
Examples of acanthosis in
Psoriasis
Lichen Simplex
Chronicus
ANAPLASIA
The atypical appearance of nuclei as is found in malignant neoplasia.
Anaplastic nuclei are usually large, irregular and hyperchromatic, and may
produce bizarre or atypical mitotic figures.
APOPTOSIS
The dropping off of colloid bodies from the epidermis into the dermis.
Apoptosis typically occurs in disorders in which basal cell damage occurs, such as
lichenoid tissue reactions
Lichen Plannus
BULLA
A cavity of at least 5 mm in diameter forming within or below the epidermis
EPIDERMOLITIK HIPERKERATOSIS
Also called granular degeneration. It is characterized by:
1.
2.
3.
4.
Actinic Keratoses
EPITHELOID
Cells derived from macrophages, seen in granulomas and characterized by a large,
usually oval, pale, vesicular nucleus with a clearly visible nuclear membrane.
The cytoplasm is abundant,
abundant ill
ill-defined
defined and slightly eosinophilic.
eosinophilic
Multinucleated epithelioid or giant cells arise from mature macrophages
that fuse rather than divide.
Langhans giant cells have nuclei in a semicircle at the cell periphery.
Foreign body giant cells have nuclei distributed randomly.
GIANT CELL
Large multinucleated cells.
Epidermal multinucleated giant cells are characteristic of herpes virus infections.
Histiocytic giant cells whose nuclei form a horseshoe arrangement are called
Langhans type giant cells.
Touton type giant cells have a ring of nuclei surrounding foamy cytoplasm with
cytoplasm usually also visible around the nuclei.
Foreign-body giant cells have a haphazard nuclear arrangement
PARAKERATOSIS
Retention of nuclei in the stratum corneum.
This is a normal finding on mucous membranes
PLEOMORFIK
The variation in the appearance of the nuclei of the same cell type. If pronounced
and associated with large, irregular, hyperchromatic nuclei it is termed anaplasia
and is often an indication of malignancy.
VILLUS
A dermal papilla extending into a bulla, vesicle, or lacuna which is covered with a
single layer of epidermal cells resulting from suprabasalar acantholysis .
Example of Villus in Pemphigus vulgaris
Eczema Dermatitis
Histologic sections of skin show epidermal acanthosis with marked spongiosis,
spongiosis
leading to intraepidermal vesicle formation. The vesicles are filled with serum and
inflammatory cells.
Eczema
Dermatitis
Erythema Multiformis
Erythema Multiformis
The early lesion of EM is characterized
by infiltration of lymphocytes at the
dermal-epidermal interface with
accompanying exocytosis and
spongiosis in the epidermis.
Individual eosinophilic necrotic
keratinocytes may be scattered and
surrounded by lymphocytes (satellite
cell necrosis).
The dermal changes
include edematous papillary dermis,
ectatic and swollen endothelial cells of
the vessels, and extravasation of the
red blood cells.
Psoriasis
Psoriasis
Epidermis
Mitotic activity of basal keratinocytes is increased almost 50-fold, with
keratinocytes migrating from the basal to the cornified layers in only 3
3-5
5 days
compared to the normal 28-30 days.
With hyperproliferation of skin cells, the epidermis becomes thickened or
acanthotic in appearance and an increase in size of the rete ridges is observed.
Abnormal keratinocyte differentiation is noted throughout the psoriatic plaques,
as manifested by the loss of the granular layer
layer.
The stratum corneum is also thickened, and the retention of cell nuclei in this
layer is referred to as parakeratosis.
Neutrophils and lymphocytes can be observed migrating upwards from the
dermis into the acanthotic epidermis. Neutrophils may form localized collections
known as Munro microabscesses
microabscesses. The presence of alternating collections of
neutrophils sandwiched between layers of parakeratotic stratum corneum is
virtually pathognomonic for psoriasis.
Psoriasis
Dermis
Marked hypervascularity and an increase in the size of the dermal
papillae occur
occur.
An activated CD3+ lymphocytic infiltrate is noted around blood vessels, with
T cells expressing cutaneous lymphocyteassociated antigen, co-stimulatory
molecules such as CD2, and LFA-1 adhesion molecules.
An aggregation of neutrophils in the dermis occurs that extends up into the
epidermis.
Lichen Planus
Lichen Planus
The inflammatory reaction pattern is characteristic.
The epidermis is hyperkeratotic with irregular acanthosis and focal thickening in
the granular layer
layer.
Degenerative keratinocytes, known as colloid or Civatte bodies, are found in
the lower epidermis.
In addition to apoptotic keratinocytes, colloid bodies are composed of globular
deposits of IgM (occasionally immunoglobulin G [IgG] or immunoglobulin A [IgA])
and complement.
Linear or shaggy deposits of fibrin and fibrinogen and liquefaction are in the
basement membrane zone.
Lichen Planus
Epidermal thickening of all layers is noted, with elongation of rete ridges and with
pseudoepitheliomatous hyperplasia. Papillary dermal fibrosis with vertical streaking of
collagen bundles is characteristic.