Professional Documents
Culture Documents
A. Bednar tumor
B. Cylindroma
B. SyringomaCorrect Choice
D. Trichoadenoma
1
In extramammary Pagets disease, there are epidermotropic, large cells with a bluish cytoplasm. At
times these cells can form nests, but in general, there is usually a compressed basal layer beneath
the nests.
4) This is a desmoplakin:
A. Plakophilin
B. Plakoglobin
D. Beta-catenin
E. Desmocollin
Desmoplakins include desmoplakin 1, BPAg1, envoplakin, and periplakin
A. Angiokeratomas
C. Collagenomas
D. Neurofibromas
B. Sebaceous carcinoma
D. Hibernoma
E. Mucocele
Lipomembranous change is a non-specific histologic pattern that is most commonly seen in
lipodermatosclerosis, which is also known as sclerosing panniculitis; this condition may be
secondary to venous stasis
2
7) The diagnosis is:
Image Link 1
Image Link 2
A. sarcoidosis
B. foreign body
E. lymphocytoma cutis
A. Pilomatrixoma
B. Metastatic carcinoma
C. Tattoo
D. Wood splinter
A. Neurilemmoma
D. Reticulohistiocytoma
E. Neuroma
NEEDS EXPLANATIONS
3
A. spiradenoma
B. mastocytosis
C. hidradenoma
D. glomangiomaCorrect Choice
E. Kimura's
In glomangiomas, one sees multiple lumina lined by cells with pink cytoplasm and indisctinct
borders with very round nuclei. Generally, the lumina are lined by one or two layers of glomus cells.
11) 62-year old female with history of acute myeloid leukemia presents with multiple edematous,
erythematous papules after starting G-CSF.
B. Leukocytoclastic vasculitis
C. Erythema multiforme
B. Alagille's
C. Rubinstein-Taybi's
D. Schopf's
E. Brooke-SpieglerCorrect Choice
In Brooke-Spiegler syndrome, there are multiple trichoepitheliomas, cylindromas, and
spiradenomas. Nicolau and Balus syndrome has multiple eruptive syringomas, milia, and
atrophoderma vermiculata. Alagilles syndrome is the association of arteriohepatic dsyplasia with
nevus comdonicus. Schopfs syndrome associates multiple hidrocystomas with hypodontia,
palmoplantar hyperkeratosis, and onychodystrophy. In Rubinstein-Taybis syndrome, patients are
short of stature with broad thumbs and multiple pilomatricomas
4
13) This patient has multiple lesions showing the following histology. She has a family history of
such lesions. You check her for:
Image Link 1
Image Link 2
Image Link 3
B. transglutaminase
C. epoxide hydrolase
D. sulfatase
E. urease
B. pemphigus vulgaris
C. epidermal nevus
D. bullous pemphigoid
E. dermatitis herpetiformis
B. trichoepithelioma
D. syringoma
5
In adenoid cystic carcinoma, there are cords and tubules of basaloid cells, arranged in a cribiform
pattern. The cystic spaces contain a bluish material. Perineural invasion is common. The cells stain
positively for epithelial membrane antigen (EMA).
B. trichoepithelioma
D. syringoma
16) For this patient, you request that the lab perform indirect immunofluorescence using what
substrate?
A. Monkey esophagus
B. Mouse epithelium
C. Rat bladder
E. Hep-2 cells
This patient has pemphigus folicaceus, and indirect immunofluorescence works best on guinea pig
esophagus
A. Renal function
C. Liver function
D. ThyroidCorrect Choice
E. Glucose
6
Herpes gestationis is associated with an increased incidence of Graves disease.
A. Wegeners granulomatosis
B. Syphilis
A. Immunosuppression
C. Gastrointestinal polyps
D. Breast cancer
E. Cowdens
Clear cell acanthoma is associated with ichthyosis
A. metastatic carcinoma
C. pyogenic granuloma
D. bacillary angiomatous
7
Image Link 3
Image Link 4
C. Hidroacanthoma simplex
D. Poroma
A. DSG3
B. ATP2A2
C. ATP2C1Correct Choice
D. SERCA2
E. CHRNA9
In Hailey-Hailey disease, there is full-thickness acantholysis of the epidermis. The gene defect is in
ATP2C1
A. Neurothekeoma
B. Dermatofibroma
C. Angiosarcoma
E. Nodular fasciitis
Characteristic immunohistochemistry of epithelioid sarcoma is vimentin- and cytokeratin- positivity
8
24) The diagnosis is:
Image Link 1
Image Link 2
Image Link 3
A. argyriaCorrect Choice
B. minocycline-induced pigmentation
C. hemochromatosis
D. ochronosis
E. gold effect
In argyria, the silver deposits (black particles) are often seen around eccrine glands.
A. traumatic neuroma
B. acral angiofibroma
C. accessory digit
D. Koenen's tumor
A. granular IgG
D. tubular IgG
E. linear IgM
9
In dermatitis herpetiformis, there are characteristic clusters of neutrophils at the tips of dermal
papillae. Immunofluorescence will show granular IgA in the dermal papillae. Neutrophils at the
dermo-epidermal junction of a bulla can also be seen in bullous systemic lupus erythematosus,
linear IgA disease, neutrophilic bullous pemphigoid, and inflammatory epidermolysis bullosa
acquisita
A. epidermal nevus
B. poromaCorrect Choice
C. bowenoid papulosis
E. verruca
In a poroma, there is a down-growing epidermal proliferation composed of uniform cells, often with
indistinct cytoplasmic borders that have rounded, monomorphous nuclei. Within this proliferation,
there are often ducts lined by an eosinophilic cuticle
A. Congo red
B. Mucin
C. Cytokeratin 20
D. CD1aCorrect Choice
E. HMB-45
Eosinophilic granuloma is a form of Langerhans Cell Histocytosis (LCH), previously called
Histiocytosis X. Eosinophilic granuloma is a localized, benign form which is more common in males
and generally affects the bones. All forms of LCH are characterized by the infiltration of Langerhans
cells on pathology, which staing for S-100, CD1a and contain cytoplasmic birbeck granules
B. Lupus
C. Lichen planus
10
E. Lichen striatus
The histologic features shown are indicative of lichen nitidus. Lichen nitidus has a very characteristic
"claw clutching ball" appearance where the rete ridges extend downward around a lichenoid
infiltrate
C. Trichotillomania
D. Lichen planopilaris
E. Telogen effluvium
In alopecia areata, especially early stages, increased miniaturized catagen hairs can be seen in
addition to the finding of peribulbar lymphocytes resembling a swarm of bees. Lichen planopilaris
is a scarring alopecia in which vertical tracts of fibrosis are seen in place of follicles. Trichotillomania
displays follicular plugging, trichomalacia, pigmented casts, hemorrhage, and increased catagen
hairs on biopsy. Telogen effluvium is characterized by an increased number of telogen hairs
A. Monsel's reaction
B. chrysiasis
C. amalgam tattoo
D. minocycline-induced pigmentation
E. ochronosisCorrect Choice
In ochronosis, there is slightly thickened banana-shaped collagen in the superficial dermis that
appears yellow-brown in color
A. Erythema nodosum
C. Granuloma annulare
11
D. Leukocytoclstic vasculitis
E. Reumatoid nodule
Polyarteritis nodosa is a necrotizing vasculitis of medium-sized arteries in the derma-subcutaneous
junction. It is a septal panniculitis as a result of vasculitis. There is more fibrinous changes than in
thrombophlebitis and less necrosis than erythema induratum
A. Acanthosis nigricans
C. Seborrheic keratosis
D. Normal skin
E. Epidermal nevus
The histologic characteristics of verruca plana are presence of hyperkeratosis and acanthosis.
Koilocytes appear in the upper one-third of the epidermis
A. fiinger
B. glans penis
C. nose
D. labia majora
E. eyelidCorrect Choice
Vellus hair follicles are seen commonly in accessory tragic and eyelid skin
A. Bowen's disease
B. melanoma
C. sebaceous carcinoma
12
D. pagetoid reticulosis
A. mixed tumor
C. alopecia areata
D. lichen planopilaris
E. pityrosporum folliculitis
A. Incontinentia pigmenti
B. PlasmacytomaCorrect Choice
C. Urticaria
E. Pemphigus vulgaris
Plasmacytomas are characterized by the presence of monoclonal plasma cells. Plasmacytomas may
occur from primary cutaneous focus or secondarily from myeloma
B. neuroblastoma
13
C. plasmacytoma
D. Lymphoma
E. melanoma
This is a Merkel cell carcinoma, in which there is a dense collection of small blue cells with scant
cytoplasm in the dermis. The cells are sometimes arranged in trabeculae and other times in
nodules. The cells appear very blue on low power, and on higher power have somewhat pale nuclei
that have paler/darker foci within them in a salt-and-pepper pattern
A. Mastocytoma
B. Spitz nevus
D. Pilomatricoma
E. Bullous pemphigoid
Smooth muscle hamartomas are benign tumors which arise from smooth muscle of the dermis.
Pseudo-Darier's sign may be elicited due to transient piloerection after rubbing. Histologically, red-
orange bundles and fascicles are present with blunt-ended nuclei
A. apocrine adenoma
B. amyloidosis
41) The most likely diagnosis for this painful neoplasm is:
A. Glomus tumor
B. Neurilemmoma
14
C. Cutaneous endometriosisCorrect Choice
E. Angiolipoma
Cutaneous endometriosis usually occurs after gynecologic surgery. The rich, cellular stroma with
regularly shaped channels and glandular structures are typical. Hemorrhage may also be present in
deeper sections
42) What infectious agent is most likely responsible for this reaction of fibrin and antibodies which
help to prevent phagocytosis?
A. ActinomycosisCorrect Choice
B. Anthrax
C. Candida albicans
D. Ricketsii species
E. Nocardia
Hoeppli-Splendore reaction is characterized histologically by intensely eosinophilic material
consisting of fibrin and antibodies. Causes of the phenomenon include Actinomycosis israelii, Staph
aureus, Proteus, Pseudomonas and E. coli
B. Steatocystoma
D. Dermoid cyst
E. Endometriosis
Bronchogenic cysts have a pseudostratified cuboidal or columnar lining that is ciliated; goblet cells
are found in the lining as well
A. Metastatic carcinoma
15
D. Nodular hidradenoma
E. Mucinous carcinoma
NEEDS EXPLANATIONS
45) The most common cause of this in the U.S. is:
Image Link 1
Image Link 2
Image Link 3
A. Microsporum distortum
B. Epidermophyton floccosum
D. Microsporum canis
E. Trichophyton mentagrophytes
Trichophyton rubrum is the most common cause of Majocchis granuloma, a type of folliculitis where
the dermatophyte likely tracks down the follicle and creates a foreign-body-type inflammatory
reaction in the dermis
46) This patient recently developed this rash. You decide to patch test her, but in the meanwhile
you tell her to avoid:
A. Primin
B. Abietic acid
C. Benzocaine
D. CinnamonCorrect Choice
E. Chamomile
This patient likely has a fragrance allergy. Patients allergic to fragrances also need to avoid certain
spices like cinnamon
A. Cowden's
B. Wermer'sCorrect Choice
C. Cowper's
16
D. Werner's
E. Brooke's
MEN type I (Wermer's Syndrome) is sometmes associated with multiple angiofibromas. Tuberous
sclerosis is also associated with adenoma sebaceum (angiofibromas
A. Rubeola
B. Mumps
C. Roseola
D. Syphilis
E. RubellaCorrect Choice
Turk cells are atypical lymphocytes found in rubella
A. Masson's
B. bacillary angiomatosis
C. hemangioendothelioma
E. apocrine adenoma
A. Deposition disorder
B. PanniculitisCorrect Choice
C. Granulomatous disease
D. Neutrophilic dermatosis
E. Infectious process
17
Texier's disease is a panniculitis secondary to vitamin K injections causing sclerotic lesions with lilac
borders on the buttocks and thighs resembling a cowboy belt and holster
51) A patient with dystrophic nails and multiple lesions with this histologic finding may have what
gene defect?
A. Phosphorylase
C. Beta-catenin
D. Keratin 6a/16
E. Keratin 1/10
Pachonychia congenita type II (also known as Jackson-Lawler) is a autosomal dominant disorder
characterized by natal teeth, steatocystoma multiplex, and pincer nails. Steatocystomas have cyst
walls that are intricately folded or crenulated. Sebaceous glands are present within the cyst wall
A. Warty dyskeratoma
C. Trichilemmoma
D. Ecthyma contagiosum
E. Orf
This is a lesion of Molluscum contagiosum, in which there is a lobulated down-growth (cup-shaped)
of keratinocytes; centrally towards the surface, the keratinocytes are enlarged with cytoplasmic
pink inclusions (Henderson-Patterson bodies
A. Gaucher's
B. Sipple's
C. fucosidosisCorrect Choice
D. Louis-Barr
E. Bourneville's
18
multiple angiokeratomas in a bathing trunk distribution may be associated with Fabry's disease
(angiokeratoma corporis diffusum) or fucosidosis as well as some other storage diseases as well as
possibly being a normal finding. There has been a recent report of angiokeratomas in a bathing
trunk distribution in a woman with no other signs of a storage disorder
A. Lipoid protinosis
B. Erythrpoietic protoporphyria
D. Lichen amyolidosus
E. Morphea
This is lichen sclerosus et atrophicus in which there is hyperkeratosis overlying an atrophic
epidermis. Underlying the epidermis is a layer of homogenized light pink collagen. Beneath that,
there is a somewhat band-like inflammatory infiltrate of predominantly lymphocytes, but also
histiocytes and plasma cells
A. Seborrheic keratosis
B. Hidroacanthoma simplex
C. Epidermal nevus
E. Nevus sebaceus
Fibroepithelioma of Pinkus is a form of basal cell carcinoma. Histology shows long, thin,
anastomosing strans of basal cell embedded in fibrous stroma with many connections to the
epidermis
56) A newborn infant presents with bullous lesions. Based upon the pathology, what is the most
likely gene defect causing her skin condition?
A. Keratin 1 and 10
B. PAX3
C. NEMOCorrect Choice
D. Keratin 5 and 14
E. SPINK5
19
Incontinentia pigmenti is an X_linked dominant genodermatosis which presents in the newborn
period with vesicles in a Blaschkoid distribution. A biopsy would show eosinophilic spongiosis with
dyskeratotic keratinocytes and pigment incontinence. A gene defect in NEMO has been identified as
the cause for the constellation of fingings
57) The most common location for this lesion would be:
A. Upper lip
C. Buttock
D. Finger
E. Groin
Eccrine poroma is a benign, solitary tumor arsing in the lower portion of the epidermis. It is
characterized by small, uniformly cuboidal cells with deeply basophilic nuclei. The tumor mass is
assembled in broad anastomosing bands and may have narrow ductal lumina lined by eosinophilic
cuticle
C. neuroendocrine carcinoma
B. Jadassohn-Lewandowsky
C. Zinsser-Engman-Cole
D. Schaufer-Brunauer
20
E. Touraine-Solente-Gole
Jackson-Lawler (Jackson-Sertoli) is known as pachyonychia congenital type 2. Multiple steatocysts
can be seen in this condition
A. Spitz Nevi
D. Plasmacytoid Cells
E. Malakoplakia
Weibel-Palade bodies are seen in endothelial cells and are therefore found in vascular lesions.
Kamino bodies are found in Spitz nevi. Henderson Patterson bodies are seen in molluscum. Dutcher
bodies are intranuclear inclusions seen in plasmacytoid cells. Michaelis Gutmann bodies are partially
digested bacteria seen in malakoplakia
A. Norwegian salt-petter
E. Pb intoxication
The eosinophilia myalgia syndrome is characterized by marked peripheral eosinophilia with a clinical
spectrum of signs and symptoms, including generalized myalgias, pneumonitis, myocarditis,
neuropathy, encephalopathy and fibrosis. Many patients progress to a clinical picture clinically
indistinguishable from eosinophilic fasciitis. The disease is caused by the ingestion of certain lots of
L-tryptophan
62) Blue-gray pigmentation on the legs secondary to minocycline on biopsy stains with:
C. Sudan black
D. Fontana Masson
21
E. Perls
There are three types of pigmentary change that are caused by minocycline. The blue-gray
pigmentation on the legs and the blue pigment in scars is thought to be secondary to a drug-protein
complex deposited in the dermis. The blue-gray pigment on the legs stains with Perls and Fontana-
Masson. The blue in scars (often on the face) stains with Perls. The muddy-brown discoloration on
sun-exposed areas shows increased basilar pigment and melanin incontinence on biopsy. It is likely
secondary to phototoxicity.
A. Artecoll reaction
B. goutCorrect Choice
C. mucinous carcinoma
D. Urbach-Wiethe's
E. Hunter's
In gout, there are characteristic amorphous light pink masses of material within which it is
sometimes possible to see outlines of needle-like spaces. The urate crystals can only be seen if
alcohol fixation is used. The amorphous material is generally surrounded by histiocytes and foreign-
body giant cells
64) The histologic finding of "shoulder parakaratosis", parakeratosis with prediliection for the
follicular ostia, is characteristic of pityriasis rubra pilaris as well as:
A. Stasis dermatitis
B. Atopic dermatitis
D. Nummular dermatitis
22
Image Link 5
Image Link 6
A. scleroderma, early
B. erythema induratum
C. sarcoidosis
A. Psoriasis
B. Bowen's disease
D. Trichilemmoma
E. Poroma
NEEDS EXPLANATIONS
A. Electrodessication
B. Dessication
E. Freeze
The presence of deeply basophilic, wavy, angulated foreign material characteristic of gel foam
artifact
23
B. Macular amyloidosis Correct Choice
C. Mucocele
D. Neurothekeoma
E. Chondroid syringoma
Macular amyloidosis is associated with MEN IIa
A. Lymphoma
C. Glomus tumor
E. Rhabdomyosarcoma
NEEDS EXPLANATIONS
A. acrospiroma
D. syringofibroadenoma
A. Plane xanthoma
B. Necrobiotic xanthogranuloma
24
C. Scleromyxedema
E. Scleredema
Sclerosing panniculitis (lipodermatosclerosis) displays characteristic changes in the fat
(lipomembranous change); it is not associated with paraproteinemia. Generalized plane xanthomas,
scleromyxedema, necrobiotic xanthogranuloma, scleredema, erythema elevatum diutinum,
xanthoma disseminatum, and pyoderma gangrenosum have all been associated with a
paraproteinemia
A. Cylindroma
B. Trichoblastoma
C. Hidradenoma
D. Acrospiroma
A. Spiradenoma
B. CylindromaCorrect Choice
25
D. Syringocystadenoma papilliferum
E. Trichoblastoma
This is a cylindroma, in which there is a jigsaw puzzle type arrangement of islands of basaloid cells
with intervening fibrous, pink stroma. The basaloid cells are sometimes rimmed by a thick, pink
basement membrane
C. Phagolysosomes
D. Golgi
E. Ribosomes
Hibernomas commonly arise in the neck, axillae, and posterior shoulder. The cells are
multivacuolated and resemble mulberries; the cells are filled with mitochondria, as are the cells in
normal brown fat
A. Glossina
B. SimuliumCorrect Choice
C. Lutzomyia
D. Phlebotomus
E. Triatoma
Triatoma (reduviid bug) species transmit American trypanosomiasis. Glossina is the genus of tsetse
flies that transmit African trypanosomiasis. Simulium is the genus of the black fly that can tranmit
Onchocerciasis and possibly the endemic form of pemphigus foliceus (fogo selvagem). Phlebotomus
and Lutzomyia are types of sandflies that can transmit Leishmaniasis, Carrions disease, and viral
sandfly fever
77) Which of the following hitologic features would be most helpful in differentiating lichenoid drug
eruption from lichen planus?
26
C. Parakeratosis and eosinophilsCorrect Choice
D. Presence of pruritus
E. Civatte bodies
Lichenoid drug eruptions share clinical and histopathologic features with lichen planus. Sometimes
differentiation is not possible; however, eosinophil, parakeratosis, and a deeper perivascular
infiltrate is more suggestive of lichenoid drug. Implicated medications include captopril,
penicillamine, and chloroquine
78) In this patient, this test will be helpful in making the diagnosis:
B. Tissue culture
D. Patch test
E. KOH exam
This patient has penicillamine-induced pemphigus foliaceus. Direct immunofluorescence testing will
be very helpful as it should reveal intercellular antibodies within the epidermis
79) This patient says the rash is spreading and not controlled with topical therapy. You give him a
course of oral treatment that lasts:
A. 1 week
B. 3 weeksCorrect Choice
C. 5 weeks
D. 4 weeks
E. 2 weeks
Generally, for poison ivy dermatitis, if patients are given a course of oral steroids, the course should
be at least 3 weeks long, as if the duration is shorter, patients may develop a rapid rebound
80) Langerhans cells express or are characterized by all of the following except:
A. HLA-DR
B. ChromagraninCorrect Choice
C. Birbeck granules
27
D. CD1a
E. S-100
Chromagranin stain neuroendocrine cells, Merkel cellcarcinomas and eccrine glands. They do not
stain Langerhans cells
A. Dermatomyofibroma
B. Leiomyosarcoma
D. Leiomyoma
E. Traumatic neuroma
This is a palisaded encapsulated neuroma, in which there are small bundles of cells that have wavy,
thin (elongated) nuclei and pink cytoplasm. The cells are separated by artifactual clefting. The
bundles are often located very superficially. Encapsulation is often incomplete/not obvious
A. Nephrolithiasis
B. HemochromatosisCorrect Choice
C. Lymphoma
D. Thalassemia
E. Pancreatic cancer
Porphyria cutanea tarda has been shown to be associated with hemochromatosis. Patients with
porphyria cutanea tarda have mutations in the HFE gene, and early detection of mutations can
improve life expectancy for these patients
A. myxedema
28
D. mucinous granuloma annulare
E. papular mucinosis
In a digital mucous cyst, one sees a collection of mucin in the dermis beneath acral skin. This entity
is not a true cyst as there is no epithelial lining to the cyst. The mucin is largely composed of
hyaluronic acid
A. neurothkeoma
D. dermatofibroma
E. leiomyoma
In palisaded encapsulated neuroma, there are broad fascicles of spindle cells set in a clear matrix.
The fascicles of spindle cells are sometimes clearly separated from the surrounding normal dermis
by a capsule, but other times blend into the dermis. The spindle cells have elongated, thin/tapered
nuclei. Palisading of nuclei is often not obvious
A. granuloma faciale
B. pigmented purpura
D. mastocytosis
E. acrodermatitis of Mali
In leukocytoclastic vasculitis, on low power there is an inflammatory infiltrate generally clustered
around the vessels (although sometimes more dense and interstitial). There is extravasation of
erythrocytes around vessels with predominantly neutrophils around vessels and often within the
walls of the vessels. There is fragmentation of neutrophilic nuclei (nuclear dust) with fibrin (pink
amorphous material) within the walls of vessels and sometimes frank destruction of vessels
29
A. ElectrodessicationCorrect Choice
B. Gel foam
C. Knife chatter
D. Dessication
E. Freeze
The elogation of cells and spindling of nuclei with typical "string bean" appearance are characteristic
of electrodessication artifact
A. Tufted angioma
B. Acroangiodermatitis of Mali
D. Glomeruloid hemangioma
A. Lupus erythematosus
B. Mycosis fungoides
30
C. Poroma
D. Porokeratosis
E. PsoriasisCorrect Choice
This is psoriasis, in which there is parakeratosis with entrapped neutrophils overlying a regularly
acanthotic epidermis. There is hypogranulosis of the epidermis with increased mitoses in the basal
layer. There are thinned suprapapillary plates with dilated vessels in the superficial dermal papillae.
There is a lympho-histiocytic infiltrate around superficial vessels. Occasionally, clusters of
neutrophils can be seen in the stratum spinosum (spongiform pustules of Kogoj
A. Melanoma
C. Sebaceous carcinoma
D. Bowens
E. Condyloma
This is an example of extramammary Pagets, in which there are atypical cells singly and in groups
within the epidermis. The cells have abundant bluish cytoplasm
A. paraproteinemia
B. a dull blade
C. silicone injections
E. metastatic carcinoma
Gel foam in tissue sections is a characteristic wavy material that stains bluish-gray
92) The predominant location of the cleft in transient neonatal pustular melanosis is:
A. Suprabasal
31
C. Subcorneal/granularCorrect Choice
D. Dermal
E. Basal keratinocytes
Transient neonatal pustular melanosis is an idiopathic pustular eruption of newborns, mostly on the
chest, that heals with hyperpigmentation. It is most common on pigmented individuals.
Histologically it presents as subcorneal pustules with eosinophils and neutrophils
A. ChondrodermatitisCorrect Choice
C. Bromoderma
E. Actinic keratosis
This is chondrodermatitis nodularis helices, in which there is hyperkeratosis and parakeratosis
overlying an altered/thickened epidermis. Beneath that area, in the dermis, there is often fibrosis.
Flanking the fibrosis on either side, there is a proliferation of vessels and inflammation (resembling
granulation tissue
A. Lichen planus
B. Lichenoid purpura
E. Lichen planopilaris
Lichen striatus is an uncommon inflammatory dermatitis seen most commonly in children aged 5 to
15. It presents unilaterally along Blaschko's lines as raised, slightly scaly, erythematous papules,
which are often pruritic. These lesions typically regress spontaneously within a year. The
histopathologic features of lichen striatus include a superficial perivascular inflammatory
lymphohistiocytic infiltrate with rare plasma cells and eosinophils. There is a focal lichenoid infiltrate
in the papillary dermis with basilar vacuolar alteration and necrotic keratinocytes. Spongiosis with
exocytosis of lymphocytes can be seen in the epidermis. A specific and distinctive feature of lichen
striatus is the presence of an inflammatory infiltrate that surrounds hair follicles and eccrine glands
A. EyelidCorrect Choice
32
B. Nose
C. Finger
D. Glans penis
E. Labia majora
Vellus hair follicles are seen commonly in accessory tragic and eyelid skin
A. Incontinentia pigmenti
B. Lichen striatus
A. nicotinamide
B. tetracycline
C. mycophenolic acid
D. captoprilCorrect Choice
E. cyclosporine
Bullous pemphigoid can be drug-induced and a common inciting drug is captopril. Other causes
include lasix, nalidixic acid, penicillamine, antibiotics (penicillin, amoxicillin, ampicillin), and PUVA
98) All have been associated with increased risk of breast cancer except:
33
B. ataxia telangiectasia
C. Multicentric reticulohistiocytosis
D. Peutz-Jeghers
E. Cowdens
Birt-Hogg-Dube is associated with renal cancer and thyroid cancer. Female carriers of a mutated
ATM (homozygous mutations ATM cause ataxia telangiectasia) have an increased risk of breast
cancer
C. syringofibroadenoma
D. mucinous carcinoma
A. Dermal
C. Subcorneal/granularCorrect Choice
D. Suprabasal
E. Basal keratinocytes
Acropustulosis of infancy presents as idiopathic pustules on acral skin. Diagnosis is made only after
other causes of pustules have been ruled out, and it usually resolves in a few years. The cleft in
acropustulosis of infancy is subcorneal/granular with neutrophils
101) Cicatricial pemphigoid antibodies directed against this are associated with high frequency of
malignancy:
34
A. Laminin 5 Correct Choice
B. Beta4-integrin
C. BPAg2
D. Laminin 6
A. metalloproteinase
B. transglutaminase
C. myeloperoxidaseCorrect Choice
D. proteinase-3
E. aminotransferase
The figures are consitent with polyarteritis nodosa. Patients with polyarteritis nodosa may have
antibodies to p-ANCA or myeloperoxidase
C. epithelioid sarcoma
D. neurofibroma
E. dermatofibrosarcoma protuberans
35
In nodular fasciitis, there is a ill-defined deep (often extending into fat) proliferation of plump
spindle cells that on higher power resemble tissue-culture fibroblasts with elongated cytoplasm
often set in a background of many small vessels and extravasated erythrocytes. The spindle cells
are arranged haphazardly, and the stroma is often myxoid. Mitoses are common
A. Psoriasis
C. Lichen nitidus
D. Dermatophyte
E. Lichen planus
Granular parakeratosis results from abnormal keratinization which generally occurs in the flexural
areas. Histologically, the thick parakeratotic layer with retention of keratohyaline granules. In
addition, the granular layer is preserved with relatively normal epidermis
A. Mastocytosis
B. Leprosy
C. Sarcoid
106) Which of the following drugs has been known to cause pyogenic granuloma?
A. CapecitabineCorrect Choice
B. Paclitaxel
C. Isosfamide
D. Daunorubicin
E. Mithramycin
Systemic retinoids, indinavir and capecitabine have all been describe to cause pyogenic granulomas
36
A. Increased sebum production
108) In this patient, this test will be helpful in making the diagnosis:
A. Patch test
C. Tissue culture
D. KOH exam
E. Indirect immunofluorescence
This patient has herpes zoster. A direct fluorescent antibody test for the varicella zoster virus can be
performed to confirm the diagnosis.
A. malignancyCorrect Choice
B. liver cirrhosis
C. diabetes
D. pulmonary firbrosis
E. immunosuppression
The histology shows numerous neutrophils in the dermis with a lack of vasculitis, consistent with
Sweets syndrome. In a patient with Sweets syndrome, the presence of anemia is associated with
an internal malignancy.
37
A. Cowden'sCorrect Choice
B. Gorlin's
C. Werner's
D. Bloom's
E. Sipple's
Multiple sclerotic fibromas are seen in Cowdens syndrome.
A. Dermatofibrosarcoma
C. Epithelioid sarcoma
D. Nodular fasciitis
E. Liposarcoma
NEEDS EXPLANATIONS
B. Stromelysin-3
C. Desmin
E. S-100
PGP-9.5 and S100-a6 stains cellular neurothekeoma. Stromelysin-3 is positive in dermatofibromas
and negative in dermatofibrosarcoma protuberans. Desmin stains rhabdomyosarcoma. S-100 stains
neural tumors and melanocytic tumors among other things, but cellular neurothekeomas are
generally S100-negative
113) What stain may be used to differentiate this entity from metastatic oat cell carcinoma of the
lung?
A. HMB 45
B. CEA
38
C. PAS
E. S-100
Merkel cell carcinoma is a neuroendocrine cancer, usually of the head and neck. The tumor stain
with cytokeratin 20 which is expressed in a paranuclear dot-like pattern. This stain helps to
differentiate Merkel cell carcinoma from metastatic oat cell carinoma of the lung.
A. Epithelioid sarcoma
B. Angiosarcoma
C. Epithelioid hemangioendothelioma
E. Aneurismal dermatofibroma
In nodular Kaposis sarcoma, one sees a proliferation of spindle cells, often arranged in nodules
separated by fibrous bands. On higher power examination of the spindle cells, numerous
extravasated erythrocytes can be seen between the cells. Often, hemosiderin-filled macrophages
and plasma cells can be seen as well. The spindle cells are packed closely together and often will
have intracytoplasmic pink inclusions (erythrophagolysosomes
A. Psoriasis
D. Prurigo nodularis
E. Ichthyosis
NEEDS EXPLANATION
B. Fibrofolliculoma
39
C. Pilar sheath acanthoma
D. Keratosis pilaris
E. Trichoadenoma
This is a dilated pore, in which there is an invagination lined by epidermis that is slightly acanthotic
A. S100
B. factor XIIIa
C. cytokeratin
D. CD34
E. actinCorrect Choice
This is a dermatomyofibroma. Dermatomyofibromas are often found over the scapula of women.
The spindle cells are oriented parallel to the epidermis, and stain with vimentin and non-specific
muscle actin. The spinde cells do not stain with desmin, S100, CD34, or Factor XIIIa
A. Impetigo
D. Dermatitis herpetiformis
119) This developed in a patient with a history of breast cancer s/p surgical excision/radiation. Her
diagnosis is:
Image Link 1
Image Link 2
Image Link 3
A. Horner's
40
B. Stewart-TrevesCorrect Choice
C. Parkes-Weber
D. Kettle's
E. Klippel-Trenaunay
Angiosarcoma can develop in a lymphedematous extremity. When it develops in the upper
extremity after surgical treatment of breast cancer, it is referred to as Stewart-Treves syndrome.
When it develops in the lower extremity after lymph node dissection for a melanoma, it is referred
to as Kettle's syndrome
A. Trichofolliculoma
B. Spiradenoma
C. Trichilemmoma
D. Mixed tumor
E. TrichoepithliomaCorrect Choice
This is a trichoepithelioma, in which there are islands of basaloid cells in a somewhat fibrous stroma
with no retraction between the islands and the stroma. Often horn cysts are seen (not shown).
121) The inclusions in infantile digital fibromatosis stain for trichrome and:
A. Thioflavin T
B. Pentahydroxy flavanol
C. Osmium tetroxide
E. Bodian
Osmium tetroxide stains fat. Thioflavin T stains amyloid. The Bodian stain is for nerves.
Pentahydroxy flavanol is a fluorescent stain for calcium
A. myofibromatosis
41
B. schwannoma
C. Kaposi's sarcoma
D. neurofibromaCorrect Choice
E. leiomyoma
This is a plexiform neurofibroma. There are discrete nodules of spindle cells within the dermis. On
higher power, the cells have wavy nuclei with pink cytoplasm
B. Monsels reaction
C. Blue nevus
D. Postinflammatory hyperpigmentation
E. Minocycline-induced hyperpigmentation
This is a carbon tattoo, in which there are extracellular and intracellular particles of black material in
the superficial dermis
B. Recurrent nevus
E. Nevoid melanoma
This is a congenital nevus, in which there are nests of nevomelanocytic cells at the dermoepidermal
junction and extending deep into the dermis. In the deeper dermis, the cells infiltrate through
collagen bundles and extend around adnexal structures. There is hyperkeratosis, acanthosis, and
papillomatosis of the surface epidermis
A. Stromelysin
42
C. Fumarase
D. Chloracetate
E. Alkaline phosphatase
Chloromas are greenish tumor grossly secondary to involvement of the skin in acute granulocytic
leukemia. The green color is secondary to myeloperoxidase
126) Supporting evidence for the diagnosis of mycosis fungoides is CD4+ lymphocytes with loss of
CD7 as well as loss of
A. CD20
B. CD2
C. CD30
E. CD3
CD5 as well as CD7 are sometimes lost on the surface of epidermotropic T cells in mycosis
fungoides. CD2, CD3, and CD5 are T cell markers. CD20 is a B cell marker. CD30 is positive in
anaplastic large cell lymphoma cells, Hodgkins lymphoma, and lymphomatoid papulosis. Reactive
infiltrates can also have some CD30-positive cells
127) Clinically, a nondescript hyperkeratotic papule on the ulnar side of the base of the fifth finger
is most likely:
A. Cutaneous horn
C. Digital fibromatosis
E. Glomus tumor
Accessory digits (supernumerary digits) are usually found at the base of the fifth finger, often
bilaterally
A. Brooke-Fordyce syndrome
B. Rombo syndrome
43
C. Gorlin's syndrome Correct Choice
D. Brooke-Spiegler syndrome
E. Bazex's syndrome
Gorlin's syndrome is nevoid basal cell carcinoma syndrome; multiple trichoepitheliomas are not
seen. Several syndromes have been associated with multiple trichoepitheliomas: Basex, Brooke-
Fordyce, Brooke-Spiegler, Rombo, and possibly Rasmussen. (Rasmussen described one family in
1975 with autosomal dominant inheritance of multiple trichoepitheliomas, milia, and cylindromas.)
Basex syndrome (follicular atrophoderma, hypotrichosis, occasional trichoepitheliomas, basal cell
carcinomas, and localized or generalized hypohidrosis) is inherited in an X-linked dominant manner.
Brooke and Fordyce both described multiple trichoepitheliomas concurrently in 1892, and therefore
multiple familial trichoepitheliomas are sometimes called Brooke-Fordyce sydrome. Spiegler
described patients with multiple cylindromas in 1899 and also noted that many of these patients
had mutiple trichoepitheliomas; more recently it has been noted that multiple spiradenomas may be
seen in patients with multiple trichoepitheliomas and cylinidromas; this co-occurrence of tumors has
been referred to as Brooke-Spiegler syndrome. (Brooke-Fordyce and Brooke-Spiegler are likely
the same syndrome.) Rombo syndrome is characterized by vermiculate atrophoderma, multiple
BCCs, multiple trichoepitheliomas, cyanosis and peripheral vasodilation
B. leiomyoma
C. dermatomyofibroma
D. neurofibroma
E. dermatofibroma
B. Trichoblastoma
D. Trichodiscoma
44
collagen. The basaloid proliferation off of the surface of the epidermis is more typical of a superficial
multicentric basal cell carcinoma and aids in the diagnosis
A. photosensitivity
B. keratoacanthomasCorrect Choice
C. pigmentary anomalies
D. odontogenic cysts
E. arsenical keratoses
The figures show a sebaceous adenoma. Sebaceous adenomas are associated with Muir-Torre
syndrome, in which patients can have an internal malignancy and multiple keratoacanthomas
132) The most likely diagnosis for this lesion would be:
A. Verruca
B. Acrochordon
D. Amputation neuroma
E. Supernumery digit
The diagnosis of this acral lesion is an acquired digital fibrokeratoma which shows a small, exophytic
circumscribed lesions. Collagen bundles are oriented perpendicularly to the skin surface. The lesion
lacks nerve twigs and bone, which may be present in supernumery digit or amputation neuroma
A. Sarcoidosis
B. Malignancy
D. Lichen myxedematosis
E. Argyria
45
Clear cell syringomas are associated with diabetes. Syringomas are associated with Downs
syndrome
C. syringoma
D. trichoepithelioma
A. Hemochromatosis
B. Post-inflammatory hyperpigmetation
C. Minocycline ingestion
D. ArgyriaCorrect Choice
E. Chrysiasis
The characteristic feature of argyria is the presence of black granules in the eccrine glands. It
differentiates this condition from other pigmentary disorders
A. Erythropoietic protoporphyria
B. Lipoid proteinosis
C. Radiation dermatitis
D. Colloid milium
46
E. Lichen sclerosus et atrophicusCorrect Choice
In lichen sclerosus et atrophicus, there is often an atrophic epidermis with overlying orthokeratosis
that is thicker than the stratum spinosum, with some follicular plugging. There is sometimes a
subepidermal separation. The upper dermis is homogenized and pink/pale. Sometimes underlying
the homogenized zone, there is a band-like infiltrate (not seen here
137) A patient with a blue-red discoloration of the nail plate reports that the same finger becomes
very tender when exposed to the cold. You suspect a:
A. Pyogenic granuloma
C. Periungual verruca
D. Mucous cyst
E. Pterygium
Glomus tumors are tumors of the arterio-venous anastamosis of the digital dermis. They occur most
frequently in the nail bed. The commonly have a bluish-red discoloration and may be tender or
painful with exposure to heat or cold
A. Distal extremities
139) This patient developed an acute vesicular rash after eating a mango. She has returned for a
routine follow-up. She needs to be careful of exposure to:
C. Croton
D. Ragweed
47
E. Tea tree oil
Patients allergic to the peel of a mango can also be allergic to other plants/products of the
Anacardiaceae family. Cross-reactions can occur with exposure to any plants of the genus
Toxicodendron, to the oil from the cashew nut shell, to the Brazilian pepper tree, to lacquer from
the Japanese lacquer tree, to ink from the Indian marking nut, and to the fruit pulp of the ginkgo
tree, and others
A. Blastomycosis
B. Cryptococcosis
C. Histoplasmosis
D. Toxoplasmosis
E. LeishmaniaisisCorrect Choice
The diagnosis is Leishmaniasis. In this condition, the epidermis is often ulcerated (not seen in this
case) with a dense infiltrate is seen within the dermis. There are numerous macrophages
(Leishman-Donovan bodies) within the infiltrate that have intracellular amastigotes within them. On
close examination of the parasites, a kinetoplast is evident. In contrast to histoplasmosis, a discrete
halo is not seen around the amastigotes
A. Dyskeratosis congenital
C. Amyloidosis
D. Lipoid proteinosis
E. Mucocele
Caterpillar bodies are thought to be type IV collagen
142) A healthy 6 month old girl has a subcutaneous nodule above her right eyebrow. A skin biopsy
demonstrates a cystic lesion with adnexal structures in the wall. Your diagnosis is:
A. Nevus sebaceous
48
C. Steatocystoma
D. Pilar cyst
B. malignant acrospiroma
D. porocarcinoma
B. Dermatomyofibroma
C. Neurofibroma
49