Rizki Hanriko

Laboratorium Anatomi-Histo-PA
FK UNILA
2016
 The Skin
2

SKIN AS A PROTECTIVE ORGAN

DISORDERS OF PIGMENTATION AND MELANOCYTES
BENIGN EPITHELIAL TUMORS
PREMALIGNANT EPIDERMAL TUMOR
MALIGNANT EPIDERMAL TUMORS
DISORDER OF EPIDERMAL APPENDAGES
INFECTIONS AND INFESTATIONS
ACUTE-CHRONIC INFLAMMATORY DERMATOSES
BULLOUS DISEASE
3
4
 Makroskopik:
makula,papula,nodula,plak,
vesikel, bula, pustula,
skuama, likenifikasi, ekskoriasi
5

MIKROSKOPIK:
HIPERKERATOSIS,
PARAKERATOSIS, DISKERATOSIS
AKANTOSIS, PAPILOMATOSIS,
AKANTOLISIS, SPONGIOSIS
Disorders of Pigmentation
and Melanocytes
6

LENTIGO
NEVUS NEVOSELLULER
NEVUS DISPLASTIK
MELANOMA MALIGNA
Idiopatik,
segala usia, ras dan
sex,
kulit dan mukosa

Makros:
àØ 5-10 mm, oval,
makula coklat
Mikros:
hiperplasia rete pegs, hiperpigmentasi sel basal,
proliferasi sel melanosit (-)
ž Nevus: lesi kulit kongenital
ž Neoplasma melanosit kong/acq
ž Makros:
à Papula, coklat muda-tua, warna
merata, ر5mm, batas tegas melingkar
Sporadis/familial (dominan autosomal)

Makros:
à >nevus nevoselluler,
makula datar-papula, perm tidak rata,
variegation, batas ireguler.
Precursor of malignant melanoma.
Nevus Diagnostic Cytologic
Variant Architectural Features Features Clinical Significance
Congenital Deep dermal and Identical to Present at birth; large
nevus sometimes subcutaneous ordinary acquired variants have
growth around adnexa, nevi increased melanoma
neurovascular bundles, risk
and blood vessel walls

Blue nevus Non-nested dermal Highly dendritic, Black-blue nodule;

infiltration, often with heavily often confused with
associated fibrosis pigmented nevus melanoma clinically
cells
Spindle and Fascicular growth Large, plump Common in children;
epithelioid cells with pink-red-pink nodule; often
cell nevus blue cytoplasm; confused with
(Spitz fusiform cells hemangioma clinically
nevus)
Halo nevus Lymphocytic infiltration Identical to Host immune
surrounding nevus cells ordinary acquired response against
nevi nevus cells and
surrounding normal
melanocytes
Dysplastic Coalescent Cytologic atypia Potential marker or
nevus intraepidermal nests precursor of
Relatif seringà mematikan
Predisp: sunlight
pre existing naevus:
eg
dysplastic

Makros:
à gatal?,
perubahan warna/
ukuran lesi
berwarna,
nodul berpigmen,
cenderung ulserasi
Histologi pertumbuhan radial dan
vertikal
Clark Level, Breslow Thickness
 Benign
epithelial tumors
18

KERATOSIS SEBOROIK
FIBROEPITHELIAL TUMOR
KERATOACHANTOMA
APPENDAGES(ADNEXAL) TUMOR
Umum, usia tengah- lanjut, pria>wanita,
spontan, badan, ekst, kepala dan leher
Makros:
plak bulat, datar, Ø mm-cm, cokelat muda-
tua,
permukaan granuler
Mikros:
à exophytic, batas tegas,
tdd sel basaloidàpigmentasi melanosit
hiperkeratosisàhorn cyst (inside)
 Fibroepithelial tumor
21

— Umum ditemukan, usia pertengahan

— Leher, batang badan, wajah, Intertrigo
— Makros:
à soft flesh color, small stalk
— Mikros:
à fibrovascular cores covered by
squamous epithel
— Hub à DM, intestinal polyposis,pregnancy
22
Usia: >50th àkaukasia, pajanan matahari,
Pipi, hidung, telinga dan punggung tangan

Makros:
à Nodul dg sumbat isi keratin (spt
kawah), 1cm >, warna=kulit
Mikros:
Kawah keratin dikelilingi proliferasi
sel- sel epitel, sitoplasma eosinofilik
“kaca”
 Appendage tumor
25

— Jarang
— Silindroma:
àdiff apokrin,
nodule scalp,
appear early in
life
 Appendage tumor
26
— Syringoma:
àdiff ekrin, palpebra inf, multipel
 Appendage tumor
— Trichoepithelioma: 27

àdiff folikel rambut, face,scalp,neck/up trunk

Appendage tumor
28
 Keratosis actinik
29
— Lesi pramaligna
à pajanan matahari + timbunan keratin
— Makros:
papul/plak Ø <1cm, cokelat muda-tua/merah, kasar,
keratin horn
— Mikros:
Atipia sel basal epidermis
à diskeratosis, pink /red cytoplasma, parakeratosis,
basal membrane intake
Dermis:
à bluegray elasticfibers elastosis ec. abn fiber synt,
sun damage fibroblas
30
31
Malignant tumor
32

SQUAMOUS CELL CA
BASAL CELL CA
 SCC Insitu

Makros:
àplak skuama merah, batas tegas
Mikros:
àepidermal atypia,
 Squamous cell ca
34

— Sering, usia lanjut, ec. pajanan matahari, L>P

— Predisposisi:
matahari, ulkus Marjolin, scar luka bakar,
industrial carcinogens (tars & oils), arsen,
radiasi dan tembakau (rongga mulut)
— Eksogen:
ØUV light
ØImunosupresi
ØXeroderma pigmentosum
Makros:
ànodular, hiperkeratosis, mgk ulserasi
Umum, lambat, jarang metastase, usia>40th, kulit
terang (wajah), terpajan matahari lama, UVB,
Gen PTCH1.

Makros:
Papul mengkilap (telangiektasia), bbrp mgd
melanin
~nevus/melanoma -> ulserasi, invasi ke
tulang/sinus wajah (ulkus roden)
Mikros:
àPattern growth:
Multifokal (extended) or Nodular (down
ward)
 Akne vulgaris
40

— Disorder of epidermal appendages

— Altered cornification of follicular
infundibula;
— Increased and altered secretion of sebum;
— Proliferation of bacteria within infundubula;
— Increased androgen activity.
 Akne vulgaris
— Komedo
41
à blackhead à oksidasi lipid
à whitehead
— Mikros:
à struktur pilosebaseus berisi keratin dan
lipid
42
43
 Infections
and
Infestations
44

VERUKA
MOLUSKUM KONTAGIOSUM
LEPRA
 Veruka
45

— Anak-remaja, HPV, kontak lgs/outoinokulasi, swasirna ½-2th

— Veruka vulgaris: tersering,

dorsum manus/periungual,
papula putih abu2-coklat,
datar-konveks, 0,1-1cm, perm kasar
— Veruka plana: wajah/dorsum manus, papula datar,
halus, coklat muda,
— Veruka plantaris/palmaris: skuama kasar,Ø1-2cm,
bersatu~kalus,
— Kondiloma akuminata: veneral, kembang kol,
lunak kecoklatan
Mikros:
àHiperplasia epidermis
papilomatosa
/verukosa,
granul keratohialin,
koilositosisàhalo ,
 Moluskum Kontagiosum
47

— Umbilicated papul, umumnya di penis, vulva, groin

(STD),
— Sembuh sendiri 6-12 bulan
— Epidermal hiperplasia à badan Henderson-
Patterson, Ø 35µ,
— Eosinofilik – basofilik intrasitoplasmik inklusi
menekan inti dan granula keratohialin
48
49
 Lepra
50
— ec. M.leprae
1. Tuberkuloid:
÷ Respon Tcell baik, lambat, dapat sembuh
÷ Makros: makula anestetik hipopigmentasi
÷ Mikros: granuloma sel epitel/ granuloma tuberkuloid,
limfosit>>, kuman<<
2. Lepromatosa:
÷ Imun rendah, susah sembuh, deformitas
÷ Mikros: foamy macrophage, limfosit<<, kuman>>
↓
agregasi makrofag à ∆ nodularitas kulit
3. Borderline
51
52
 Kista kulit
53

Kista Epidermal
Dibatasi SC
berkeratinisasi,
mgd keratin lamina
 Kista kulit
54

Kista Dermoid
q Kongenital,

q garispenutupan/penyatuan kulit
embrional,
q dermoid angular eksternal

q Dibatasi epitel dg bbg adnexa epidermis,

tmsk fol rambut dan kel sebaseus
55
DERMATOSIS Urtikaria
56

— Degranulasi lokal sel Mast

à hiperpermeabilitas
mikrovaskuler dermis à
papul pluritik ---plak
edematosa (urtika)

— Rx Hipersensitivitas tipe I

Dermatosis Peradangan Akut

 Urtikaria
57

Mikroskopik:
— Infiltrat perivenula superfisial ringan (sel MN &
neutrofil)
— Eosinofil di dermis midretikuler
— Berkas kolagen renggang
— Edema ruang perivaskuler dermis superfisial

Dermatosis Peradangan Akut

 Dermatitis Ekzematosa Akut
58

— Eksim
à Lesi merah, papulovesikuler, isi cairan & krusta --
-- plak skuamosa
— Dermatitis spongiosa
— DKI, DKA, ATOPI

Dermatosis Peradangan Akut

 Eritema Multiforme
59

— Respon hipersensitivitas thd infeksi dan obat ttt

— Swasirna, lesi multiforme
— SSJ & NET
Mikroskopik:
— Infiltrat limfositik superfisial perivaskuler
— Edema dermis
— Marginasi limfosit sepanjang DEJ à nekrosis
epidermis & bula
Dermatosis Peradangan Akut
 Psoriasis
60

— Genetik & imunologik

— Plak batas tegas, merah muda—kekuningan ditutupi
skuama longgar putih keperakan
— Koebner Phenomenon

Dermatosis Peradangan Kronis

 Psoriasis
Mikroskopis: 61
— Turn over sel epidermis à akantosis
— Rete ridge memanjang
— Str. Granulosum & skuama parakeratotik
— Tanda Auspitz, pustul Spongiform, mikroabses Munro

Dermatosis Peradangan Kronis

 Liken Planus
62

— Pruritic, purple,
polygonal papules,
striae wickham
— Swasirna 1-2 th
à lesi hiperpigmentasi pasca inflamasi
Mikroskopis:
— Infiltrat limfositik padat kontinu sepanjang DEJ à zig
zag contour ( sawthooting)
— Badan Civatte
— Hiperplasia epidermis, hipergranulosis, hiperkeratosis
Dermatosis Peradangan Kronis
 Pemfigus
63

— Rx hipersensitivitas tipe II, auto imun

— Hilangnya integritas jembatan antar sel N di epidermis
& epitel mukosa
— Pemfigus vulgaris 80% à vesikobulosa mudah pecah
— Pemfigus vegetans à plak vegetans besar, basah,
verukosa, dipenuhi pustula
— Pemfigus foliaseus & eritematosa à ringan
Penyakit Bulosa
 Pemfigus
64

— Mikroskopis:
— Akantolisis
— Bula akantolitik suprabasal
— Infiltrasi limfositik, histiosit, eosinofil
Penyakit Bulosa
 Pemfigoid Bulosa
65

— Usia lanjut
— Bula tegang, tidak mudah pecah,
isi cairan jernih pd kulit N/ eritematosa
Mikroskopis:
— Bula sub epidermis non akantolitik
— Edema dermis superfisial & vakuolisasi lapisan sel
basal à bula
Penyakit Bulosa
 Dermatitis
66
Herpetiformis
— Urtikaria & vesikel berkelompok,
bilateral & simetris
— Enteropati à Cheliac disease
Mikroskopis:
— Mikro abses di ujung papilla dermis
( fibrin & neutrofil)
— Vakuolisasi di atasnya à bula sub
epidermis
— Imunofluoresens à endapan Ig A

Penyakit Bulosa
 67

Wassalam