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Scribd Dermatopathology-Q-A PDF
Scribd Dermatopathology-Q-A PDF
C. Urticaria
D. Granuloma inguinale
E. Sweet's Syndrome
Rheumatoid neutrophilic dermatitis is seen in the setting of severe rheumatoid arthritis. The
pathogenesis is not understood, but in the few reports of this rare dermatosis, a true vasculitis has
not been seen. Sweet's syndrome also does not show evidence of a true vasculitis. Erythema
elevatum diutinum histologically shows a leukocytoclastic vaculitis, but with prominent interstitial
neutrophils. Other conditions with evidence of LCV include Henoch-Schonlein purpura, granuloma
faciale, urticarial vasculitis, and occasionally serum sickness. (B)
A. CD10
B. CD23
C. CD138
D. bcl-1
E. bcl-6
Bcl-1 (Cyclin D1) is a marker for mantle cell lymphoma. CD10, bcl-6, and bcl-2 are markers for
follicular cell lymphoma. Bcl-2 also stains normal T cells. CD23 is a marker for CLL/SLL and is
negative in mantle cell lymphoma. CD138 is a marker for plasma cells. (D)
3-Clinically, this lesion often has a blue hue and usually occurs on the face:
A. Apocrine hidrocystoma
C. Bronchogenic cyst
D. Eccrine hidradenoma
E. Myxoid cyst
apocrine hidrocystoma are usually solitary, tranlucent nodules which may have a bluish hue due to
the Tyndall effect. Histologically, they have one or several large cystic spaces with decapitation
secretion. (A)
A. Keratin 6
B. Keratin 8
C. Keratin 10
D. Keratin 16
E. Keratin 17
Keratins 6 and 16 are found in the nail. Keratin 17 is seen in the nail as well as in the hair follicle, and
patients with pachyonychia congenital type 2, in which there is a mutation of keratins 6b and 17,
have nail findings as well as steatocysts. (E)
A. Lipoid proteinosis
B. Amyloidosis
E. Dyskeratosis congenital
A. Tufted angioma
B. Glomeruloid hemangioma
D. Acroangiodermatitis of Mali
E. Kaposi?s sarcoma
The promontory sign refers to the formation of new vessels around existing vessels and adnexal
structures. This is seen in Kaposi?s. (E)
7-You examine a biopsy that is square on low power. The clinical history
reports an IgG paraproteinemia and the presence of a "doughnut sign".
Which of the following conditions would you think of without looking on
higher power?
A. Scleromyxedema
B. Scleroderma
C. Scleredema
D. Localized Morphea
E. Pretibial myxedema
The doughnut sign is seen on proximal interphalangeal joints where a central depression
surrounded by an elevated rim can be seen (Bolognia p649). This is a feature of the skin thickening
seen in Scleromyxedema. The other options will have a square appearance on low power
microscopic examination and scleredema can have an IgG paraprotein. Other microscopic findings
in scleromyxedema include incrased fibroblasts with fibrosis/increased collagen and thickening of
the dermis. Mucin may be scant or absent. This bx is more cellular than pretibial myxedema. (A)
8-Multiple dermatofibromas are seen in:
A. Cowden's
B. Lobomycosis
C. Incontinentia pigmenti
D. Lupus erythematosus
E. Reticulohistiocytosis
A. Hyperpigmentation
B. Transient piloerection
C. Hypertrichosis
Smooth muscle hamartomas of the skin may develop from three locations: the arrector pili muscles,
blood vessel walls, and genital/areolar skin. The have been associated with hyperpigmentation,
tranisent piloerection ("pseudo-Darier's sign") and hypertrichosis. It is thought to be the underlying
lesion in "Michelin tire baby" syndrome in boys, not girls.(D)
A. Ichthyosis
B. Cowden's
C. Immunosuppression
D. Gastrointestinal polyps
E. Breast cancer
D. S-100 positivity
E. Vimentin positivity
Dermatofibromas have characteristic features that can include collagen trapping, hyperplasia of
epidermis, hyperpigmentation of basal layer, dermal spindle cells, and whorls of fibrous tissue with
keloidal collagen. It stains with factor XIIIa(+) but not MAC 387 (-), S-100(-), or CD34 (-). DFSP
infiltrates the fat with a honeycomb pattern. (E)
A. Neutrophilic dermatosis
B. Deposition disorder
C. Infectious process
D. Panniculitis
E. Granulomatous disease
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. (D)
13-Which fixative would best preserve the histologic features of a gout
tophus?
A. Saline
B. Absolute ethanol
C. Formaldehyde
D. Michel's fixative
Gout tophi are caused by deposition of monosodium urate monohydrate crystals. Using absolute
ethanol to fix the biopsy specimen will preserve the crystalline architechture. In formaldehyde fixed
tissure, the crystals are less obvious. (B)
B. Malignant firbroushistiocytoma
E. Sebaceous carcinoma
Neuron-specific enolase is a cytoplasmic product produced by Schwann cells and neurons. This
enzyme is present in neuroendocrine cells, neurons and tumors derived from them. Positive staining
for neuron-specific enolase is found in Merkel cell carcinomas, carcinoid tumors, and malignant
melanoma. (D)
A. Kaposi's sarcoma
B. Angiosarcoma
C. Tufted angioma
D. Kaposiform hemangioendothelioma
Dorf balls are pink amorphous globules seen in vessels in Kaposi's sarcoma. Typical histologic
findings include proliferation of spindle cells, prominent slitlike vascular spaces, and extravasated
red blood cells. (A)
A. Roseola
B. Mumps
C. Rubella
D. Syphilis
E. Rubeola
A. Connective tissue
B. Smooth muscle
C. Vascular tissue
D. Neural tissue
E. Adipose tissue
40% of granular cell tumors occur on the tongue. They appear well-circumscribed, raised, firm
nodules. Histologically, the cells are plump and polygonal arranged in nests and cords. Cells are
filled with fine granules representing lysozymes. The tumors are neurally derived and stain with S-
100 and PAS. (D)
A. Daunorubicin
B. Mithramycin
C. Isosfamide
D. Capecitabine
E. Paclitaxel
Systemic retinoids, indinavir and capecitabine have all been describe to cause pyogenic
granulomas. (D)
A. Cresyl violet
B. Methyl-green pyronin
C. Silver nitrate
D. Bodian
Cresyl violet stains the pigment deposits in ochronosis black. Methylene blue will also stain the
pigment black. This pigment does not stain with silver nitrate. The Bodian stain is for nerves. Methyl-
green pyronin stains RNA and DNA. (A)
A. Alagille
B. Brooke-Spiegler
C. Nicolau-Balus?
D. Schopf?s
E. Lhermitte-Duclos
Brooke-Spiegler syndrome combines multiple cylindromas and multiple trichoepitheliomas, and
sometimes multiple spiradenomas can be seen as well. Alagille syndrome associates arteriohepatic
dysplasia and nevus comedonicus. Nicolau-Balus? syndrome describes the constellation of multiple
eruptive syringomas, milia, and atrophoderma vermiculata. Schopf?s syndrome combines multiple
apocrine hidrocystomas, palmar-plantar keratoderma, teeth abnormalities (hypodontia), and
onychodystrophy. Lhermitte-Duclos disease may be a manifestation of Cowden?s. In Lhermitte-
Duclos, there is a proliferation in the cerebellum (dysplastic gangliocytoma) with macrocephaly.
(B)
A. PAS
B. Eosin
C. Giemsa
D. Aldehyde fuchsin
E. Crystal violet
Stains for amyloidosis: Congo Red, Thioflavin T, Crystal Violet, Methyl violet, Pagoda red no. 9, PAS
+ diastase, amyloid P-component antibody (E)
A. CD4
B. CD8
C. CD10
D. CD45
E. CD57
There seems to be two subsets of subcutaneous panniculitis-like T-cell lymphoma. One has an
indolent course, and is often CD8-positive and is positive for the alpha-beta T-cell receptor. The
other has an aggressive course, sometimes with evidence of systemic hemophagocytosis and high
mortality. This subset is CD56-positive and positive for the gamma-delta T-cell receptor. (B)
A. Dermal
C. Basal keratinocytes
D. Supra basal
E. Subcorneal/granular
Cicatricial pemphigoid is an autoimmune blistering disease that presents with ulcers, blisters and
erosions of mucosal surfaces, especially the eyes and mouth. The cleft in cicatricial pemphigoid is
found in the basement membrane zone/subepidermal as the antigens are usually BPAg2,laminin 5
and alpha-6-beta-4 integrin. Direct immunoflourescence is identical to that of bullous pemphigoid
showing linear IgG and complement deposits in the basement membrane zone. (B)
A. An apocrine origin
B. An eccrine origin
C. A sebaceous origin
D. A follicular origin
Gross cystic disease fluid protein-15 (GCDFP-15) is a commonly used apocrine marker. (A)
25-Goblet cells are seen in:
B. Endometriosis
C. Dermoid cyst
D. Bronchogenic cyst
E. Steatocystoma
Bronchogenic cysts have a pseudostratified cuboidal or columnar lining that is ciliated; goblet cells
are found in the lining as well. (D)
26-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. Steatocystoma
B. Pilar cyst
C. Nevus sebaceous
E. Dermoid cyst
Dermoid cysts present along lines of embryonic closure. The are most commonly found on the head
(around the eyes) and the neck. They are lined by an epidermis that contains various epidermal
appendages that are usually fully matured. (E)
C. Frequent mitoses
D. Exocytosis of lymphocytes
E. Virchow bodies
Pleomorphic lipomas characteristically have a mixture of variably sized fat cells with a varying
number of pleomorphic enlarged cells. These cells contain nuclei arranged in a circumferential
pattern that has been termed floret cells. Rare lipoblasts are found. Focal collections of lymphocytes
and plasma cells within the tumor are seen. (B)
B. Osmium tetroxide
C. Thioflavin T
D. Bodian
E. Pentahydroxy flavanol
Osmium tetroxide stains fat. Thioflavin T stains amyloid. The Bodian stain is for nerves.
Pentahydroxy flavanol is a fluorescent stain for calcium. (A)
A. Neurilemmoma
B. Neurofibroma
D. Traumatic neuroma
E. Neurothekeoma
Mucosal neuromas in MEN IIb often look histologically like PENs. Occasionally mucosal neuromas
display thickened nerves/perineurium. (C)
30-Which of the following is commonly seen histopathologically in
pityriasis rosea?
A. Absent spongiosis
E. Focal parakeratosis
A. Lymphoma
B. Nephrolithiasis
C. Pancreatic cancer
D. Hemochromatosis
E. Thalassemia
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. (D)
B. Reticulohistiocytoma
E. Necrobiotic xanthogranuloma
Osteoclast-like giant cells are seen in giant cell tumor of the tendon sheath. Osteoclast-like giant
cells have eosinophilic cytoplasm with haphazardly arranged nuclei. Reticulohistiocytoma is
characterized by giant cells with an oncocytic glassy pink cytoplasm. (D)
A. Myotonic dystrophy
B. Cowden's
C. Turner's
D. Gorlin's
A. S-100
B. HMB-45
C. Fontana-Masson
D. MART-1
E. Melan-A
Fontana-Masson is a silver stain and stains melanin black. S-100, HMB 45, MART-1 (Melan-A) are
melanocyte stains. S-100 also decorates Langerhans cells, acrosyringium, and neural crest-derived
cells. (C)
A. SPINK5
B. SERCA2
C. ATP2A2
D. ATP2C1
In Darier�s disease, the ATP2A2 gene encoding the SERCA2 Ca(2+)-ATPase is mutated in some
patients. SPINK5 is the gene that is mutated in some patients with Netherton�s syndrome, and this
gene the serine protease inhibitor LEKTI. ATP2C1 is the gene mutated in some patients with Hailey-
Hailey disease. (B)
A. Nocardia
B. Ricketsii species
C. Actinomycosis
D. Candida albicans
E. Anthrax
D. Neither the roof or floor of the split since IgA is the most common reactant
Epidermolysis bullosa acquisita (EBA) is a bullous disease of adults in which minor trauma (usually
on the hands and feet) leads to blisters that heal with scaring. On histology there is classically a
noninflammatory subepidermal split. The blister will immunostain with IgG on the floor of salt-split
skin, as the antigen is type VII collagen. (C)
A. Dermatofibrosarcoma
B. Nodular fasciitis
C. Angiolipoma
D. Epithelioid sarcoma
E. Liposarcoma
Angiolipomas are tumors of fat that are characteristically painful. Histopathologically, mature
adipocytes are seen with numerous vessels. Microthrombi are often present. (C)
B. Lichen striatus
C. Lichen planus
D. 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. (B)
B. Distal extremities
C. Oral mucosae and genital areas
Verruciform xanthoma is an uncommon lesion that usually occurs on the oral mucosa of middle-
aged persons or on the scrotum of middle-aged to elderly Japanese men. The most common site for
verruciform xanthoma is the oral mucosa. (C)
A. Hypocalcemia
B. Hypercalcemia
C. Hypokalemia
D. Hyperkalemia
E. Hyponatremia
Hypercalcemia has been noted in some cases of subcutaneous fat necrosis of the newborn. (B)
A. Stasis dermatitis
B. Atopic dermatitis
C. Seborrheic dermatitis
D. Nummular dermatitis
A. Dermal
C. Basal keratinocytes
D. Suprabasal
E. Subcorneal/granular
Erythema toxicorum neonatorum is an idiopathic vesiculopustular eruption on the face and trunk of
neonates that often resolves in a few weeks. Histologically it presents with subcorneal eosinophil
rich pustules.(E)
A. Laminin 5
B. Laminin 6
C. Beta4-integrin
D. BPAg2
A. IgA pemphigus
B. Bullous pemphigoid
D. Dematitis herpetiformis
E. Herpes gestationalis
Dermatitis herpetiformis or Duhring's disease, presents with very pruritic vesicles symmetrically on
extensor surfaces. On histology it presents as suprapapillary vesicles with mostly neutrophils and
inflammatory destruction of the basement membrane zone. Direct immunoflourescence shows
granular deposition of IgA in the dermal papillae and along the basement membrane zone. (D)
A. Ginkgo fruit
B. Croton
C. Ragweed
A. Smooth muscle
B. Eccrine glands
C. Endothelial cells
D. Macrophages
E. Melanocytes
Ulex europeus agglutinin I is a stain which identifies endothelial cells, keratinocytes, angiosarcomes
and Kaposi's sarcoma. (C)
A. Dermal
C. Basal keratinocytes
D. Suprabasal
E. Subcorneal/granular
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. (E)
A. Chromagranin
B. HLA-DR
C. CD1a
D. Birbeck granules
E. S-100
Chromagranin stain neuroendocrine cells, Merkel cellcarcinomas and eccrine glands. They do not
stain Langerhans cells.(A)
51-All have been associated with increased risk of breast cancer except:
A. Cowden?s
B. Multicentric reticulohistiocytosis
C. Peutz-Jeghers
D. Birt-Hogg-Dube
E. ataxia telangiectasia
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. (D)
A. Norwegian salt-petter
C. Pb intoxication
D. L-Tryptophan
A. Labia majora
B. Labia minora
C. Glans
D. Prepuce
E. Vermilion
Eccrine glands are present all over the body except on the vermilion of lips, glans, labia minora, nail
beds, and inner prepuce. (A)
A. Wedge-shaped parakeratosis
B. Irregular acanthosis
D. Parakeratosis
C. Acanthosis nigricans
D. Reiter?s syndrome
56-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. Periungual verruca
B. Glomus tumor
C. Pterygium
D. Mucous cyst
E. Pyogenic granuloma
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. (B)
A. Dermatitis herpetiformis
B. Darier's disease
C. Grover's disease
D. Pemphigus vulgaris
E. Hailey-Hailey diesease
Dermatitis herpetiformis is a bullous disease that on histology shows neutrophils in the dermal
papillae. On direct immunoflourescence IgA is seen in a granular depostion pattern. Acantholysis is
seen histologicaly in Darier's disease, Grover's disease, Pemphigus vulgaris, Hailey-Hailey disease
and warty dyskeratoma.(A)
58-The predominant cleft in dermatitis herpetiformis is:
A. Dermal
C. Basal keratinocytes
D. Suprabasal
E. Subcorneal/granular
Dermatitis herpetiformis or Duhring's disease, presents with very pruritic vesicles symmetrically on
extensor surfaces. On histology it presents as suprapapillary vesicles with mostly neutrophils and
inflammatory destruction of the basement membrane zone. Direct immunoflourescence shows
granular deposition of IgA in the dermal papillae and along the basement membrane zone. The cleft
in dermatitis herpetiformis is most commonly found in the basement membrane zone/subepidermal.
The antigen is transglutaminase.(B)
A. Tyson
B. Moll
C. Wolf
D. Fordyce
E. Meibomian
Moll?s glands are modified apocrine glands located on the eyelid. Sebaceous glands in certain
locations have an associated name (Tyson?s on the penis, Wolf?s or Meibomian on the eyelid, and
Fordyce on the vermilion/oral mucosa). (B)
60-In which of the following would you expect to find Dutcher bodies?
A. Molluscum contagiosum
B. Sarcoidosis
C. Chromoblastomycosis
D. Schwannoma
Dutcher bodies may be found in chronic lymphocytic leukemia and multiple myeloma. They
represent intranuclear inclusions of immunoglobulin, which may be mistaken for nucleoli.(E)
C. Epidermodysplasia verruciformis
D. Verruciform xanthomas
E. Poromas
Mutations have been found in the EVER1 and EVER2 genes in epidermodysplasia verruciformis;
these genes are on 17q25, the location of the PSORS2 gene (one of the genes implicated in the
inheritance of psoriasis). (C)
A. Negri body
B. Lipschutz body
C. Michaelis-Gutman body
D. Guarnieri body
The Michaelis-Gutman body is a concentrically laminated spherical inclusion that contains calcium
that is seen within macrophages in malakoplakia. Other inclusion bodies that contain calcium are
Schaumann bodies and psammoma bodies. The Negri body is seen in rabies. The Lipschutz body is
an intranuclear inclusion seen in herpes. It is considered synonymous with the Cowdry A body. The
Guarnieri body is seen in smallpox. (C)
63-Clear cell syringomas are associated with:
A. Malignancy
B. Sarcoidosis
C. Argyria
D. Diabetes
E. Lichen myxedematosis
Clear cell syringomas are associated with diabetes. Syringomas are associated with Down�s
syndrome. (D)
A. Neurothekeoma
B. Macular amyloidosis
C. Malignant peripheral nerve sheath tumor
D. Chondroid syringoma
E. Mucocele
66-In this patient, this test will be helpful in making the diagnosis:
B. Patch test
C. Tissue culture
D. Indirect immunofluorescence
E. KOH exam
This patient has herpes zoster. A direct fluorescent antibody test for the varicella zoster virus can be
performed to confirm the diagnosis.(A)
67-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. 2 weeks
C. 3 weeks
D. 4 weeks
E. 5 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.(C)
A. Arginase
B. Adenosine deaminase
C. Endoglin
D. MC1R
E. Fumarate hydratase
Fumarate hydratase is deficient in familial multiple cutaneous leiomyomatosis. This same enzyme is
deficient in familial uterine leiomyomatosis associated with renal cell cancer. Arginase is deficient in
arginemia. Adenosine deaminase is deficient in autosomal recessive severe combined
immunodeficiency disease (SCID). Endoglin is deficient in some patients with Osler-Weber-Rendu.
MC1R (melanocortin 1 receptor) shows sequence variation in people with red hair. (E)
69-An increased number of miniaturized hairs are seen in:
A. Lichen planopilaris
B. Alopecia areata
C. Trichotillomania
D. 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. (B)
A. Angiosarcoma
B. Neurothekeoma
C. Nodular fasciitis
D. Dermatofibroma
E. Epithelioid sarcoma
This infant has epidermolysis bullosa simplex, a disorder in which there is defective keratin 5 and
14. Because of this defect, there is abnormal attachment of the basal cells at the dermoepidermal
junction, and a split forms ?within? the basal layer. (C)
A. Rothmund-Thompson
B. Scleredema
C. Ehlers-Danlos
D. Acrogeria
E. Down?s
Elastosis perforans serpiginosa is associated with Down?s syndrome, Ehlers-Danlos type IV,
Osteogenesis imperfecta, Rothmund Thompson, Marfan?s, Werner?s, acrogeria, and penicillamine
therapy. (B)
73-A skin biopsy shows numerous fibroblasts with fibrosis and thickening
of the dermis. There is sparse mucin deposition and on low power the
biopsy appears square. Which of the following paraproteins would you
expect to find in this patient?
A. IgG lambda
B. IgA
C. IgM
D. IgG kappa
E. IgA gamma
The description of the biopsy above is that of scleromyxedema. These patients have an associated
IgG lambda paraprotein. Other IgG subtypes may occur but lambda is most common.
Scleromyxedema is a subset of lichen myxedematosus (papular mucinosis). It will present with
coalescent erythematous to yellow papules and plaques. The most common location is the face, but
will occur in many other locations. The surrounding skin is usually sclerodermoid in appearance.
(Bolognia, p648-9) (A)
A. Dermal
C. Basal keratinocytes
D. Suprabasal
E. Subcorneal/granular
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. (E)
A. Pink
B. Green
C. Blue
D. Purple
E. Black
Methyl-green pyronin stains RNA pink and stain DNA green. (A)
A. Fontana Masson
B. Perls
C. Sudan black
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. (D)
A. Civatte bodies
D. Presence of pruritus
A. Dermatofibrosarcoma
B. Dermatofibroma
C. Epitheloid sarcoma
E. Plasmacytoma
CK20 is useful in diagnosis of Merkel Cell Ca. Dermatofibrosarcoma would stain CD34+.
Dermatofibroma would stain CD68 +. Plasmacytoma would stain CD138 + and CEDa�. Epithelioid
sarcoma would stain CD34+. (D)
A. Endothelial cells
B. 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)
A. Phagolysosomes
B. Ribosomes
C. Mitochondria
D. Intermediate filaments
E. Vacuoles
The granules in granular cell tumor are phagolysosomes. The granularity of the granular cell layer in
epidermodysplasia verruciformis may be secondary to increased ribosomes. Mitochondria fill the
cells in hibernoma. (A)
81-This patient has a lichenified plaque in the lower mid abdomen as well
as these two exczematous plaques. This patient needs:
A. patch testing
B. a steroid
C. an antiviral
D. a KOH scraping
E. an antifungal
This patient is likely allergic to the nickel in his belt buckle and possibly to metals that he places in
his pocket. He needs patch testing. While a topical steroid might help resolve pruritus, the patient
ultimately needs to be diagnosed with his allergy and avoid nickel. Dimethylglyoxime can be used as
an indicator to detect nickel in metals. (A)
A. Jadassohn-Lewandowsky
B. Jackson-Lawler
C. Schaufer-Brunauer
D. Zinsser-Engman-Cole
E. Touraine-Solente-Gole
A. Rosacea
B. Angiofibroma
D. Kaposi's sarcoma
E. Radiodermatitis
This is an angiofibroma, in which there are slightly dilated superficial vessels, stellate fibroblasts,
and incrased collagen. Sometimes the collagen surround vessels and adnexal structures in an
?onion-skin? pattern. (B)
A. Neurofibromas
B. Angiofibromas
C. Collagenomas
D. Angiokeratomas
Adenoma sebaceum, fibrous papules and pearly penile papules all have similar features
histologically, presenting as angiofibromas. Features include atrophic epidermis with patchy
melanocytic hyperplasia and hyperkeratosis, vertically oriented collagen, increased fibroblasts and
blood vessels. (B)
A. Hibernoma
C. Sebaceous carcinoma
D. Mucocele
E. Sclerosing panniculitis
A. Bazex's syndrome
B. Brooke-Fordyce syndrome
C. Brooke-Spiegler syndrome
D. Gorlin's syndrome
E. Rombo 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. (D)
A. Stromelysin
B. Chloracetate
C. Fumarase
D. Myeloperoxidase
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. (D)
A. CAM 5.2
B. Bcl-2
C. PTAH
D. CEA
E. Cytokeratin 8
Trichoepitheliomas stain with bcl-2 on the periphery of individual tumor islands. (B)
A. Spontaneous pneumothorax
B. Hepatic cysts
C. Adrenal hemorrhage
D. Cirrhosis
E. Gastrointestinal polyps
A. Scleromyxedema
B. Necrobiotic xanthogranuloma
C. Scleredema
D. Sclerosing panniculitis
E. Plane xanthoma
A. Silica
B. Tattoos
C. Liquid silicone
E. Zirconium
Parafinoma and silicone granuloma both have a swiss cheese type appearance in the dermis to
subcutaneous fat. The remaining options typically appear sarcoidal. (C)
A. Mixed-cell infiltrate
E. Prominant vasculature with thick-walled blood vessels lined by plump endothelial cells
95-This patient recently developed this rash. You decide to patch test her,
but in the meanwhile you tell her to avoid:
A. Chamomile
B. Primin
C. Abietic acid
D. Benzocaine
E. Cinnamon
This patient likely has a fragrance allergy. Patients allergic to fragrances also need to avoid certain
spices like cinnamon.(E)
96-Clinically, a nondescript hyperkeratotic papule on the ulnar side of the
base of the fifth finger is most likely:
B. Accessory digit
C. Cutaneous horn
D. Digital fibromatosis
E. Glomus tumor
Accessory digits (supernumerary digits) are usually found at the base of the fifth finger, often
bilaterally. (B)
E. No follicular plugging
Morphea vs. Lichen schlerosus et atrophicus: Morphea has a relatively normal epidermis without
follicular plugging. Interface changes are rare. In the dermis, the collagen fibers appear
homogenized. Elastic fibers are preserved. The inflammation and sclerosis can extend into the
subcutaneous fat. LS&A has an atrophic epidermis with follicular plugging. There is often prominent
hydropic changes with clefting. There is often edema of the papillary dermis and elastic fibers are
often absent. The subcutis is uninvolved.(B)
Systemic use of conjugated estrogens in postmenopausal women increases total skin thickness,
dermal collagen content and mitotic activity of keratinocytes. In addition, there is a reduction of dry
skin, slackness and increased hydration.(C)
A. HMB-45
B. Cytokeratin 20
C. Congo red
D. Mucin
E. CD1a
A. Eccrine glands
B. Apocrine glands
C. Hair follicles
D. Fat
A. Munro microabscesses
D. Hypergranulosis
E. Suprapapillary thinning
A. Phagolysosomes
B. Mitochondria
C. Golgi
D. 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. (B)
C. Myxofibrosarcoma
D. Myofibromatosis
An entity called giant cell fibroblastoma is CD34-positive, is mostly seen in male children on the
neck/trunk, and is thought to be a juvenile counterpart of DFSP. (B)
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. (C)
A. Dermal
C. Basal keratinocytes
D. Subrabasal
E. Subcorneal/granular
Porphyria cutanea tarda (PCT) is the most common porhyria. It is due to a deficiency of
uroprophyrin decarboxylase. Adults present with sun induced vesicles, papules, crusts and milia in
areas of scaring. On histology the cleft in porphyria cutanea tarda is subepidermal or in the
basement membrane zone with festooning of dermal papillae into the blister. Hyalinized material
around blood vessels in the papillary dermis may be seen, as well as caterpillar bodies (eosinophilic
segemented basement membrane) in the roof of the blister. PCT is associated with hepatitis C,
alcohol abuse and liver disease. (B)
B. Malakoplakia
C. Sarcoidosis
D. Lipoid proteinosis
E. Gaucher�s
Comma-shaped bodies and worm-shaped bodies can be seen in a variety of histiocytoses and are
non-specific. The most common association is with benign cephalic histiocytosis. (A)
S-100 protein is an acidic protein that binds Ca2+ and Zn2+. At a neutral pH, it is soluble in 100%
ammonium sulfate. It is useful in diagnosing both spindle cell melanomas, desmoplastic
melanomas, as well as poorly differentiated cutaneous metastases. It also stains positively in
neurofibromas and schwannomas. (C)
B. Multiple trichoepitheliomas
D. Multiple trichodiscomas
A. Cylindroma
C. Chondroid syringoma
D. Bednar tumor
Cutaneous mixed tumor, also known as Chondroid syringoma, represents an acquired hamartoma
with folliculosebaceous-apocrine differentiation that has been generally interpreted as a form of
adnexal adenoma (neoplasm). It has both a mesenchymal and epithelial component.(C)
A. Colloidal iron
B. Oil red O
C. Mucicarmine
D. Giemsa
The yeast cytoplasm of Crytococcosis stains with PAS and methanamine silver while the the
capsule stains with Alcain blue and mucicarmine. Colloidal iron stains mucin; Oil red O stains fat;
Giemsa stains mast cells and leishmaniasis; Verhoeff von Gieson stains elastic tissue. (C)
A. Stromelysin-3
B. Desmin
C. S-100
D. PGP-9.5
113-The PDGF gene has been shown to be translocated into the collagen I
gene in:
A. Angiofibroma
B. Dermatofibroma
C. Dermatofibrosarcoma protuberans
A translocation involving the PDGF gene and collagen I gene is found in dermatofibrosarcoma
protuberans. (C)
A. Dermatofibroma
C. Dermatofibromasarcoma protuberans
E. Breast carcinoma
A. Myxoid cyst
B. Verruca vulgaris
C. Psoriasis
D. Onychomycosis
E. Paronychia
A myxoid cyst is not a true cyst as it is devoid of cyst lining. They usually occur in an acral location
and are the most common cause of a longitudinal groove of a nail plate.(A)
C. Eosinophilia
Histologic appearance of metastatic breast carcinoma to the skin typically shows tumor cells in
linear arrangement in so-called �Indian-filing� pattern. These tend to occur in the dermis and
subcutaneous lymphatics. Extensive lymphatic dissemination may be caused by retrograde
lymphatic spread. The tumor cells are large, pleomorphic with hyperchromatic nuclei.(D)
A. CD2
B. CD3
C. CD5
D. CD20
E. CD30
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, Hodgkin�s lymphoma, and lymphomatoid papulosis. Reactive
infiltrates can also have some CD30-positive cells. (C)
118-For this patient, you request that the lab perform indirect
immunofluorescence using what substrate?
A. Monkey esophagus
B. Rat bladder
D. Mouse epithelium
E. Hep-2 cells
This patient has pemphigus folicaceus, and indirect immunofluorescence works best on guinea pig
esophagus.(C)
A. CD1a
B. CD11
C. CD30
D. CD56
E. CD68
A. Type I collagen
B. Type II collagen
D. Type IV collagen
Chondrodermatitis nodularis helices presents as a tender nodule usually on the helix or antihelix of
the ear. It is thought to be a result of vascular insufficiency. Degeneration of the cartilage is seen on
histopathology which is primarily composed of type II collagen.(B)
121-This is a desmoplakin:
A. BPAg1
B. Plakoglobin
C. Plakophilin
D. Desmocollin
E. Beta-catenin
A. Sweet's syndrome
B. Leukocytoclastic vasculitis
E. Erythema multiforme
Sweet's syndrome, or acute febrile neutrophilic dermatoses, is often associated with AML and G-
CSF. Histologically, there is marked dermal edema with a prominent infiltrate composed of
neutrophils with leukocytoclasia. There is an absence of extensive vascular damage.(A)
A. Dermal
C. Basal keratinocytes
D. Suprabasal
E. Subcorneal/granular
Linear IgA bullous dermatosis is an autoimmune disorder that presents with tense blisters along red
annular rings (like a string of pearls). Antibodies are found in the lamina lucida against LAD-1
antigen in anchoring filaments. The cleft in linear IgA would be found in the basement membrane
zone/subepidermal with direct immunostaining IgA in a linear pattern at the dermal-epidermal
junction.(B)