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
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 Makroskopik:
makula,papula,nodula,plak,
vesikel, bula, pustula,
skuama, likenifikasi, ekskoriasi
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MIKROSKOPIK:
HIPERKERATOSIS,
PARAKERATOSIS, DISKERATOSIS
AKANTOSIS, PAPILOMATOSIS,
AKANTOLISIS, SPONGIOSIS
Disorders of Pigmentation
and Melanocytes
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LENTIGO
NEVUS NEVOSELLULER
NEVUS DISPLASTIK
MELANOMA MALIGNA
Idiopatik,
segala usia, ras dan sex,
kulit dan mukosa

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

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

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

infiltration, often with heavily pigmented confused with
associated fibrosis nevus cells melanoma clinically

Spindle and Fascicular growth Large, plump cells Common in children;

epithelioid with pink-blue red-pink nodule; often
cell nevus cytoplasm; fusiform confused with
(Spitz nevus) cells hemangioma clinically

Halo nevus Lymphocytic infiltration Identical to Host immune response

surrounding nevus cells ordinary acquired against nevus cells and
nevi surrounding normal
melanocytes

Dysplastic Coalescent intraepidermal Cytologic atypia Potential marker or

nevus nests precursor of melanoma
Relatif sering mematikan
Predisp: sunlight
pre existing naevus:
eg dysplastic

Makros:
 gatal?,
perubahan warna/
ukuran lesi berwarna,
nodul berpigmen,
cenderung ulserasi
 ABCD
Histologi pertumbuhan radial dan vertikal
Clark Level, Breslow Thickness
 Benign
epithelial tumors
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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:
 exophytic, batas tegas,
tdd sel basaloidpigmentasi melanosit
hiperkeratosishorn cyst (inside)
 Fibroepithelial tumor
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 Umum ditemukan, usia pertengahan

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

Makros:
 Nodul dg sumbat isi keratin (spt kawah),
1cm >, warna=kulit
Mikros:
Kawah keratin dikelilingi proliferasi
sel- sel epitel, sitoplasma eosinofilik “kaca”
 Appendage tumor
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 Jarang
 Silindroma:
diff apokrin,
nodule scalp,
appear early in
life
 Appendage tumor
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 Syringoma:
diff ekrin, palpebra inf, multipel
 Appendage tumor
 Trichoepithelioma: 27

diff folikel rambut, face,scalp,neck/up trunk

Appendage tumor
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 Keratosis actinik
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 Lesi pramaligna
 pajanan matahari + timbunan keratin
 Makros:
papul/plak Ø <1cm, cokelat muda-tua/merah, kasar,
keratin horn
 Mikros:
Atipia sel basal epidermis
 diskeratosis, pink /red cytoplasma, parakeratosis,
basal membrane intake
Dermis:
 bluegray elasticfibers elastosis ec. abn fiber synt,
sun damage fibroblas
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Malignant tumor
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SQUAMOUS CELL CA
BASAL CELL CA
 SCC Insitu

Makros:
plak skuama merah, batas tegas
Mikros:
epidermal atypia,
 Squamous cell ca
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 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:
UV light
Imunosupresi
Xeroderma pigmentosum
Makros:
nodular, 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:
Pattern growth:
Multifokal (extended) or Nodular (down ward)
Palisading
 Akne vulgaris
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 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
 blackhead  oksidasi lipid
 whitehead
 Mikros:
 struktur pilosebaseus berisi keratin dan
lipid
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 Infections
and
Infestations
44

VERUKA
MOLUSKUM KONTAGIOSUM
LEPRA
 Veruka
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 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:
Hiperplasia epidermis
papilomatosa /verukosa,
granul keratohialin,
koilositosishalo ,
 Moluskum Kontagiosum
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 Umbilicated papul, umumnya di penis, vulva, groin

(STD),
 Sembuh sendiri 6-12 bulan
 Epidermal hiperplasia  badan Henderson-
Patterson, Ø 35µ,
 Eosinofilik – basofilik intrasitoplasmik inklusi
menekan inti dan granula keratohialin
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 Lepra
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 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  ∆ nodularitas kulit
3. Borderline
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 Kista kulit
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Kista Epidermal
Dibatasi SC
berkeratinisasi,
mgd keratin lamina
 Kista kulit
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Kista Dermoid
 Kongenital,

 garispenutupan/penyatuan kulit
embrional,
 dermoid angular eksternal

 Dibatasi epitel dg bbg adnexa epidermis,

tmsk fol rambut dan kel sebaseus
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DERMATOSIS Urtikaria
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 Degranulasi lokal sel Mast

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

 Rx Hipersensitivitas tipe I

Dermatosis Peradangan Akut

 Urtikaria
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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
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 Eksim
 Lesi merah, papulovesikuler, isi cairan & krusta --
-- plak skuamosa
 Dermatitis spongiosa
 DKI, DKA, ATOPI

Dermatosis Peradangan Akut

 Eritema Multiforme
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 Respon hipersensitivitas thd infeksi dan obat ttt

 Swasirna, lesi multiforme
 SSJ & NET
Mikroskopik:
 Infiltrat limfositik superfisial perivaskuler
 Edema dermis
 Marginasi limfosit sepanjang DEJ  nekrosis
epidermis & bula
Dermatosis Peradangan Akut
 Psoriasis
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 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  akantosis
 Rete ridge memanjang
 Str. Granulosum & skuama parakeratotik
 Tanda Auspitz, pustul Spongiform, mikroabses Munro

Dermatosis Peradangan Kronis

 Liken Planus
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 Pruritic, purple,
polygonal papules,
striae wickham
 Swasirna 1-2 th
 lesi hiperpigmentasi pasca inflamasi
Mikroskopis:
 Infiltrat limfositik padat kontinu sepanjang DEJ  zig
zag contour ( sawthooting)
 Badan Civatte
 Hiperplasia epidermis, hipergranulosis, hiperkeratosis
Dermatosis Peradangan Kronis
 Pemfigus
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 Rx hipersensitivitas tipe II, auto imun

 Hilangnya integritas jembatan antar sel N di epidermis
& epitel mukosa
 Pemfigus vulgaris 80%  vesikobulosa mudah pecah
 Pemfigus vegetans  plak vegetans besar, basah,
verukosa, dipenuhi pustula
 Pemfigus foliaseus & eritematosa  ringan
Penyakit Bulosa
 Pemfigus
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 Mikroskopis:
 Akantolisis
 Bula akantolitik suprabasal
 Infiltrasi limfositik, histiosit, eosinofil
Penyakit Bulosa
 Pemfigoid Bulosa
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 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  bula
Penyakit Bulosa
 Dermatitis
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Herpetiformis
 Urtikaria & vesikel berkelompok,
bilateral & simetris
 Enteropati  Cheliac disease
Mikroskopis:
 Mikro abses di ujung papilla dermis
( fibrin & neutrofil)
 Vakuolisasi di atasnya  bula sub
epidermis
 Imunofluoresens  endapan Ig A

Penyakit Bulosa
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Wassalam