Rizki Hanriko

Laboratorium Anatomi-Histo-PA
FK UNILA
2018
 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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VITILIGO
LENTIGO
NEVUS NEVOSELLULER
NEVUS DISPLASTIK
MELANOMA MALIGNA
 Macules or patches hipopigment.
 Hands, wrists, and perioral and anogenital
regions.
 Partial or complete loss of melanocytes,
possibly of autoimmune etiology.
 Associated with other autoimmune
diseases ->>> Hashimoto thyroiditis, type
1 DM, or Addison disease.
 Albinism  genetic deficiency of
tyrosinase.
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.
 Relatifsering mematikan
 Predisp: sunlight
 pre existing naevus: eg dysplastic
 ultraviolet radiation that damages the
DNA of melanocytes.
 Mutations in CDKN2A,
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: 28

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
 Mutasi p53
 Papul/plak Ø <1cm, cokelat muda-
tua/merah, kasar, keratin horn

Mikros:
 Dysplasia of keratinocytes in basal portion
of epidermis; can have parakeratosis.
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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
42
 blackhead  oksidasi lipid
 whitehead
 Mikros:
 struktur pilosebaseus berisi keratin dan
lipid
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 Infections
and
Infestations
45

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: 62
 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