CASE ANALYSIS Objectives: To identify and explain basic morphologic skin lesions. Discuss the basic pathophysiology (mechanism) of the above lesions Explain the etiopathogenesis. To differentiate benign and malignant tumors. Make clinical and pathologic correlation. Explain the possible outcome and complications.


P. B. Casuela, Jr.,MD

Case 1 : A 22 year old female medical student came in because of right malar skin lesions of few days duration after camping in Los Banos, Laguna.

0.5 cm

1. Describe/characterize each lesion which could be present and indicate the proper nomenclature. Which of the above is most likely present in the patient? Explain.


A(4x;10x ): Early and full-blown lesions

2. Describe the gross lesion. 3. State conditions or diseases which could clinically present in this manner. B 3. Pictures A & B are biopsies of common diseases which could represent the above disease. Classify the morphologic type of inflammation illustrated and characterize the inflammatory response in each. 4. State the etiopathogenesis.

Case 2: Two patients presented with chronic skin diseases. Characterize the gross clinical presentation. A (forearm) B (elbow)

1. Describe the salient microscopic features of the following. Which of these correlate with the previous gross clinical presentation? State your diagnosis. A B

2. Discuss the etioathogenesis of each.

Case 3 A 45 year old female came in because of multiple skin lesions (up to 7 cm in diam.). 1. Describe and classify the lesions. State common complication of these lesions. 2. State readily available diagnostic procedure/s which could be undertaken in this case. State principles.

3. Localize (layer of skin)and characterize the following skin lesions and which lesion is compatible with the clinical presentation. State your basis.



4. Match and describe the microscopic features of three diseases one of which could be present in this patient and relate it to comA mon clinical presentation. 4x !. Herpes simplex infection 2. Bullous pemphigoid 3. Pemphigus vulgaris

B4x 40x

C 4x

4. 1. Herpes simplex -Intraepidermal vesicle with multinucleated giant cells echibiting the “Moulding phenomenon”=nuclei deform each other and never ovarlap one another. 2. Pepmphigus vulgaris - intraepidermal, suprabasal cleft or blister containing acantholytic cells (inset) 3. Bullous pemphigoid -non-acantholytic, subepidermal blister with prominent eosinophilic cell infiltrates 5. Immunofluorescence microscopy: Direct Immunofluorescence A-Pemphigus vulgaris -lace-like squamous intercellular space deposition of Ig G in the lower epidermis. B. Bullous pemphigoid –linear deposition of Ig G in the basement membrane zone.

5. This diagnostic procedure is useful in the diagnosis of two of the previous conditions. Discuss the main features and state the significance of each. A B

Case 4: A 45 year old laundry woman presented with lesions on the face of several months duration.

19. Describe and classify the clinical/gross skin lesions.

BIOPSY dshows:: Scanner View: 20x: A B

2. Describe the salient dermal histopathologic abnormalities. Classify the lesion according to the morphologic pattern. 3. State your diagnosis and differential diagnosis. 4. Discuss briefly Lepromin test – state principle and significance of results. 5. Discuss the etiopathogenesis and outcome of this disease.

Case 5 A 35 year old patient complains of pigmented lesions of the chest.

1cm 1. Describe the lesions. 2. State whether the lesion is benign or malignant. State your basis.

3. Match and describe common pigmented lesions which could


be present in this patient. 4x I. Seborrheic keratosis II. Intradermal nevus III. Junctional nevus IV. Lentigo senilis 4. Discuss age predilection & malignant potential. .

B 10x

C 10x


After five years the patient developed chest lesion which presented as shown :


5. Characterize the lesion. Is this benign or malignant? State your bases. 6. Discus the etiopathogenesis & outcome of this tumor. 7. State the basic principles of biopsy and microstaging in this case.