Difference between revisions of "Dermal cysts"
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(→EM, SJS, TEN: more) |
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*Milicem. | *Milicem. | ||
==EM | ==Epidermal necrosis== | ||
*SJS and TEN are on a spectrum, EM is considered separate. | ===General=== | ||
Full thickness DDx: | |||
*Erythema multiform (EM). | |||
*Toxic epidermal necrolysis (TEN). | |||
*Stevens-Johnson syndrome (SJS). | |||
*Trauma. | |||
*Others. (???) | |||
Partial thickness DDx: | |||
*Staphylococcal scalded skin syndrome. | |||
*Trauma. (???) | |||
*Others. (???) | |||
Notes: | |||
*SJS and TEN are on a spectrum, EM (depending on who you ask) is considered separate. | |||
===Erythema multiforme=== | ===Erythema multiforme=== | ||
| Line 16: | Line 30: | ||
====General==== | ====General==== | ||
Features:<ref name=Ref_PBoD8_1189>{{Ref PBoD8|1189}}</ref> | Features:<ref name=Ref_PBoD8_1189>{{Ref PBoD8|1189}}</ref> | ||
*Hypersensitivity disorder to a drug or | *Hypersensitivity disorder due to a drug ''or'' infection. | ||
**Associated with the following: [[HSV]], Mycoplasma, Histoplasma, others. | **Associated with the following: [[HSV]], Mycoplasma, [[Histoplasma]], others. | ||
Clinical: | Clinical: | ||
| Line 31: | Line 45: | ||
===Stevens-Johnson Syndrome=== | ===Stevens-Johnson Syndrome=== | ||
*Abbreviated SJS. | *Abbreviated SJS. | ||
====General==== | |||
Rx causes of SJS: | Rx causes of SJS: | ||
*NSAIDs. | *NSAIDs. | ||
| Line 38: | Line 52: | ||
*Penicillins. | *Penicillins. | ||
===Toxic | ====Microscopic==== | ||
Features: | |||
*Similar [[erythema multiforme]]. | |||
===Toxic epidermal necrolysis=== | |||
*Abbreviated TEN. | *Abbreviated TEN. | ||
====General==== | |||
TEN more severe form SJS. | *TEN more severe form SJS. | ||
Definition: | Definition: | ||
*>30% sheet-like epidermal detachment, diffuse erythema, severe mucous membrane involvement. | *>30% sheet-like epidermal detachment, diffuse erythema, severe mucous membrane involvement. | ||
*Most TEN (80%) Rx-related, only 50% of SJS Rx-related. | *Most TEN (80%) Rx-related, only 50% of SJS Rx-related. | ||
====Microscopic==== | |||
Features: | |||
*Like [[erythema multiforme]] - but usu. less inflammation.<ref>S. Sade. 8 September 2011.</ref> | |||
==Venous lake== | ==Venous lake== | ||
Revision as of 15:30, 9 September 2011
Dermal cysts are common in dermatopathology. Dermatopathologists can diagnose 'em.
Cysts
Common types:[1]
- Epidermal cyst (sebaceous cyst) -- most common.
- Pilar (trichilemmal) cyst.
- Dermoid cyst.
- Ganglion cyst.
- Milicem.
Epidermal necrosis
General
Full thickness DDx:
- Erythema multiform (EM).
- Toxic epidermal necrolysis (TEN).
- Stevens-Johnson syndrome (SJS).
- Trauma.
- Others. (???)
Partial thickness DDx:
- Staphylococcal scalded skin syndrome.
- Trauma. (???)
- Others. (???)
Notes:
- SJS and TEN are on a spectrum, EM (depending on who you ask) is considered separate.
Erythema multiforme
- Abbreviated EM.
General
Features:[2]
- Hypersensitivity disorder due to a drug or infection.
- Associated with the following: HSV, Mycoplasma, Histoplasma, others.
Clinical:
- Target-like lesion.
Microscopic
Features:[2]
- Lymphocytic interface dermatitis (lymphocytes at the dermal-epidermal junction).
- Necrotic/degenerative keratinocytes - key feature.
- +/-Epidermal blistering.
- +/-Epidermal sloughing.
Stevens-Johnson Syndrome
- Abbreviated SJS.
General
Rx causes of SJS:
- NSAIDs.
- Anticonvulsants.
- Sulfonamides.
- Penicillins.
Microscopic
Features:
- Similar erythema multiforme.
Toxic epidermal necrolysis
- Abbreviated TEN.
General
- TEN more severe form SJS.
Definition:
- >30% sheet-like epidermal detachment, diffuse erythema, severe mucous membrane involvement.
- Most TEN (80%) Rx-related, only 50% of SJS Rx-related.
Microscopic
Features:
- Like erythema multiforme - but usu. less inflammation.[3]
Venous lake
- Dilated vein.
Microscopic
Features:[4]
- Lined by endothelium.
- Blood in lumen.
- +/-Fibrin in lumen.
DDx:
- Angiokeratoma.
- Ectatic superficial dermal vessels.
- Irregular acanthosis.
- Longer rete ridges.
Neurofibromatosis (von Recklinghausen's disease)
Main article: Neurofibromatosis
Etiology
- Genetic - autosomal dominant disorder.
Management
- Follow for malignant transformation of neurofibroma --> neurofibrosarcoma.
Treatment
- Excise suspicious lesions & lesions that are painful.
Collagenous fibroma
General
- Benign.
- Used to be known as desmoplastic fibroblastoma.
Epidemiology:
- May be on the lip.
Microscopic
- Acellular stroma with abundant collagen.
Notes:
- No nuclear atypia.
Dermatomyositis
Gross
- Have lesions on the knuckle - Gottron's papulle
Microsopic
Features:
- Lymphocytic interface dermatitis (inflammation at the dermal-epidermal junction).
- Loss of rete ridges.
Systemic lupus erythematosus
Familial benign pemphigus
- AKA Hailey-Hailey disease. Was described by two brothers - that's why it is Hailey-Hailey.[9]
Etiology
- Autosomal dominant with incomplete penetration.[9]
- Desmosomal defect - due to mutation in the gene ATP2C1.[9]
Clinical
- Chest.
- Intriginous regions (?sp).
- Typically presents individual in their 30s and 40s.[9]
Histology
- Hair folicles spared.
- Epidermis thickened.
DDx
- May resemble pemphigus vulgaris.
Epidermal inclusion cyst
- AKA epidermal cyst.
General
- Very common.
Microscopic
Features:
- Cyst lining has a granular layer - key feature.[10]
- Trapped collagen bundles at edge of lesion with surrounded by fibroblasts.
- Keratin.
Image:
DDx:
- Dermatofibrosarcoma - if lesion is large.
- Pilar cyst - no granular layer.
Pilar cyst
- AKA trichilemmal cyst.
General
- Very common.
Microscopic
Features:
- Keratin.
- Cyst lining has no granular layer - key feature.
- Trapped collagen bundles at edge of lesion with surrounded by fibroblasts.
DDx:
- Epidermal cyst - has a granular layer.
See also
References
- ↑ TN07 D5
- ↑ 2.0 2.1 Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1189. ISBN 978-1416031215.
- ↑ S. Sade. 8 September 2011.
- ↑ Weedon's Skin Pathology. 3rd Ed. P.895.
- ↑ URL: http://www.dermatologyoutlines.com/dermskintumornonmelanocytic.html#collagenousfibroma. Accessed on: 19 March
- ↑ Mills, Stacey E; Carter, Darryl; Greenson, Joel K; Oberman, Harold A; Reuter, Victor E (2004). Sternberg's Diagnostic Surgical Pathology (4th ed.). Lippincott Williams & Wilkins. pp. 161. ISBN 978-0781740517.
- ↑ JAH. 20 February 2009.
- ↑ Crowson AN, Magro CM, Mihm MC (April 2008). "Interface dermatitis". Arch. Pathol. Lab. Med. 132 (4): 652–66. PMID 18384217. http://www.archivesofpathology.org/doi/full/10.1043/1543-2165%282008%29132%5B652%3AID%5D2.0.CO%3B2.
- ↑ 9.0 9.1 9.2 9.3 http://emedicine.medscape.com/article/1063224-overview
- ↑ URL: http://emedicine.medscape.com/article/1058907-diagnosis. Accessed on: 18 March 2011.