Case 1

58 yo AAM with new lesions on arms for 6 weeks Worse with sun exposure

PAS

Colloidal Iron

Discoid Lupus Erythematosus

Discoid Lupus Erythematosus

Dense superficial and deep periadnexal, perivascular mononuclear infiltrate Interface dermatitis Vacuolar changes, pigment incontinence, necrotic keratinocytes Follicular plugging Basement membrane thickening Increased dermal mucin

Ls of Dense Dermal Lymphocytic Infiltrates

Lupus erythematosus Lymphocytic lymphoma

Atypical lymphocytes, not usually periadnexal

Lymphocytoma cutis
Larger lymphocytes, often mimics germinal center formation

Polymorphous Light Eruption

Significant papillary dermal edema, not periadnexal

Lymphocytic infiltrates of Jessner

Similar to LE, increased numbers of B cells

Lues
Many plasma cells, no increase in mucin; Tp stains, serologies

Lyme disease
Lymphoplasmacytic infiltrates, silver stains for spirochetes

Case 2

73 yo man with itchy bumps on legs

Hypertrophic Lichen Planus

Hypertrophic Lichen Planus

Prominent hyperplasia of epidermis with overlying orthokeratosis Psoriasiform hyperplasia at margins (secondary to rubbing) Basal cell damage usually confined to the tips of rete ridges Typically infiltrate is not as dense or band-like Can see eos and plasma cells ( blockers)

Case 3

56 yo WM with new onset of tender sores on upper body Multiple sclerosis, on mycophenolate mofetil and prednisone

Disseminated Necrotic Herpes Zoster

Herpes Virus Infection

Epidermal nuclei: peripheral clumping of chromatin, homogeneous ground-glass appearance, ballooning, eosinophilic intranuclear inclusion bodies Cytoplasm: vacuolization initially along the basal layer, then entire epidermis Ballooning degeneration & reticular degeneration Perineural and some intraneural inflammation

Case 4

New rash on face of pregnant woman Growing for 2 weeks Itchy

Dermatophytosis

Dermatophytosis

Basket-weave above compact stratum corneum Collection of neutrophils Non pigmented hyphae in stratum corneum PAS diagnostic

Neutrophilic Spongiosis

Pustular psoriasis Reactive arthritis IgA pemphigus Palmoplantar pustulosis Dermatophytosis and candidiasis Acute generalized exanthematous pustulosis

Case 5

Routine annual full body skin check on 72-year-old Small scaly reddish brown papule on back

Melan-A

Melanoma in Situ
Anatomic Pathology / LICHENOID TISSUE REACTION IN MALIGNANT MELANOMA 766 Am J Clin Pathol 2002;117:766-770 American Society for Clinical Pathology

Lichenoid Tissue Reaction in Malignant Melanoma A Potential Diagnostic Pitfall

CPT Scott R. Dalton, MC, USA,1,3 Capt Matt A. Baptista, USAF, MC,1,3 COL Lester F. Libow, MC, USA,2 and COL Dirk M. Elston, MC, USA2

Retrospective study of 342 cases of invasive MM and MIS from head, neck, chest, back 23 (6.7%) had a lichenoid tissue reaction obscuring a portion of the lesion Only rarely were melanocytic nests evident within the lichenoid area upon immunostaining lichenoid regression

Case 6

43-year-old with ESRD on HD for 10 years Skin tightening started a few months ago and is getting worse

CD34

FXIIIa

CD68

Nephrogenic Systemic Fibrosis

Nephrogenic Systemic Fibrosis

Increased cellularity of dermis and subcutaneous fat Spindled and dendritic cells interspersed between thickened collagen bundles Epitheloid and multinucleated giant cells Variable increase in dermal mucin and elastic fibers Immunohistochemistry:
CD34: fibrocytes Factor XIIIa and CD-68: mono- and multinucleated cells

Case 7

New growths on leg of 53 yo man Similar lesions in mother and sister

Porokeratosis

Porokeratosis

Clonal disorder of keratinization with hyperproliferation of atypical keratinocytes Cornoid lamella: narrow column of hyperparakeratosis above a cluster of dyskeratotic keratinocytes Typically 2 cornoid lamellae lean towards each other Epidermis in between is thin, sometimes dyskeratotic Patchy lichenoid inflammation

Case 8

Painful boils on the legs of a 60 yo woman hospitalized for acute pancreatitis

Pancreatic Panniculitis

Mixed lobular and septal panniculitis Ghost cells: necrotic, partially calcified adipocytes

Case 9

16 y/o M with 3 wk h/o reddish-brown papules on arms and legs R/o xanthomas, guttate psoriasis or GA

Pityriasis Lichenoides et Varioliformis Acuta

Pityriasis Lichenoides et Varioliformis Acuta (PLEVA)

Superficial and deep, wedge shaped perivascular infiltrate Mounds of parakeratosis with neutrophils Vacuolar degeneration of basal layer Papillary dermal hemorrhage

Case 10

49 yo WM with 2 month h/o rash Previous bx: lymphoma cutis Lymphoma cutis vs drug reaction

Secondary Syphilis

Psoriasiform hyperplasia of the epidermis Superficial and deep perivascular infiltrate Plasma cells

Thank you