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Whitney A High MD,JD @MileHighDpath
Joined August 2017
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40 y/o F. Finger papules. BEST answers. Dx: A) giant cell tumor B) granuloma annulare C) reticulohistocytoma D) xanthogranuloma IHC in cells of interest: A) CD1a B) CD3 C) CD68 D) Sox10 Important to ? pt about: A) arthritis B) DM C) HTN D) NHL #Dermquiz #Dermpathquiz #Derm
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Young man (<30 y/o). Noted lesion for several years. Dx as pyogenic granuloma at some point, but continued to grow. Bx performed. The best dx is: A) cavernous hemangioma B) Kaposi sarcoma C) melanoma D) pyogenic granuloma #Dermquiz, #Dermpathquiz, #ConjunctivalLesion
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Things learned from case: T/F - pT criteria for conjuctival MM differ from those of skin T/F - evidence re: utility of PRAME for conjuctival melanoma is similar to skin MM T/F - there are several case reports in idex med lit. of conjuctival MM being confused (clinically) with PG
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My answers: TRUE -pT criteria differ for conjunct MM, some in dermpaths own group unaware; TRUE -subjectivity here, no fighting, but IMHO the utility is about same; TRUE -reports of conjunctival MM confused with PG and vice/versa Refs attached. Hope that expands ur knowledge!🙂
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Part 1. 39 y/o. Rash since 11/23. Also c/o joint/muscle pain. Chart states "saw derm last week, dx???" Derm did bx. FP APP did many blood tests. You now want: A. Want more blood tests B. Want IHC C. Want special stain D. Want to see more skin E. >/=3 of above. #Dermpath #Derm
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Hints: (1) Fam Med focused on CTD, but in limited pics, there is not photodisribution and a "boiled ham" color to pap squamous rash. (2) There are granulomatous elements (uncommon in CTD), but also tracking of inflammation down N/V bundles and curious number of plasma cells.
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Last week CDC stated syphilis infections at highest rate since 50's! Here is what was done: 1) asked for pics of palms/soles - none 2) obtained IHC for spiros (Steiner is other option) 3) I recommended RPR/VDRL and FTA-ABS ( / ) #syphilis,#dermpathquiz, #dermquiz
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34 y/o. Papule on scrotum. "R/O condyloma." No other history known. What is the best diagnosis? A. Condyloma acuminatum B. Condyloma lata C. Epidermolytic hyperkeratosis of the genitalia D. Verruciform xanthoma #Dermpathquiz,#Dermquiz
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Yes, verruciform xanthoma. Common on oral mucosa and genitalia. Histo features: 1) papillomatous architecture 2) "crypt-like" parakeratosis 3) neutrophils in parakeratosis 4) lipid laden foamy histiocytes in shallow dermis Associated in literature with CHILD syndrome.
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IMHO best theories on foam cell origin go something like this: - unknown event damages keratinocytes, perturbations in repair mechanism(s) yield cytokines that attract histiocytes, histiocytes ingest lipids from degen keratinocytes, form foam. (Hu Ja et al. 2005, among others)
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For MCQ examination purposes: Which of the following syndromes is most strongly associated with the presence of verruciform xanthomas? A. CHILD syndrome B. LAMB syndrome C. PHACE syndrome D. SAPHO syndrome
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IHC below represents "Adipu" stain (or combination of Pu.1 (brwn) - a histiocytic marker, and adipophilin (red) - a lipid marker). It highlights the lipid laden histiocytic cells in the shallow dermis. There are 3 proposed mechanisms for lipid accumulation.
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Clinical photo of columella biopsy
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Yes, apologize the clin photo wasn't more "telling" or diagnostic. Clinician who took it is excellent, but the purpose was to document site (in case it was cancer, per protocol). But you can tell it is not an area of high solar exposure relative to the rest of the nose.
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Yes, I do wish the clin photo was more "diagnostic" or "telling," but at least it shows you: 1) the sundamage is modest, 2) it is in the shadow of the nose, and 3) it is in a place where pressure from a canula or whatnot can be imagined. Thanks for looking.
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69 y/o. Bx in Derm Clinic by APP. Only info- "Right columella. Pink papule 3 x2 mm. AK vs NMSC." Best dx is: A) AKH, ulcerated B) BCC, with squamous metaplasia C) chondrodermatitis nodularis "columellis" D) SCC, ulcerated Any history wanted? Photo help? #Dermpathquiz,#derm
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I, personally, wanted more data, and so I asked for the clinical photo (which was taken for purposes of site location - not optimal). I asked "By chance, does the patient use CPAP?" Answer - "Every night... and it 'hits' right there." #dermpathquiz, #dermquiz
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