Christine J. Ko - Dermatopathology

Figure 3(B)Distribution of inflammation – major patternsSee Figure 3(A)for lichenoid

Figure 3(C)The morphology of key inflammatory cells

Lymphocyte: round blue nucleus, little cytoplasm

Neutrophil: multilobed nucleus

Eosinophil: bilobed nucleus with bright pink‐red cytoplasmic granules

Histiocyte: oval nucleus

Giant cell: multiple nuclei in one cell

Plasma cell: clock‐faced nucleus on one side of cell, perinuclear clear space

Characteristic body sites

The location on the body (body site) can often be determined by training the eye/brain to perceive certain features

Figure 4: Acral (A), mucosal (B), eyelid (C), axilla (D)

Figure 4(A)Acral skin

NoteMeissner’s corpuscles (black arrow), Pacinian corpuscles (red arrow), and thick stratum corneum with a stratum lucidum (green arrow).

Figure 4(B)Cutaneous lip (top row) has keratin and a granular layer (green arrow) as well as adnexal structures

Skeletal muscle is often present (black arrows)

Normal mucosal lip (bottom row) lacks keratin and a granular layer; the keratinocytes are pale pink with abundant cytoplasm

The mucosa shown is abnormal as there is subtle parakeratosis (black arrow bottom right image)

Figure 4(C)Eyelid skin has a thin epidermis with dermal vellus hairs (red arrow) and skeletal muscle (black arrow)

Figure 4(D)Axilla

The epidermis is undulating, often with basilar melanin pigment. There are apocrine glands in the deep dermis

Table 2(see page 22) shows a differential of “normal”‐appearing skin. Some entities, like vitiligo, require special stains (i.e., a melanocytic marker).

Figure 5(A) Argyria

There are fine black granules in the basement membrane of hair follicles and eccrine glands

Black granules are also deposited on elastotic fibers, so‐called “pseudo‐ochronosis”

Source: Case courtesy of James E. Fitzpatrick, MD.

Figure 5(B) Ichthyosis vulgaris

This example from an older patient has solar elastosis in the dermis

There is hyperkeratosis above an attenuated granular layer

Source: Case courtesy of Jeff D. Harvell, MD.

Figure 5(C) Tinea versicolor

Yeast and hyphal forms in the stratum corneum

Figure 5(D) Urticaria

Urticaria can appear “normal” at low power, particularly when inflammation is sparse

There are perivascular and interstitial lymphocytes and eosinophils

Table 2 Some entities to consider for a gestalt impression of “normal” skin.

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