Dermatopathology Practice Questions

Q: Langerhans cells in skin fall under which category?

Antigen presenting cell. ***Antigen presenting cell*** - **Langerhans cells** are specialized **dendritic cells** found in the epidermis of the skin and play a crucial role in the immune system [1], [3]. - Their primary function is to capture and process antigens from the skin environment and present them to **T lymphocytes**, initiating an immune response [1], [2]. *Keratin synthesising cell* - **Keratinocytes** are the primary cells responsible for synthesizing **keratin**, providing structural integrity to the epidermis [3]. - Langerhans cells originate from bone marrow and are not involved in keratin production. *Sensory neurons* - **Sensory neurons** (e.g., Merkel cells and nerve endings) are responsible for transmitting sensations like touch, pressure, and pain [3]. - Langerhans cells are immune cells and do not have neuronal functions. *Pigment producing cells* - **Melanocytes** are the cells responsible for producing **melanin**, the pigment that gives skin, hair, and eyes their color [3]. - Langerhans cells do not produce pigment; their role is immune surveillance [3]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, p. 200. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 174-175. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Skin, p. 1144.

Q: Psoriasis has the following features except

Prominent granular cell layer. ***Prominent granular cell layer*** - Psoriatic skin lesions are characterized by a **thinned or absent granular cell layer (stratum granulosum)**, not a prominent one. - This observation is often used histopathologically to differentiate psoriasis from other skin conditions. *Granular cell layer is thinned or almost absent* - This statement accurately describes a key histological feature of psoriasis, where the **stratum granulosum** is significantly reduced or missing. - The absence of this layer is linked to the rapid epidermal turnover seen in psoriatic plaques. *Munro abscesses in the parakeratotic layer* - **Munro microabscesses** are collections of neutrophils found within the **parakeratotic stratum corneum** in psoriatic lesions [1]. - These microabscesses are a characteristic histopathological finding that helps in the diagnosis of psoriasis. *Suprapapillary thinning of epidermis* - There is a characteristic **thinning of the suprapapillary epidermis** (the epidermis directly above the dermal papillae) [1]. - This thinning, combined with dilated capillaries in the dermal papillae, contributes to the **Auspitz sign**, where pinpoint bleeding occurs after scratching the surface of a psoriatic plaque [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Disorders Involving Inflammatory And Haemopoietic Cells, pp. 636-641.

Q: Medlar bodies are found in -

Chromoblastomycosis. ***Chromoblastomycosis*** - **Medlar bodies**, also known as **sclerotic bodies** or **copper pennies**, are thick-walled, septate, dematiaceous fungal cells characteristic of chromoblastomycosis. - They are typically found within **giant cells** or extracellularly in the dermis during histological examination of infected tissue. *Mycetoma* - Characterized by the presence of **grains** or **granules** composed of aggregated fungal hyphae (eumycetoma) or bacterial filaments (actinomycetoma) within the tissue [2]. - It presents as a chronic, progressive infection involving the skin, subcutaneous tissue, and often underlying bone [2]. *Histoplasmosis* - Caused by **_Histoplasma capsulatum_**, a dimorphic fungus that appears as small, oval, budding yeast cells within **macrophages** in infected tissues [1]. - It primarily affects the lungs but can disseminate to other organs, especially in immunocompromised individuals [1]. *Sporotrichosis* - Caused by **_Sporothrix schenckii_**, which appears as small, cigar-shaped budding yeast forms or asteroid bodies (yeast cells surrounded by an eosinophilic cuticle) in tissue. - It typically presents as **lymphocutaneous lesions** following traumatic inoculation of fungal spores [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, p. 717. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 393-394.

Q: Common differential diagnosis of verrucous carcinoma is -

Condylomata acuminata. ***Condylomata acuminata*** - **Verrucous carcinoma** is a rare, well-differentiated squamous cell carcinoma that often presents as a large, exophytic, warty mass, making it clinically similar to **condylomata acuminata (genital warts)** [1]. - Both conditions can appear as **cauliflower-like lesions** on mucosal surfaces, especially in the anogenital region, necessitating **biopsy** for definitive differentiation [1]. *Adenocarcinoma* - **Adenocarcinoma** typically arises from glandular tissue and presents as a mass or ulcer, but rarely as a **verrucous (warty)** lesion [2]. - Its histological features, characterized by **glandular differentiation**, are distinct from the acanthotic, hyperkeratotic pattern of verrucous carcinoma [2]. *Tuberculosis* - **Tuberculosis** can cause granulomatous lesions, but these are typically **ulcerative** or **nodular**, rather than large, exophytic, warty growths characteristic of verrucous carcinoma. - Diagnosis involves identifying **acid-fast bacilli** and characteristic granulomas with caseous necrosis, which are absent in verrucous carcinoma. *Condylomata lata* - **Condylomata lata** are broad, flat, moist papules associated with **secondary syphilis**, which are distinct from the exophytic, warty appearance of verrucous carcinoma [3]. - These lesions are typically **non-pruritic** and reveal spirochetes on dark-field microscopy, unlike verrucous carcinoma [3]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 974-975. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 973-974. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1000-1002.

Q: Rhinophyma is associated with-

Sebaceous gland hypertrophy. ***Sebaceous gland hypertrophy*** - **Rhinophyma** is a severe form of rosacea characterized by marked thickening and enlargement of the nose, [1] primarily due to **hypertrophy of the sebaceous glands**. - This glandular overgrowth leads to a bulbous, erythematous, and often disfigured appearance of the nose [1]. *Epithelial cell hyperplasia* - While there may be some secondary **epidermal hyperplasia** in rhinophyma, it is not the primary defining feature of the condition. - The dominant histological change is related to the **sebaceous glands** and connective tissue, not mainly the surface epithelium. *Endothelial cell hyperplasia* - **Vascular changes** and **telangiectasias** are common in rosacea, including rhinophyma, indicating some proliferation of endothelial cells [1]. - However, the most prominent and characteristic pathological feature of rhinophyma is the enlargement of the **sebaceous glands**, not the endothelial cells. *Sweat gland hypertrophy* - **Sweat glands** (eccrine or apocrine) are generally not primarily affected or undergo hypertrophy in rhinophyma. - The pathology is specifically centered on the sebaceous glands, which are distinct from sweat glands. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Skin, p. 1176.

Q: Acanthosis involves:-

Stratum malphigii. ***Stratum malphigii*** - **Acanthosis** refers to an increase in the thickness of the **stratum spinosum** (also known as the stratum malpighii) of the epidermis [1]. - This thickening is due to an increase in the number of **keratinocytes** in this layer and is a common histological feature in various skin conditions, such as psoriasis [1]. *Stratum lucidum* - The **stratum lucidum** is a thin, clear layer of the epidermis found only in thick skin (palms and soles). - It consists of flat, densely packed keratinocytes and is not typically involved in acanthosis. *Stratum corneum* - The **stratum corneum** is the outermost layer of the epidermis, composed of dead, flattened keratinocytes. - An increase in its thickness is called **hyperkeratosis**, not acanthosis. *Stratum granulosum* - The **stratum granulosum** is characterized by cells containing keratohyalin granules. - Changes in this layer are usually described as **hypergranulosis** (increased thickness) or hypogranulosis (decreased thickness), which are distinct from acanthosis. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Disorders Involving Inflammatory And Haemopoietic Cells, pp. 640-641.

Q: Patient with pigmented skin lesion shows pagetoid spread of atypical melanocytes. Diagnosis?

Superficial spreading melanoma. ### Superficial spreading melanoma - This is the most common type of melanoma and is characterized by a **radial growth phase** where atypical melanocytes spread along the **dermo-epidermal junction** and into the epidermis (pagetoid spread) [1]. - **Pagetoid spread**, referring to the upward migration of atypical melanocytes into the spinous and granular layers of the epidermis, is a hallmark histological feature. *Lentigo maligna* - This is a melanoma subtype primarily affecting **chronically sun-damaged skin** in older individuals, typically on the face. - While it has a prolonged **radial growth phase**, the atypical melanocytes tend to be confined to the **basal layer** and do not typically exhibit prominent pagetoid spread like superficial spreading melanoma. *Blue nevus* - A blue nevus is a **benign melanocytic lesion** characterized by the presence of dermal melanocytes that produce melanin deep within the dermis, giving it a characteristic blue or blue-gray color [2]. - It does not involve **atypical melanocytes** or **pagetoid spread** (upward migration of cells into the epidermis). *Nodular melanoma* - This is an aggressive subtype of melanoma characterized by a rapid **vertical growth phase** and minimal or absent radial growth phase [1]. - It presents as a **dark, raised nodule** and typically lacks the prominent pagetoid spread seen in the superficial spreading type, as its growth is primarily downward into the dermis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Skin, pp. 1151-1152. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Skin, p. 1146.

Q: In which skin disorder is the appearance of basal cells resembling a row of tombstones observed?

Pemphigus vulgaris. ***Pemphigus vulgaris*** - This autoimmune blistering disease is characterized by **acantholysis** (loss of cell-to-cell adhesion) in the **suprabasal layer** of the epidermis [2]. - The intact basal keratinocytes remain attached to the basement membrane, forming a characteristic "row of **tombstones**" appearance on histology [1]. *Pemphigus foliaceus* - This condition involves acantholysis in the more **superficial granular layer** of the epidermis, above the basal layer [2]. - This leads to subcorneal blistering and **crusted lesions**, but not the tombstone appearance [2]. *Erythema multiforme* - This is a **(type IV hypersensitivity reaction)** characterized by **target lesions** and **vacuolar degeneration** of the basal cell layer. - While it affects the basal layer, it does not involve acantholysis or the "tombstone" pattern. *Bullous pemphigoid* - This is a **subepidermal blistering disease** where autoantibodies target components of the **hemidesmosomes** at the dermoepidermal junction [2]. - The entire epidermis separates from the dermis, resulting in a **tense blister** and no acantholysis or tombstone appearance [2]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Disorders Involving Inflammatory And Haemopoietic Cells, pp. 645-646. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Skin, pp. 1170-1172.

Question 1

Langerhans cells in skin fall under which category?

Accepted Answer

Antigen presenting cell

Answer

Keratin synthesising cell

Answer

Sensory neurons

Answer

Pigment producing cells

Question 2

Psoriasis has the following features except

Accepted Answer

Prominent granular cell layer

Answer

Granular cell layer is thinned or almost absent.

Answer

Munro abscesses in the parakeratotic layer

Answer

Acanthosis with thickened lower portion

Answer

Suprapapillary thinning of  epidermis

Question 3

Medlar bodies are found in -

Accepted Answer

Chromoblastomycosis

Answer

Mycetoma

Answer

Histoplasmosis

Answer

Sporotrichosis

Question 4

Common differential diagnosis of verrucous carcinoma is -

Accepted Answer

Condylomata acuminata

Answer

Adenocarcinoma

Answer

Tuberculosis

Answer

Condylomata lata

Question 5

Rhinophyma is associated with-

Accepted Answer

Sebaceous gland hypertrophy

Answer

Epithelial cell hyperplasia

Answer

Endothelial cell hyperplasia

Answer

Sweat gland hypertrophy

Question 6

Acanthosis involves:-

Accepted Answer

Stratum malphigii

Answer

Stratum lucidum

Answer

Stratum corneum

Answer

Stratum granulosum

Question 7

The following statement about keloid is true:

Accepted Answer

It will have more collagen and vascularity

Answer

Extended excision is the treatment of choice

Answer

Elevated levels of growth factor is not seen

Answer

They do not extend beyond the wound

Question 8

Patient with pigmented skin lesion shows pagetoid spread of atypical melanocytes. Diagnosis?

Accepted Answer

Superficial spreading melanoma

Answer

Lentigo maligna

Answer

Blue nevus

Answer

Nodular melanoma

Question 9

In which skin disorder is the appearance of basal cells resembling a row of tombstones observed?

Accepted Answer

Pemphigus vulgaris

Answer

Pemphigus foliaceus

Answer

Erythema multiforme

Answer

Bullous pemphigoid

Question 10

Which histological finding is most characteristic of psoriasis?

Accepted Answer

Munro microabscesses

Answer

Acantholysis

Answer

Granular IgG deposits

Answer

Row of tombstones

Dermatopathology — MCQs

Dermatopathology — MCQs

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