Dermatopathology: The Basics

By Bruce R. Smoller and Kim M. Hiatt

Dermatopathology: The Basics serves as an effective and efficient handbook for the student of dermatopathology, and as a practical bench reference for the practicing diagnostician who desires rapid access to criteria that are useful in differentiating histologically similar entities. The reader is able to focus upon a single histologic observation, i.e., inflammatory conditions without epidermal changes, and use this as a starting point from which to build a differential diagnosis based upon pattern recognition. As each entity is addressed, there is a concise discussion of the basic clinical findings and epidemiologic associations. This is followed by a histologic description, highlighting areas that serve to discriminate between the entity under discussion and similar ones. Any immunologic studies that might augment the diagnostic sensitivity or specificity are discussed.

Chapters are thematically based and consist of essential bullet points arranged in organized outlines allowing for easy access and direct comparison between entities. The salient histologic features are depicted with abundant high quality, full-color photomicrographs placed immediately adjacent to the appropriate histologic bullet points. This volume serves as an effective and efficient handbook for the student of dermatopathology, and as a practical bench reference for the practicing diagnostician who desires rapid access to criteria that are useful in differentiating histologically similar entities. The elaborate pictorial documentation serves as an atlas of the commonest dermatologic disorders.

 

• Language: English
• Publisher: Springer
• Release date: Jun 10, 2009
• ISBN: 9781441900241

Book preview

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Bruce R. Smoller and Kim M. Hiatt (eds.)Dermatopathology: The Basics10.1007/978-1-4419-0024-1© Springer-Verlag US 2009

Editors

Bruce R. Smoller and Kim M. Hiatt

Dermatopathology: The Basics

A978-1-4419-0024-1_BookFrontmatter_Figa_HTML.png

Editors

Bruce R. Smoller

University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

[e-mail]

Kim M. Hiatt

University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

[e-mail]

ISBN 978-1-4419-0023-4e-ISBN 978-1-4419-0024-1

Library of Congress Control Number: 2009920686

© Springer-Verlag US 2009

All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden.

The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights.. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made.The publisher makes no warranty, express or implied, with re-spect to the material contained herein.

Printed on acid-free paper

Springer is part of Springer Science+Business Media (www.springer.com)

Preface

In this volume, the authors hope to share their passion for the teaching of dermatopathology with a wide range of students.The idea for the project was initiated by a group of dermatology residents trained during the past 20 years. As part of a dermatopathology curriculum within the Dermatology and Pathology departments, Drs. Smoller and Hiatt have developed a series of didactic lectures covering much of the field. Annually, the residents ask for hard copies of the lecture notes and use these to create binders to be used for studying. At their constant urging, we decided to share these lectures in the form of a series of monographs—the first volume of which is presented here.

It is not our hope to cover every subtlety in the diagnosis and pathogenesis for every dermatologic diagnosis, but rather to present a framework upon which to base the classification and diagnoses. Within each chapter, a series of related diseases are presented, outlining the major clinical and histologic features and, when appropriate, addressing ancillary techniques. For each entity discussed, we have attempted to provide photographic images to demonstrate the features outlined. Certainly, the goal of this set of volumes is not to supplant, but rather to supplement standard comprehensive textbooks of dermatopathology, by providing a simple infrastructure that will facilitate the learning of myriad facts about each of the entities covered. Along the same lines, there is no attempt to address every dermatologic condition, but rather to concentrate our efforts upon the most common and characteristic entities within each category of disease. It is our sincere hope that students of dermatopathology will find the classification scheme and the bulleted outlines describing the essential diagnostic features helpful in the mastering of this complex subject.

Acknowledgements

As is always the case with a work of this magnitude, the authors would like to acknowledge the people who have helped to make this work possible. Thus, we would like to thank the members of our wonderful dermatopathology laboratory whose work is depicted in the vast majority of the photomicrographs, including Vicky Givens, Kim Hall, Lori Talley, and R. Peyton Maddox.

Dr. Smoller would like to again acknowledge the undying support of his wife, Laura, who continues to be his inspiration and source of energy for these types of endeavors, and his two sons, Jason and Gabriel, for their patience.

Dr. Hiatt would like to thank her wonderful husband, Jim, for understanding her ambition to pursue the joys of dermatopathology, including the undertaking of these volumes. She also wants to thank her wonderful children—Stephanie, Nicholas, Kaitlyn and Natalie—for putting so much joy in every day. Finally, she wishes to thank her mentor, colleague, and friend, Bruce Smoller, for all he has done to make this possible.

Contents

1 Normal Cutaneous Histology1

Basic Skin Anatomy1

Epidermis1

Keratinocytes1

Melanocytes5

Langerhans Cells6

Merkel Cell8

Epidermal Appendages8

Basement Membrane Zone17

Basal Keratinocyte18

Lamina Lucida18

Lamina Densa19

Sub lamina Densa19

Dermis19

Vasculature20

Nerves24

Muscles26

Subcutaneous Fat29

Skin of Special Sites30

2 How to Maximize Information from a Skin Biopsy37

Presumed Neoplastic Processes38

What is the Differential Diagnosis?38

Are the Margins Important?39

Melanocytic Neoplasms40

Keratinocytic Neoplasms41

Adnexal Neoplasms43

Dermal Neoplasms46

Hematopoietic Neoplasms49

Inflammatory Processes50

Blistering Diseases50

Dermatitis and Rash50

Infectious diseases52

Connective Tissue Diseases53

Direct Immunofluorescence57

Vasculitis57

Panniculitis58

Alopecia59

Miscellaneous Conditions60

Presumed Connective Tissue Nevus, Anetoderma, Epidermal Nevus60

Rules of Thumb61

3 Special Stains in Dermatopathology63

Histochemical Stains63

Commonly Used Special Stains63

Periodic Acid-Schiff (PAS)64

PAS Uses64

Alcian Blue64

Alcian Blue/Colloidal Iron Uses65

Elastic von Gieson65

Von Gieson Uses65

Brown and Brenn Stain66

Acid Fast Stain (AFB)67

Fite Stain67

Giemsa67

Giemsa Uses67

Warthin-Starry68

Masson's Trichrome69

Congo Red70

Fontana Stain for Melanin71

Chloroacetate Esterase71

Perls72

4 Immunopathology in Diagnostic Dermatopathology75

Tool Box: Antibody Panel75

What Is a Tool Box?75

Epithelial Markers75

Mesenchymal Markers78

Neuroectodermal Markers79