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Bruce R. Smoller - Dermatopathology: The Basics

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Bruce R. Smoller Dermatopathology: The Basics

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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.

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Kim M. Hiatt and Bruce R. Smoller Dermatopathology: The Basics 10.1007/978-1-4419-0024-1_1 Springer Science+Business Media, LLC 2009
1. Normal Cutaneous Histology
Bruce R. Smoller 1
(1)
University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
Bruce R. Smoller Dr (Corresponding author)
Email:
Kim M. Hiatt
Email:
Epidermis varies in thickness with site, but ranges from < 0.1 mm on the eyelids to about 1 mm on acral sitesDermis varies in thickness with site, but ranges from 1 mm on the face to 4 mm (approximately) on the backSubcutaneous fat varies extensively in thickness (up to multiple cm)
1.1 Basic Skin Anatomy
  • Epidermis varies in thickness with site, but ranges from < 0.1 mm on the eyelids to about 1 mm on acral sites
  • Dermis varies in thickness with site, but ranges from 1 mm on the face to 4 mm (approximately) on the back
  • Subcutaneous fat varies extensively in thickness (up to multiple cm)
1.2 Epidermis
1.2.1 Keratinocytes
  • Epidermis with stratified layers
    • Stratum corneum
    • Stratum granulosum
    • Stratum spinosum
    • Stratum basalis
Fig 11 Overview of the epidermis demonstrating normal keratinocyte maturation - photo 1
Fig. 1.1
Overview of the epidermis demonstrating normal keratinocyte maturation (200)
1.2.1.1 Stratum Corneum
  • Normal pattern basket-weave orthokeratosis
    • Caused by increased lipid concentration in keratinocyte cytoplasm (Odland bodies)
    • Basket-weave pattern is not seen on frozen section
  • Nuclei are normally extruded before keratinocytes reach the stratum corneum
    • Retained in conditions of dysmaturation and hyperproliferation (valuable clue to diagnoses)
Fig 12 The stratum corneum demonstrates basket-weave orthokeratosis 400 - photo 2
Fig. 1.2
The stratum corneum demonstrates basket-weave orthokeratosis (400)
1.2.1.2 Stratum Granulosum
  • Keratohyaline granules characterize this layer
  • Profilaggrin involved in appropriate clumping of keratin in preparation for transformation to stratum corneum
    • Histidine-rich granules
    • Defect in profilaggrin seen in ichthyosis vulgaris (no granular layer present)
  • Involucrin and keratolinin also appear as substrate for transglutaminase in cross linking of cellular envelope at this level
1.2.1.3 Stratum Spinosum
  • Zone of maturation
  • Takes basal cell 14 days to reach the stratum corneum and another 14 to desquamate under normal conditions
  • Nuclear:cytoplasmic ratio becomes progressively smaller in these layers
  • Keratin production switches from lower molecular weight (cytokeratin 5 and 14) to higher molecular weights (mainly keratins 1 and 10)
Fig 13 The stratum granulosum demonstrates keratinocytes with abundant - photo 3
Fig. 1.3
The stratum granulosum demonstrates keratinocytes with abundant keratohyaline granules. The spinosum layer keratinocytes have abundant eosinophilic cytoplasm (400)
1.2.1.4 Stratum Basalis
  • Cells at base of rete ridges are stem cells that proliferate most rapidly
  • Basal cells at tips of dermal papillae proliferate slowly
  • Basal cells produce lowest molecular weight keratins (of all keratinocytes) keratins 5 and 14
Fig 14 The basal layer demonstrates pigment-laden keratnocytes and vacuolated - photo 4
Fig. 1.4
The basal layer demonstrates pigment-laden keratnocytes and vacuolated melanocytes (600)
1.2.2 Melanocytes
  • Every tenth cell along basal layer is a melanocyte (on average)
    • Increased in hyperpigmented and sun-exposed body sites
    • Decreased on palms and soles
  • Each melanocyte serves, via dendritic processes, 36 keratinocytes with melanin (on average)
  • Increased numbers of melanocytes with sun exposure
  • Produce eumelanin (brown and black) and phaeomelanin (red brown higher in sulfur content)
  • Transfer melanosomes to lysosomes within keratinocytes via phagocytosis
  • Individual variation in skin color is a function of relative numbers of stage IIV melanosomes. In general, all individuals have the same numbers of melanocytes (more stage IV in darker skin, more stage I in lighter skin)
  • Darker races have larger, singly dispersed melanosomes in keratinocytes
  • Caucasians have melanosome complexes within keratinocytes
Fig 15 Cells with hyperchromatic nuclei and surrounding spaces along the - photo 5
Fig. 1.5
Cells with hyperchromatic nuclei and surrounding spaces along the basal layer (arrows) are melanocytes (600)
1.2.3 Langerhans Cells
  • Mid-epidermal dendritic cells
  • Constitute 34% of all epidermal cells
  • Involved in antigen presentation
  • Bone marrow derived
  • Express HLA-DR, ATPase, S100, CD1a
  • Electron microscope demonstrates Birbeck granules, a pentalaminar structure shaped like a tennis racquet when viewed in full longitudinal section
  • Increased numbers in conditions with increased antigen presentation (i.e., contact dermatitis)
  • May coalesce into microgranulomata simulating nests of melanocytes
Fig 16 Langerhans cells appear as hyperchromatic nuclei with surrounding - photo 6
Fig. 1.6
Langerhans cells appear as hyperchromatic nuclei with surrounding spaces in the mid-straum spinosum (600)
Fig 17 CD1a demonstrates the dendritic nature of the intraepidermal - photo 7
Fig. 1.7
CD1a demonstrates the dendritic nature of the intraepidermal Langerhans cells (600)
1.2.4 Merkel Cells
  • Part of the sensory nervous system
  • Sit on basement membrane
  • Have desmosomal contacts with keratinocytes
  • Haarscheibe one free nerve ending from dermis touches up to 50 Merkel cells to form this unit
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