Kasia S. Masterpol - Atlas of Essential Dermatopathology

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Part 1
Anatomy

Kasia S. Masterpol , Andrea Primiani and Lyn M. Duncan Atlas of Essential Dermatopathology 2013 10.1007/978-1-4471-4471-7_1 Springer-Verlag London 2013

1. Basic Anatomy

Kasia Szyfelbein Masterpol 1, Andrea Primiani 2 and Lyn McDivitt Duncan 3

(1)

Department of Dermatology, Boston Medical Center, Boston, MA, USA

(2)

Massachusetts General Hospital WRN2, Pathology Service, Boston, MA, USA

(3)

Massachusetts General Hospital WRN825, Dermatopathology Unit, Boston, MA, USA

Abstract

Stratified squamous epithelium composed of layers of keratinocytes

Epidermis

• Stratified squamous epithelium composed of layers of keratinocytes

  • From superficial to deep:

    • Stratum corneum
    • Stratum granulosum
    • Stratum spinosum
    • Stratum basale
• Intermingled cell types :

  • Melanocytes: at dermoepidermal junction

    • Transfer melanin keratinocytes
  • Langerhans cells: CD1a + and Langerin + dendritic cells in stratum spinosum

    • Function in antigen presentation
  • Merkel cells: neuroendocrine cells in the stratum basale, associated with nerve endings from the dermis

Dermis

• Papillary dermis :

  • Dermal papillae complement rete ridges of epidermis
  • Fine, pale eosinophilic collagen fibers
  • Contains free nerve endings and Meissners corpuscles
  • Separated from the reticular dermis by the superficial vascular plexus
• Reticular dermis :

  • Thick, deeply eosinophilic collagen fibers
  • Contains the deep vascular plexus, adnexal structures, nerve trunks, Pacinian corpuscles, glomus bodies

Subcutaneous Fat

• Separated into lobules by fibrous septae extending from the reticular dermis
• Contains anagen hair bulbs and medium sized arterioles and veins

Fig. 1.1

The skin is composed of epidermis ( brown ), dermis ( pink ) and subcutaneous fat ( yellow ). Dendritic cells in the epidermis include Langerhans cells in the stratum spinosum and melanocytes at the base of the epidermis. The dermis is separated by the superficial vascular plexus into the papillary dermis and reticular dermis

Kasia S. Masterpol , Andrea Primiani and Lyn M. Duncan Atlas of Essential Dermatopathology 2013 10.1007/978-1-4471-4471-7_2 Springer-Verlag London 2013

2. Adnexal Anatomy

Kasia Szyfelbein Masterpol 1, Andrea Primiani 2 and Lyn McDivitt Duncan 3

(1)

Department of Dermatology, Boston Medical Center, Boston, MA, USA

(2)

Massachusetts General Hospital WRN2, Pathology Service, Boston, MA, USA

(3)

Massachusetts General Hospital WRN825, Dermatopathology Unit, Boston, MA, USA

Abstract

The cutaneous adnexal structures include the pilosebaceous apocrine unit and the eccrine unit. Apocrine glands and sebaceous glands secrete their products into the hair follicle through short ducts. The sebaceous glands are often seen in association with hair follicles; apocrine glands are more inconspicuous. The smooth muscle arrector pili connects the pilosebaceous apparatus to the epidermis, contraction of the arrector pili produces goose bumps. The eccrine unit is distinct and separate from the pilosebaceous apocrine unit. The glands lay deep in the dermis, coiled like a garden hose, and are connected to the epidermis by a long straight eccrine duct. The coiled exit of the eccrine duct through the epidermis is termed the acrosyringium

Eccrine Unit

• Eccrine Glands : palms, soles, forehead, axillae

  • Coiled, secretory component in deep dermis

    • Single layer of cuboidal epithelium, eosinophilic cytoplasm
    • Surrounded by myoepithelial cells
• Eccrine Ducts

  • Long duct, extends from glandular coil in deep dermis to exit through the epidermis as an acrosyringium
  • Two layers of epithelium, no myoepithelial cells

Pilosebaceous Apocrine Unit

• Hair Follicles

  • Types: terminal (diameter 0.06 mm), vellus (diameter 0.03 mm)
  • Zones (from superficial to deep):

    • Infundibulum = region above entry of sebaceous gland duct
    • Isthmus = extends from attachment of arrector pili muscle to entry of sebaceous gland duct
    • Hair bulb = dermal papillae and hair matrix
  • Phases: Anagen (growth), Catagen (involution), Telogen (resting phase)
  • Hair shaft = composed of cuticle, cortex, and medulla
  • Arrector pili = smooth muscle innervated by sympathetic nervous system
• Sebaceous Glands

  • Acinar pattern, multiple lobules
  • Inner layers of cells with vacuolated, lipid-filled cytoplasm
  • Outer rim of cuboidal basophilic germinative cells
  • Short duct with stratified squamous epithelium, enters into pilosebaceous unit

    • Rarely the sebaceous duct exits through the epidermis directly
• Apocrine Units : axillae, anogenital region, areola, eyelid

  • Coiled, secretory component in dermis

    • Decapitation secretion, snouts
    • Single layer of cuboidal to columnar epithelial cells, eosinophilic cytoplasm
    • Surrounded by myoepithelial cells
  • Short duct opens into infundibulum of associated hair follicle

Fig. 2.1

The cutaneous adnexal structures include the pilosebaceous apocrine unit and the eccrine unit. Apocrine glands and sebaceous glands secrete their products into the hair follicle through short ducts. The sebaceous glands are often seen in association with hair follicles; apocrine glands are more inconspicuous. The smooth muscle arrector pili connects the pilosebaceous apparatus to the epidermis, contraction of the arrector pili produces goose bumps. The eccrine unit is distinct and separate from the pilosebaceous apocrine unit. The glands lay deep in the dermis, coiled like a garden hose, and are connected to the epidermis by a long straight eccrine duct. The coiled exit of the eccrine duct through the epidermis is termed the acrosyringium

Fig. 2.2

Pilosebaceous Apocrine Unit. The sebaceous glands are associated with hair follicles. Apocrine glands are lined by plump epithelial cells with deep pink cytoplasm and surface blebs that are secreted by decapitation ( inset )

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