Atlas of Dermatopathology E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 131

Veröffentlichungsjahr: 2015

Beschreibung

Improve your dermatological diagnostic accuracy.

The most efficient method in the diagnosis of skin diseases is the combined validation of clinical and histopathological features. The results of biopsy investigation in isolation don’t always yield answers. But when considered together, the clinical pattern and the histopathology, then diagnosis can become clearer. In this process the diagnostic impact of histopathology may be decisive or just confirmative to the clinical differential diagnosis. The structure of the book  follows a basic approach to morphology, which is overall orientation at scanning magnification first, then identifying a prototypic pattern, and finally  finding the essential diagnostic clue(s) under high power magnification.

Dermatopathology: Practical Differential Diagnosis by Clinicopathologic Pattern provides top quality images to correlate clinical presentations with histopathologic features. Annotated images highlight subtle indications that can clinch the diagnosis. Concise, bullet-pointed text provides further context.

Written by internationally renowned authors, the book is ideal for anyone involved in the diagnosis of skin disease.  

Leseprobe

Table of Contents

Title Page

Copyright

Dedication

Preface

Abbreviations

Introduction

Chapter 1: Horny Layer

Reduced granular layer

Prominent granular layer

Chapter 2: Epidermis

Eczematous

Psoriasiform

Bullous, acantholytic

Pustular

Degenerative

Atrophic

Chapter 3: Dermal–epidermal Junction (Interface)

Lichenoid

Subepidermal blistering

Chapter 4: Dermis

Edema

Infiltrates

Connective tissue

Chapter 5: Vessels

Intravascular coagulation

Vasculitis

Vasculopathic changes

Chapter 6: Subcutis

Panniculitis, septal

Panniculitis, lobular

Fat necrosis

Chapter 7: Deposition and Storage

Foreign bodies

Lipids

Mucin

Amyloid

Calcium and bone

Chapter 8: Adnexae

Pilosebaceous unit

Hair: Hair follicles not reduced

Index

End User License Agreement

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Guide

Cover

Table of Contents

Preface

Begin Reading

Atlas of Dermatopathology

Practical Differential Diagnosis by Clinicopathologic Pattern

Editors

Günter Burg MD

Department of DermatologyUniversity Hospital ZurichZürichSwitzerland

Werner Kempf MD

Department of DermatologyUniversity Hospital ZurichZürichSwitzerland

Heinz Kutzner MD

Dermatopathology InstituteFriedrichshafenGermany

Co-Editors

Josef Feit MD, PhD

Pathology and DermatopathologyMDgK plus, BiovendorBrnoCzech Republic

Laszlo J Karai MD, PhD

Pathology and DermatopathologyMiami LakesFL, USA

This edition first published 2015, © 2015 by John Wiley & Sons, Ltd

Registered office: John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex,PO19 8SQ, UK

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Library of Congress Cataloging-in-Publication Data

Atlas of dermatopathology (Burg)

Atlas of dermatopathology: practical differential diagnosis by clinicopathologic pattern / editors, Günter Burg, Werner Kempf, Heinz Kutzner ; co-editors, Josef Feit and Laszlo Karai.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-1-118-65831-4 (cloth)

I. Burg, Günter, editor. II. Kempf, Werner, editor. III. Kutzner, Heinz, editor. IV. Feit, Josef, editor. V. Karai, Laszlo, editor. VI. Title.

[DNLM: 1. Skin Diseases–pathology–Atlases. 2. Diagnosis, Differential–Atlases. 3. Skin Diseases–diagnosis–Atlases. WR 17]

RL105

616.5′075–dc23

2015006613

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

To our families and teachers

Preface

This atlas is addressed to pathologists and dermatologists who intend to become familiar with a practical approach to dermatopathology.

The structure of the book and of its chapters follows a basic approach to morphology. In histomorphology, as in clinical (macro-)morphology, the first step is to identify the localization of the pathological changes which is mostly done at scanning magnification; the ­second step includes assessing the distribution or pattern of pathologic elements at higher magnification and finally to search for the pathognomic elements – the so-called diagnostic clues.

It is like approaching a painting. In one of the almost 50 cabinets of the Alte Pinakothek in Munich, ­German paintings of the 14th–17th century are displayed (step 1). Among them one can detect a wonderful painting by Albrecht Altdorfer (1529) (step 2). Looking more closely one will discover between the many details Darius of Persia in flight and Alexander of Greece pursuing him (step 3). This is the clue for the “diagnosis,” telling us that the Battle of Issus (333 BC), occident against orient, is the main theme of the painting.

Looking at a microscopic slide, our brain is following the same approach of overall orientation, identifying a prototypic pattern and finding the essential clue(s) for the diagnosis.

Therefore, in this book histo- and cytomorphologic elements should give guidance rather than any pathogenetic parameters we may have in our minds. Starting with the cornified layer of the epidermis, the chapters follow the pathological findings in the various levels of the epidermis, dermis and subcutaneous fat tissue and describe and display prototypes of diagnoses, their variants and the differential diagnoses, which may simulate the prototype. Each diagnosis is shown by its clinical appearance (Cl:) and by its histomorphology (Hi:) at scanning magnification and at high power magnification, pointing to special clues.

The Battle of Alexander at Issus 333 BC by Albrecht Altdorfer.

(bpk/Bayerische Staatsgemäldesammlung, München)

Descriptions in italic are not displayed as pictures in the same chapter, but may be demonstrated in another one.

Many of the histologic images shown are taken from the Hypertext Atlas of Dermatopathology (www.atlases.muni.cz).1

References are not comprehensive, but may be of some help for getting more detailed information.

1

Hypertext Atlas of Dermatopathology

Josef Feit, Hana Jedličková, Zdeněk Vlašín, Günter Burg, Werner Kempf, Leo Schärer, Luděk Matyska (

www.atlases.muni.cz

)

Abbreviations

Cl

Clinical features

CNS

Central nervous system

DIF

Direct Immunofluorescence

Hi

Histological features

HPF

High power field

PAS

Periodic acid-Schiff

PCR

Polymerase chain reaction

Dermatopathology

Text-Atlas for Practical DifferentialDiagnosis of ClinicopathologicPattern of InflammatorySkin Diseases

Editors: Günter Burg, Werner Kempf, Heinz KutznerCo-Editors: Josef Feit and Laszlo Karai

Introduction

Some basic terms in dermatohistology

Horny Layer

Orthokeratosis: Basket weave stratum corneum

Hyperkeratosis: Thickened stratum corneum

Parakeratosis: Remnants of nuclei in stratum corneum

Epidermis

Atrophy

Acanthosis

Papillomatosis

Hypergranulomatosis

Spongiosis

Acantholysis

Ballooning

Dyskeratosis(*)

Necrotic keratinocytes

Interface

Interface dermatitis

Subepidermal blistering

Subepidermal edema

Dermis

Fibrosis

Sclerosis

Elastosis, actinic

Elastica stain

Vasculitis

Calcification (vessel wall)

Langhans giant cells with acid fast bacilli (inset)

Foreign body giant cells

Touton giant cells

Clinicopathologic Correlation

When considering clinicopathologic correlations in approaching a diagnosis there basically are four ­scenarios, in which the diagnostic impact of histopathology may be high, moderate, low or none.

1. High diagnostic impact of histology, when the clinical presentations are almost identical

Psoriasis (left) vs seborrheic dermatitis (right)

Psoriasiform acanthosis

Free floating parakeratotic scale without psoriasiform acanthosis

Urticaria (left) vs Sweet's syndrome (right)

Sparse granulocytic infiltrate

Densely packed sheets of neutrophils

Lichen planus (left) vs lichen sclerosus et atrophicus (right)

Sawtooth pattern with hypergranulosis and lichenoid interface dermatitis

Tricolore pattern with red epidermis, white sclerosis, and blue band-like infiltrate.

2. Moderate diagnostic impact of histology, when the histology is just confirmation of the clinical diagnosis and is not mandatory as such

Nummular dermatitis (left) vs fungal infection (tinea) (right)

Scale crust without fungal organisms.

Hyphae and spores within cornified layer.

3. Low diagnostic impact of histology, when the clinician has to make the diagnosis based on the clinical presentation

Transient acantholytic dermatosis (Grover's disease) (left) vs benign chronic familial pemphigus (Hailey-Hailey disease) (right)

Focal acantholytic dyskeratosis (arrow)

Transepidermal acantholysis (arrow)

Systemic diffuse scleroderma (left) vs circumscribed scleroderma (morphea) (right)

Dermatomyositis (left) vs acute systemic lupus erythematosus (right)

Denser infiltrate.

Less round cell infiltrate, more mucin deposits.

4. Little or no diagnostic impact of histology, when neither the clinical nor the histological presentation allows a definite diagnosis, which often is revealed only by the clinical course or the therapeutic susceptibility

Pseudolymphoma (left) vs cutaneous B-cell lymphoma (right)

Similar pattern and immunophenotype in both lymphatic infiltrates.

The Diagnostic Puzzle

Even though apart from a thorough history, clinical presentation and histomorphology are the basic elements in reaching a proper diagnosis, additional investigations like immunophenotyping, genotyping and molecular techniques in conjunction with laboratory investigations sometimes are very helpful in completing a complex puzzle by “rearrangements” of various facts.

Stepwise approach to diagnosis byVDJC rearrangement of information

Final diagnosis

Helpful links

For more information on common skin diseases you can register and login free of charge at DOIT (Dermatology Online with Interactive Technology; www.cyberderm.net).

For guidance through the program have a look on YouTube: https://www.youtube.com/watch?v=3ekhor35w0w&feature=emm-upload_owner#action=share.

A Collection of high resolution histological images are presented free of charge in the Hypertext Atlas of Dermatopathology (www.atlases.muni.cz).

Chapter 1Horny Layer

CHAPTER MENU

Reduced granular layer

Prominent granular layer

Reduced granular layer

PROTOTYPE: Ichthyosis vulgaris

Cl:Starts in first year of life, dry rough scaly skin, gray-white scales are shed, symmetrical sparing of flexural areas, hyperlinear palms and soles, often atopic dermatitis (50%).

Ichthyosis vulgaris

Hi:Compact orthohyperkeratosis, granular layer reduced or absent, lack of parakeratosis, follicular dilatation and hyperkeratosis. Epidermis usually normal, sometimes acanthotic or atrophic. No or sparse perivascular infiltrate in the papillary dermis.

VARIANTS:Acquired ichthyosis vulgaris

Histology is identical to ichthyosis vulgaris.

DIFFERENTIAL DIAGNOSIS: Ichthyosis hystrix

Cl: