SKIN DISEASES

CASE ANALYSIS

Objectives:

To identify and explain basic morphologic skin lesions.

Discuss the basic pathophysiology (mechanism) of the above lesions
Explain the etiopathogenesis.
To differentiate benign and malignant tumors.
Make clinical and pathologic correlation.
Explain the possible outcome and complications.
 SKIN DISEASES
‘07

CASE ANALYSIS

P. B. Casuela, Jr.,MD
 Case 1 :

A 22 year old female medical student came in because of right

malar skin lesions of few days duration after camping in Los
Banos, Laguna.

0.5 cm
A B C D

1. Describe/characterize each lesion which could be present and

indicate the proper nomenclature.
Which of the above is most likely present in the patient? Explain.
Patient A(4x;10x ): Early and full-blown lesions

2. Describe the gross lesion.

3. State conditions or diseases
which could clinically
present in this manner. B
3. Pictures A & B are biopsies
of common diseases which
could represent the above
disease. Classify the morphologic type
of inflammation illustrated and
characterize the inflammatory
response in each.
4. State the etiopathogenesis.
Case 2: Two patients presented with chronic skin diseases.
Characterize the gross clinical presentation.

A (forearm) B (elbow)
1. Describe the salient microscopic features of the following. Which
of these correlate with the previous gross clinical presentation?
State your diagnosis.

A B

2. Discuss the etioathogenesis of each.

Case 3

A 45 year old female

came in because of
multiple skin lesions
(up to 7 cm in diam.).

1. Describe and classify

the lesions.
State common
complication of
these lesions.
2. State readily available
diagnostic
procedure/s which
could be under-
taken in this case.
State principles.
3. Localize (layer of skin)and
characterize the following
skin lesions
and
which lesion is compatible
with the clinical
presentation.

State your basis.

A

B
4. Match and describe the microscopic
features of three diseases one
of which could be present in this
patient and relate it to com- A
mon clinical presentation. 4x
!. Herpes simplex infection
2. Bullous pemphigoid
3. Pemphigus vulgaris
B4x 40x C 4x
4.

1. Herpes simplex
-Intraepidermal vesicle with multinucleated giant cells echibiting the
“Moulding phenomenon”=nuclei deform each other and never ovarlap
one another.

2. Pepmphigus vulgaris
- intraepidermal, suprabasal cleft or blister containing acantholytic cells (inset)

3. Bullous pemphigoid
-non-acantholytic, subepidermal blister with prominent eosinophilic cell infiltrates

5. Immunofluorescence microscopy: Direct Immunofluorescence

A-Pemphigus vulgaris
-lace-like squamous intercellular space deposition of Ig G in the lower
epidermis.

B. Bullous pemphigoid –linear deposition of Ig G in the basement membrane

zone.
5. This diagnostic procedure is useful in the diagnosis of
two of the previous conditions. Discuss the main features
and state the significance of each.
A B
Case 4: A 45 year old laundry woman presented with lesions
on the face of several months duration.

19. Describe and classify the clinical/gross skin lesions.

BIOPSY dshows::
Scanner View:

20x: A B

2. Describe the salient dermal histopathologic abnormalities.

Classify the lesion according to the morphologic pattern.
3. State your diagnosis and differential diagnosis.
4. Discuss briefly Lepromin test – state principle and significance
of results.
5. Discuss the etiopathogenesis and outcome of this disease.
Case 5

A 35 year old patient complains of pigmented lesions of the

chest.

1. Describe the lesions. 1cm

2. State whether the lesion is benign or malignant.
State your basis.
3. Match and describe common
pigmented lesions which could A
be present in this patient. 4x
I. Seborrheic keratosis
II. Intradermal nevus
III. Junctional nevus
IV. Lentigo senilis
4. Discuss age predilection & malignant potential.
.
B 10x C 10x D4x
 After five years the patient developed chest lesion
which presented as shown :

1cm

5. Characterize the lesion. Is this benign or malignant?

State your bases.
6. Discus the etiopathogenesis & outcome of this tumor.
7. State the basic principles of biopsy and microstaging in this case.
 END

THANK YOU