Dermatopathology Quiz-2

Deba P Sarma, MD
Omaha
Case 1
M 80, right eyebrow

What is your diagnosis?

Apocrine hidrocystoma
 Apocrine hydrocystoma
(Hidrocystoma, apocrine type)

Uncommon, solitary cyst derived from apocrine duct occurring

on the head and neck.
Unilocular or multilocular dermal cyst lined by two layers of
cells: an outer layer of flattened myoepithelial cells and an
inner layer of tall columnar cells with red cytoplasm and
basally placed nuclei.
Decapitation secretion is present. If significant papillary
epithelial projections are seen within the cyst, the lesion is
called an apocrine cystadenoma.
Case 2

M 66, ulcerated papule, left upper eyelid

What is your diagnosis?

Blastomycosis
- Cutaneous blastomycosis

- A deep fungal disease, usually primary in the lung with spread to

other organs including skin.

- Caused by fungus Blastomyces dermatitidis.

- Skin shows ulceration and granulomatous inflammation, sometimes

pseudoepithelial epidermal hyperplasia.

- Organisms appear in tissues as thick-walled spores

(some with single buds) averaging 10 micron in diameter.

- They are seen in H&E stain. Also positive with PAS and GMS stain.
Case 3
F 31, left chest wall

AFB and PAS stain: Negative

CD 68: Positive
Factor XIIIa: Positive
What is your diagnosis?

Xanthogranuloma
 Xanthogranuloma

Intact epidermis with a diffuse dermal proliferation of

large cells with angulated nuclei, abundant foamy
cytoplasm, and well defined cell borders.
The nuclei show inconspicuous nucleoli. Several
multinucleated Touton-type giant cells ase seen.
The cytoplasm of the cells stain for CD 68 and Factor
XIIIa, but not with S-100 and CD 1a.
The lesion is most commonly seen in children, but it
can occur at any age.
 Case 4 F 70, left elbow

What is your diagnosis?

Verruca vulgaris
 Verruca vulgaris

Commonly caused by Human papilloma virus: HPV-2 and -4.

Verruca vulgaris is a mature squamous cell lesion.

Verruciform or acanthotic squamous cell proliferation.

Rete ridges at the periphery of the lesion point to the center.

Base of the lesion shows normal basal cuboidal keratinocytes.

Keratin on the top of the lesion is compact type.

 Case 5 F 56, scalp

What is your diagnosis?

Syringocystadenoma papilliferum
 Syringocystadenoma papilliferum

Syringocystadenoma papilliferum (SP) is a benign adnexal

tumor, probably from apocrine glands most commonly located
on the scalp or face, which frequently arises from a nevus
sebaceus (NS).

Epidermis shows acanthosis and papillomatosis.

Cystic invaginations with papillary projections extend downward
from the epidermis.
The papillary projections are lined by two layers of cuboidal and
columnar epithelial cells. Luminal cells may show decapitation
secretion.
The stroma is infiltrated by a numerous plasma cells.
Malformed sebaceous glands and hair structures may be
present.
END