PATHOLOGI ANATOMI

KULIT
Dr.SUKIRMAN,MARS,M.kes,Sp.PA
Hasanuddin University
Makassar, INDONESIA
 Layers of the Skin

Epidermis

Dermis

Subcutis
 Epidermis
• Outermost layer
• 0.04 mm on the eyelids to 1.6 mm on the
palms  average: 0.1 mm
• Principal purpose: cornification (formation
of the outermost dead layer of the skin –
stratum corneum)
1. synthesis of lamellar granules & distinctive
proteins (keratins, fillagrin, involucrin)
2. alterations of nuclei, cytoplasmic organelles,
plasma membranes, & desmosomes
 Layers of the Epidermis
1. Stratum corneum (cornified layer)
2. Stratum granulosum (granular layer)
3. Stratum spinosum (prickle cell layer)
4. Stratum basale (basal cell layer)

stratum malpighii (rete malpighii) – 3 lower

layers (basal, spinosum, granular layer)
• stratum lucidum – palms and soles
 Epidermis
Stratum corneum

Stratum granulosum

Stratum
Stratum spinosum
malpighii

Stratum basale
palms & soles
 Stratum Basale (Basal Cell Layer)

• Germinative cells
• Single layer, cuboidal or
columnar cells
• Large oval nuclei
• More basophilic cytoplasm
• Often contain melanin
pigment transferred from
adjacent melanocytes
• Have hemidesmosmes
 Stratum Spinosum (Prickle Cell Layer)
• Polygonal/polyhedral cells
• Vesicular nuclei
• Grayish-blue cytoplasm
• W/ distinct, spine-like
processes
– Conventional
microscope:
Intercellular bridges
– EM: desmosomes
• 5 - 10 layers thick
 Stratum Granulosum (Granular Layer)
• Horizontally oriented
diamond-shaped cells,
filled w/ coarse, basophilic
(keratohyaline) granules
• Proportional to the
thickness of the horny
layer: 1 - 3 layers thick,
up to 10 layers on palms
and soles
• Inverse relationship
between the thickness of
the granular layer and
parakeratosis
 Stratum Corneum (Horny Layer)
• Anucleated
• Stains eosinophilic as a result of omission
of basophilic nuclei
• Basket-weave pattern
 Epidermis
• 3 basic cell types
1. Keratinocytes
2. Melanocytes
3. Langerhans cells
• additional cell types
1. Merkel cells
2. Indeterminate
dendritic cells
Melanocytes
• Neural crest origin
• H&E: clear cells
• Dendritic cytoplasm
• 1 melanocyte:4 basal keratinocytes
(cheeks) to 1:10 (limbs) → forming with
them an ”epidermal melanin unit”
• Production of melanin
• HMB-45, Fontana-Masson, S-100 protein
Langerhans cells
• Clear, dendritic cells just above the
middle of the spinous zone of the
epidermis
• Striking cytoplasmic vacuolation
• EM: indented nucleus &
Birbeck granules
(Rod/Racquet inclusions)
• Potent stimulators of T-cell
mediated immunoreactions
 Merkel cells
• At the base of epidermal rete
ridges which are in contact w/
nerve fibers
• Palms, soles, infundibula,
epithelium of nail beds, oral
mucosa, genital regions
• EM: possess distinctive
electron-dense granules w/in
their cytoplasm
• Thought to participate in Merkel cell-neurite complex
cutaneous sensation and Mc – Merkel cell
neuroendocrine function K – keratinocytes
G – core granules
A – axon
 Basement Membrane
• junction between epidermis &
dermis
• 4 zones:
1. Plasma membrane
- basal keratinocytes that constitute
the upper boundary of the interface
2. Lamina lucida
- electron-lucent region that lies
beneath basal keratinocytes
3. Lamina densa
- elctron-dense plate below lamina
lucida & above papillary dermis
4. Sub-basal lamina fibrous zone
- below lamina densa, consisting of
uppermost portion of papillary dermis
• demonstrated by PAS
 Dermis

• Derived from
mesenchyme
• Composed of:
a. collagen (70%)
b. elastin (1-3%)
c. ground substance
(proteoglycans)

• 2 parts:
1. Papillary dermis
2. Reticular dermis
 Dermis
Papillary dermis
– Thin zone immediately
beneath the epidermis
– thin, haphazardly arranged
collagen bundles
– Delicate branching elastic
fibers
– Plentiful fibrocytes
– Abundant ground substance
– Highly developed circulation
made up mostly of capillaries
 Dermis
Reticular dermis
– Thick collagen bundles
arranged in orthogonal
pattern
– Collagen fibers have
parallel orientation
(accounts for lines of
cleavage)
– Elastic fibers course
along collagen bundles
– Fewer fibrocytes, blood
vessels & ground
substance
papillary dermis

reticular dermis
Elastic Tissue
• 2 - 4% of dermis
• for retractile properties of
the skin
• synthesized by fibroblasts
• Papillary dermis: thin and E E
run at right angles to the
skin surface C

• Reticular dermis: thicker C

and oriented parallel to E
skin surface
• Demonstrated by Verhoef
van-Gieson stain
Plastic-embedded section showing
collagen (C) and elastin (E) within
normal human reticular dermis
Sebaceous Glands

Cuboidal cells with

basophilic cytoplasm
at the periphery give
rise to central cell with
foamy cytoplasm
Sebaceous Glands
• Holocrine glands
• Multilobular or unilobular
• Develop as lateral protrusions from the outer root
sheath of hair follicles
• Found everywhere on the body except the palms and
soles
• More abundant in the scalp, face, midline of the back,
perineum and orifices of the body
– eyelids: glands of Zeis and meibomian gland
– buccal mucosa & vermilion of lip: Fordyce’s spots
– areola of women: Montgomery’s tubercles
– labia minora & glans: Tyson’s glands
Eccrine Sweat Glands
• Found everywhere on the skin except the lips,
clitoris, labia minora, external auditory canals
• Maximum distribution: palms, soles, axillae, forehead
• 4 subunits:
– irregularly coiled secretory gland proximally
– coiled dermal duct that leads from secretory gland
– straight dermal duct that passes through the
length of the dermis
– coiled intraepidermal duct (acrosyringium)
 Eccrine Sweat Glands
• Dermal duct (D)
D
– double layer of darkly
basophilic, cuboidal cells
– PAS-positive homogeous
eosinophilic cuticle lining the
lumen
G
• Secretory portion (G)
– located in the deep dermis
and subcutis
– shows only one distinct layer D
composed of secretory cells
– secretory cells lining the
lumen consist equally of two
types: clear cells (glycogen-
containing) and dark cells G
(sialomicin)
Apocrine Glands
• tubular glands
• Axillae, areola, periumbilical
region, perineal &
circumanal areas, prepuce,
scrotum, mons pubis, labia
minora, external auditory
canals (ceruminous glands),
eyelids (Moll’s glands)
• Small & non-functional until
puberty
• Apocrine (decapitation)
secretion – apical portion of
glandular cells appear “pinched-
off” & released into lumen of
gland during secretion
Comparison Between Eccrine and Apocrine Gland

Eccrine gland Apocrine gland

(diameter several times >)
Blood supply

• Superficial vascular plexus

– positioned in the upper part
of the reticular dermis, just
beneath the papillary dermis

• Deep vascular plexus

– lower part of the reticular
dermis, & separates it from
the subcutaneous fat
 Small arteries (deep vascular
plexus) and arterioles (dermis)
possess three layers:
• Intima - composed of
endothelial cells and an
internal elastic lamina
• Media – contains collagen,
elastic fibers, & several
concentric layers of smooth
muscle cells bounded by an
external elastic lamina (in
arteries) artery
• Adventitia – composed of
fibrocytes, collagen, & elastic
fibers
 ARTERIES
• narrower lumen
• thicker walls
• clear-cut layers
artery

VEINS
• thinner walls
• less clearly divided
into
3 layers
vein
 Nerves
• travel along the course of
superficial & deep vascular
plexus → “neurovascular
plexus”
• wavy, spindle-shaped, or S-
shaped nucleus
 Subcutis/Panniculus
• Deepest layer
• Derived from
mesenchyme
• Consists of adipose
tissue, blood vessels
& nerves
Type of Inflammatory Cells
Lymphocytes

Dark-staining, round
dense nuclei
Narrow rim of light blue
cytoplasm
Histiocytes

• Vesicular nucleus
• Clear nucleoli
• Gray-blue on H&E

Larger, paler nucleus &

more abundant
cytoplasm (compared to
lymphocytes)
Neutrophils
Nucleus: multi-lobed
(3-5 lobes)
Cytoplasm: pale
amphophilic granules

Epidermis:
Psoriasis
Impetigo
Dermatophytosis
Dermis:
Dermatitis herpetiformis
Sweet’s syndrome
Eosinophils

Segmented (bilobed) nuclei

Numerous, coarse red
granules w/in cytoplasm

Epidermis:
Arthropod bites
Allergic contact dermatitis
Dermis:
Drug eruptions
Urticaria
Eczematous dermatitis
Plasma Cells

Ovoid, w/ eccentric
round nuclei
Deep purple cytoplasm

Mucous membranes
Syphilis
Leishmaniasis
Granuloma inguinale
 Mast cells

Eosinophilic staining
Fried egg appearance
(round central nucleus w/in
amphophilic cytoplasm)

Urticaria pigmentosa &

mastocytosis
Neural tumors
Mucinous areas
Multinucleated giant cells

1. Touton-type
ring of nuclei around a
central core of cytoplasm

Xanthoma
Xanthogranuloma
Multinucleated giant cells

2. Langhans-type
histiocytic giant cells w/
nuclei arranged in a
horseshoe at the
periphery

tuberculous gumma
Multinucleated giant cells

3. Foreign-body type
nuclei haphazardly
scattered throughout
the cytoplasm

idiopathic calcinosis cutis

Epithelioid cells

Large, oval, pale,

vesicular nuclei &
abundant eosinophilic
cytoplasm

Sarcoidosis
Tuberculoid leprosy
Melanophages

Histiocyte containing
phagocytized melanin

Postinflammatory
hyperpigmentation
Fixed drug eruption
Parakeratosis
pyknotic keratinocyte nuclei
w/in the stratum corneum
Orthokeratosis

hyperkeratosis w/o parakeratosis

Hypergranulosis

thickened granular layer

almost always accompanied
by hyperkeratosis
Hypogranulosis

decrease in thickness of the

granular layer
may be seen in any condition w/
parakeratosis
Spongiosis

intercellular edema between

keratinocytes

may lead to
spongiotic
intraepidermal
vesicles
Acantholysis

loss of cohesion between keratinocytes

Epidermal Atrophy

decrease in thickness of epidermis

(s. malpighii)
Vacuolar Degeneration

tiny spaces at the DEJ, often leaving

the junction indistinct

formation of subepidermal blister may

result
Papillomatosis

epidermal and papillary dermal

proliferation upward in
irregular waves
Pseudoepitheliomatous hyperplasia

irregular acanthosis (↑
thickness of st. malpighii) with
downward proliferation of the
epidermis
Follicular Plugging

hyperkeratosis
within hair follicles
Cornoid Lamella

column shaped
parakeratosis
Dyskeratotic Keratinocytes
- abnormally or prematurely keratinized individual keratinocytes in
the epidermis that stain intensely pink with H & E

Colloid bodies, Hyaline bodies,

or Civatte bodies
homogeneous, eosinophilic round
structures in lower epidermis or
upper dermis
Dyskeratotic Keratinocytes
Corps ronds and grains
- acantholytic dyskeratotic epidermal cells
Dyskeratotic Keratinocytes

corps ronds
– round nucleus, often surrounded by
halo
corps grains
– oval, grain-like nucleus & resemble
parakeratotic cells

Darier’s disease
Warty dyskeratoma
Transient acantholytic
disease
Exocytosis
migration of inflammatory cells (lymphocytes, neutrophils, or
eosinophils) into the epidermis with spongiosis
Epidermotropism
migration of malignant cells into the epidermis without spongiosis

Mycosis fungoides
Pautrier’s Microabscess

collection of 3 or more
atypical lymphocytes
w/in the epidermis often
surrounded by a clear
space, or “halo”

Mycosis fungoides
Munro’s Microabscesses

neutrophil aggregates w/in

the stratum corneum

psoriasis
Spongiform Pustule of Kogoj

collection of neutrophils w/in

the epidermis (upper stratum
malpighii), often surrounded by
clear spaces or “halos”
Melanin Incontinence

presence of melanin in the upper

dermis often w/ melanophages,
due to loss of melanin from
damaged basal layer
Dermal Edema

paleness in the dermis by

accumulation of interstitial
fluid
Sclerosis

hyalinized collagen w/
marked decrease in
fibroblasts

morphea
Myxomatous Changes
- presence of abundant mucin
- H & E shows pale, washed-out area
Fibrinoid Degeneration

deposition of eosinophilic
fibrin in & around vessel
walls

necrotizing vasculitis
Grenz Zone
narrow band of sparing between the
epidermis & a dense infiltrate in the dermis
Alcian blue pH 2.5 – acid MPS
ph 0.5 – sulfated MPS

mucin - blue
(Paget’s disease)
Crystal Violet - acid MPS, amyloid

amyloid - reddish-blue
(amyloidosis)
Fite Faraco - acid-fast bacilli

acid-fast bacilli – red

(leprosy)
Fontana-Masson - melanin (argentaffin)

minocycline
pigment - black
Giemsa - mast cells, acid MPS, myeloid granules, Leishmania,
Histoplasma, Rickettsia, Donovan bodies

mast cells - purple

Giemsa - mast cells, acid MPS, myeloid granules, Leishmania,
Histoplasma, Rickettsia, Donovan bodies

organisms present in
vacuoles in cytoplasm
of macrophages

Granuloma inguinale
Gomori Methenamine Silver - fungi

fungal hyphae - black

(aspergillosis)
Mucicarmine - “epithelial” mucin

mucin - red
(Paget’s disease)
Oil-Red O - lipids

lipid - red
(xanthoma)
Orcein - elastic fibers,
mast cells, melanin,
collagen, amyloid

elastic fibers - black

(perforating pseudoxanthoma
elasticum)
PAS - glycogen, neutral MPS, fungi, basement membranes,
fibrin, hyaline

basement membrane,
fungal hyphae - red
(tinea versicolor)
Perl’s stain - iron (hemosiderin)

hemosiderin - blue
(hemochromatosis)
S-100 Protein
- melanocytic cells & tumors,
neural & Schwann’s cell
tumors, granular cell tumors,
sweat ducts, Langerhans’ cells

brown immunoperoxidase
staining
(amelanotic melanoma)
Toluidine blue - acid MPS, mast cells

mast cells

urticaria
pigmentosa
Verhoeff-van Gieson - elastic fibers, collagen,
muscles, nerves

elastic fibers - black

collagen – red
(actinic granuloma)
von Kossa
- calcium, carbonates,
phosphates, oxalates,
sulfates, urates, chloride

calcium - black