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6.13 Dermoscopy
Fig. 6.51 Dermoscopy colors of keratinizing, melanocytic, and vascular tumors. (From High WA, Tomasini CF, Argenziano G, Zalaudek I. Basic principles of dermatology. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology. 4th ed. Philadelphia: Elsevier; 2018:1–43.)
Table 6.8 Vascular Structures Seen in Various Skin Tumors
Pattern Definition Diagnostic Significance
Comma Coarse vessels that are slightly curved and barely branching Congenital and dermal nevi (monomorphous);
Dotted Tiny red dots densely aligned next to each other Melanocytic lesion (often Spitz nevus and
Linear-irregular
(serpentine)
Hairpin Vascular loops sometimes twisted and bending that can be surrounded
Glomerular Variation on the theme of dotted vessels; tortuous (coiled) capillaries, often distributed in
Arborizing Larger diameter vessels that branch into finer secondary vessels; bright red color;
Crown Groups of orderly bending, scarcely branching; vessels located along the border of the
Lacunae Red, purple, or black clods Angioma (red, purple)
Strawberry Pink to red “pseudonetwork” around hair follicles of the face, frequently intermingled
Corkscrew Linear vessels twisted along a central axis Thick melanoma or melanoma metastasis
String of pearls Dotted vessels in serpiginous pattern Clear cell acanthoma
Milky-red color Globules and/or larger areas of fuzzy or unfocused milky-red color often corresponding
Polymorphous Any combination of two or more different types of vascular structures. The most
Modied from High WA, Tomasini CF, Argenziano G, Zalaudek I. Basic principles of dermatology. In: Bolognia JL, Schaffer JV, Cerroni L. Dermatology. 4th ed.
Philadelphia: Elsevier. 2018:1–43.
Linear, irregularly shaped, sized and distributed red structures Melanoma
by a whitish halo
clusters mimicking the glomerular apparatus of the kidney
in-focus on dermoscopy as a result of their superficial location
lesion but do not cross center
with fine, linear wavy vessels; often hair follicles are filled with yellowish keratotic
plugs
to an elevated part of the lesion
frequent is linear-irregular and dotted vessels
if polymorphous, then consider melanoma
melanoma)
Supercial basal cell carcinoma
With white halo: keratinizing proliferation (seb-
orrheic keratosis, squamous cell carcinoma,
keratoacanthoma, and viral wart)
Without white halo: melanoma
Bowen disease
Basal cell carcinoma
Sebaceous hyperplasia
Angiokeratoma (black, blue)
Actinic keratosis
Melanoma
Malignant tumor (melanoma, basal cell carci-
noma, Merkel cell carcinoma, angiosarcoma,
and squamous cell carcinoma)
Eccrine poroma
385
CHAPTER 6 • Neoplastic Dermatology
Fig. 6.52 Seborrheic keratosis: milia-like cysts (white dots) and comedo-like open-
ings (black targetoid circles). (From Soyer PH, Argenziano G, Hofmann-Wellenhof
R, Zalaudek I. Pattern analysis: dermoscopic criteria for specic diagnoses. In:
Dermoscopy: The Essentials. 3rd ed. Philadelphia: Elsevier; 2020:33–137.)
Fig. 6.53 Dermatobroma: central white patch (asterisk) and subtle pigment
network (arrows). (From Soyer PH, Argenziano G, Hofmann-Wellenhof R,
Zalaudek I. Pattern analysis: dermoscopic criteria for specic diagnoses. In:
Dermoscopy: The Essentials. 3rd ed. Philadelphia: Elsevier; 2020:33–137.)
Fig. 6.55 Basal cell carcinoma: Leaf-like areas (3 o’clock to 6 o’clock at the
periphery of the lesion). (From Soyer PH, Argenziano G, Hofmann-Wellenhof R,
Zalaudek I. Pattern analysis: dermoscopic criteria for specic diagnoses. In:
Dermoscopy: The Essentials. 3rd ed. Philadelphia: Elsevier; 2020:33–137.)
Fig. 6.56 Pyogenic granuloma: homogenous red color with red lacunae. (From
Soyer PH, Argenziano G, Hofmann-Wellenhof R, Zalaudek I. Pattern analysis:
dermoscopic criteria for specic diagnoses. In: Dermoscopy: The Essentials. 3rd
ed. Philadelphia: Elsevier; 2020:33–137.)
Fig. 6.54 Basal cell carcinoma: arborizing blood vessels, blue-gray blotches
(asterisks), and ulceration (circle). (From Soyer PH, Argenziano G, Hofmann-
Wellenhof R, Zalaudek I. Pattern analysis: dermoscopic criteria for specic diagnoses. In: Dermoscopy: The Essentials. 3rd ed. Philadelphia: Elsevier; 2020:
33–137.)
386
Fig. 6.57 Keratoacanthoma: classic hairpin-shaped vessels (arrows), white back-
ground (hyperkeratosis of keratinizing tumor), and central crust. (From Soyer PH,
Argenziano G, Hofmann-Wellenhof R, Zalaudek I. Common clinical scenarios: sideby-side comparisons of similar-appearing lesions that are benign or malignant. In:
Dermoscopy: The Essentials. 3rd ed. Philadelphia: Elsevier; 2020:138–214.)
6.13 Dermoscopy
Squamous cell carcinoma
• Ulceration may be seen 1/– bleeding
• May be pink versus white with possible central crust/scale
• White circles
• Varied-appearing blood vessels (e.g., looped vessels, diffuse)
Dermatobroma
• Central white patch
• Annular (peripheral) pigment network
Ink spot lentigo
• Dark, bizarre, and sharply demarcated pigment network
Fig. 6.58 Pigmented Bowen disease: well-circumscribed glomeruloid blood
vessels (circle) with closely packed tiny brown dots (arrow s). (From Soyer PH,
Argenziano G, Hofmann-Wellenhof R, Zalaudek I. Common clinical scenarios:
side-by-side comparisons of similar-appearing lesions that are benign or
malignant. In: Dermoscopy: The Essentials . 2nd ed. Philadelphia: Elsevier;
2012.)
Fig. 6.59 Clear cell acanthoma: this pattern of dotted vessels is rather typical for
clear cell acanthoma. (From Soyer PH, Argenziano G, Hofmann-Wellenhof R,
Zalaudek I. Common clinical scenarios: side-by-side comparisons of similarappearing lesions that are benign or malignant. In: Dermoscopy: The Essentials
2nd ed. Philadelphia: Elsevier; 2012.)
Vascular lesions (e.g., cherry angiomas)
• Red or purple lacunae
Hemorrhage
• Peripheral red/purple/blue globules
Porokeratosis
• Cornoid lamella around lesion (seen better w/ marker
applied to lesion, then wiped off with ETOH)
Sebaceous hyperplasia
• Yellow lobules in a polygonal pattern around a central
follicular opening
• Uniform, regular “crown” telangiectasias
Dermoscopic patterns of melanocytic lesions
• Melanoma ndings: atypical pigment network, negative
pigment network, blue-whitish veil, atypical vessels, more
than four colors, milky red areas, streaks, shiny white streaks
(a/w dermal invasion), peripheral streaks, black color,
irregular blotches, ulceration w/o pigmented network,
granularity/peppering (a/w BRAF, NRAS mutations), dotted
vessels (a/w BRAF wild-type melanomas), dark
homogeneous streaks (a/w KIT mutations)
See Tables 6.8–6.10 and Figs. 6.60–6.65
Table 6.9 Melanocytic Global Patterns
Global Pattern/Local
Variant Morphology Histology Diagnosis
Reticular Honeycomb-like network of brownish lines Elongated, pigmented rete ridges Melanocytic lesion
Atypical pigment network Black, brown, and gray reticular pattern with
thickened lines and irregular meshing
Typical pigment network Thin, regularly meshed, brown reticular pattern
with evenly spaced meshing
Irregular and broadened rete ridges Melanoma
Regular and elongated rete ridges Benign nevus
Continued
387
CHAPTER 6 • Neoplastic Dermatology
Table 6.9 Melanocytic Global Patterns—cont’d
Global Pattern/Local
Variant Morphology Histology Diagnosis
Negative pigment network Thick, interconnected reticular hypopigmented
lines around brown curved globules/clods
Globular Variably sized, round to oval structures Aggregates of mela nin-containing structures
Irregular dots and globules Irregular distribution of variably sized round
to oval structures
Regular dots and globes Regular distribution of variably sized round
to oval structures
Homogenous Diffuse, uniform, and structureless color in
the absence of other local criteria
Irregular blotches Diffuse hyperpigmentation that varies in size
and shape with irregular borders; obscures
other dermoscopic features
Regular blotches Diffuse hyperpigmentation with uniform
shape and col or symmetrically located in
the lesion
Blue-whitish veil Irregular, confluent, and gray-blue to white-blue
pigmentation
Homogenous blue pattern Uniform blue color Dermal melanocytes (high density) Blue nevus
Regression Bone white scar-like depigmentation
with or without gray pepper-like
granules
Starburst Pigmented streaks, and/or dots and globules
in a radial arrangement at the periphery of a
melanocytic lesion
Regular streaks Pigmented linear structures of variable
thickness found regularly dispersed around
the periphery of the entire circumference of a
lesion (radial streaming)
Irregular streaks Pigmented linear structures found irregularly
dispersed around the periphery of a portion
of a lesion (pseudopods)
Pos sibly hy popig mente d e longa ted r ete ridg es
aro und mela nocyt e nes ts in th e der mal
pap illae
located throu ghout the epidermis and upper
dermis
Irregularly distributed melanin-containing structures
in the epidermis and upper dermis
Regularly distributed melanin-containing structures
in the epidermis and upper dermis
Varies depending on colors Melanocytic lesion
Histopathologic structures with pronounced melanin
throughout the epidermis and upper dermis
Histopathologic structures with pronounced melanin
throughout the epidermis and upper dermis
Acanthosis and hypergranulosis above
pigmentation in dermis
Thickened papillary dermis with fibrosis and variable
amounts of melanophages
Fascicles of pigmented cells running parallel to the
epidermis at the dermoepidermal junction
Fascicles of pigmented cells regularly dispersed
running parallel to the epidermis
Fascicles of pigmented cells irregularly dispersed
running parallel to the epidermis
Melanoma
Spitz nevus
Melanocytic lesion
Melanoma
Benign nevus
Melanoma
Benign nevus
Melanoma
Melanoma
Melanoma
Reed nevus/Spitz
nevus
Reed nevus/Spitz
nevus
Melanoma
Table 6.10 Site-Specic Melanoma-Specic Criteria
Site Criteria Morphology
Face, nose, ears Annular-granular structures Brown or blue-gray dots surrounding follicular ostia
Asymmetrically pigmented follicles Gray circles/rings of pigment asymmetrically distributed around follicular ostia (“circle within
Rhomboidal structures/angulated lines Thickened areas of pigmentation surrounding the follicular ostia with a rhomboidal
Gray pseudonetwork Confluent annular-granular structures forming gray pigment surrounding follicular ostia
Acral sites Parallel ridge Parallel pigmented lines thicker than nonpigmented ones with white dots running along like
Nails Irregular pigmented bands Thick, possibly multicolored, irregularly spaced lines stemming from the proximal nail fold
Mucosal sites Homogeneous pattern w/ various colors
(blue, gray, white)
This criterion and the three listed below are seen in lentigo maligna
a circle” is a variant)
appearance
a string of pearls
Of note, parallel furrow pattern is the opposite and is benign
Diffuse discoloration w/ no clear structures
388
6.13 Dermoscopy
Fig. 6.60 Benign nevus with reticular pattern in dermoscopy. (From Marghoob
AA, Usatine RP. Dermoscopy. In: Usatine RP, Pfenninger JL, Stulberg DL, Small
R, eds. Dermatologic and Cosmetic Procedures in Ofce Practice . Philadelphia:
Elsevier; 2012:384–403. Copyright Ashfaq A. Marghoob, MD.)
3GEN
Fig. 6.61 Dermatoscopic patterns of Reed nevus. Starburst pattern in which
black, homogeneous, central pigmentation can be seen with regular radial projections at the periphery. (From Sainz-Gaspar L, Sánchez-Bernal J, NogueraMorel L, Hernández-Martín A, Colmenero I, Torrelo A. Spitz nevus and other
spitzoid tumors in children—part 1: clinical, histopathologic, and immunohistochemical features. Actas Dermosiliogr. 2020;111[1]:7–19.)
mm
Fig. 6.63 Acral melanoma: parallel ridge pattern.
Fig. 6.64 Melanoma: annular-granular structures make up rhomboidal structures
(arrow). Conuent rhomboidal structures make up the gray pseudonetwork (circle)
Fig. 6.62 Acral nevus: parallel furrow pattern.
Fig. 6.65 Melanoma: atypical pigment network (circle), irregular dots and glob-
ules (asterisks), irregular streaks (black arrows), irregular blotches (white arrows),
with blue-white structures centrally.
389
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7
Dermatopathology
Julia S. Lehman and Roberto A. Novoa
CONTENTS LIST
7.1 ESSENTIAL CONCEPTS IN DERMATOPATHOLOGY
7.2 HIGH-YIELD DERMATOPATHOLOGY DIAGNOSES AT A GLANCE
7.3 HIGH-YIELD DERMATOPATHOLOGY DIFFERENTIAL DIAGNOSES
Acknowledgments: We wish to thank Dr. John Grifn and
Dr. Rahul Chavan, the authors of the previous edition’s Dermatopathology chapter.
7.1 ESSENTIAL CONCEPTS IN
DERMATOPATHOLOGY
The microscopic appearance of normal skin varies based on
anatomic location, and it is important to understand normal
histology (Table 7.1) so as to then recognize pathologic fea-
tures, particularly those that are so subtle that they comprise
Table 7.1 Features of Normal Skin
Site Histopathologic Clues Comments
Anogenital skin Undulating epidermis (papillomatous) , abundant smooth muscle
in dermis, and highly vascular
Areola Smooth muscle (abundant); may also see lactiferous/mammary ducts
(modified apocrine glands)
Axilla Apocrine glands (abundant) —
Back Thick dermis (extends deeper than other sites); broad fascicles of collagen Most commonly asked to distinguish from
Ear Thin epidermis, cartilage, and numerous vellus hairs (small caliber hairs with
bulbs situated in dermis)
Eyelid Dermis contains only loosely arranged collagen, lacks subcutaneous fat, and has
superficially located skeletal muscle
Lip (dry vermillion) Keratinizing epidermis (has stratum corneum) with granular layer; skeletal
muscle (main clue)
Lip (wet mucosa) Pale keratinocytes (glycogen rich), lacks granular layer, non-keratinizing
(lacks stratum corneum), minor salivary glands (basaloid), and lacks hair follicles
(glabrous)
Nose Abundant sebaceous glands
Frequent intrafollicular Demodex
Palms/soles Massively thickened stratum corneum, compact orthohyperkeratosis;
Meissner’s corpuscles in dermal papillae; lacks hair follicles (glabrous)
Scalp Numerous terminal hairs w/ deeply situated bulbs (subcutaneous fat) —
the “normal skin” differential diagnosis (see Table 7.12 in
Section 7.3).
Various histopathologic changes, including characteristic bodies or cells, may be suggestive of particular diagnoses (Table 7.2).
The use of special stains can help identify subtle or ambiguous
ndings (Tables 7.3–7.5). It is important to differentiate patho-
logic changes from artifacts and/or the effects of exogenous
material (Table 7.6). Certain categories of neoplasms, including
spindle cell neoplasms, those showing pagetoid scatter, or epithelial carcinomas, can be challenging to diagnose based on
histopathologic changes alone. Immunostaining may be required for accurate diagnosis (Tables 7.8–7.9).
Text continued on p. 400
Presence of smooth muscle differentiates from axilla
Presence of lactiferous ducts differentiates from
genital
scleredema, which has abundant mucin between
widely-spaced collagen fibers
Accessory tragus: domed papule w/ identical
histopathologic features
Eyelid skin 1 foamy histiocytes in dermis 5
xanthelasma
Vulvar mucosa appears similar (but lacks salivary
glands and skeletal muscle)
Parakeratotic scale on lip is clue to abnormal
mucosa (oral LP . other inammatory dz)
391
CHAPTER 7 • Dermatopathology
Table 7.2 High-Yield Dermpath Bodies/Cells
Body Description Associated Disease(s)/Comments
Antoni A Cellular area of schwannomas; has abundant Verocay bodies Schwannoma (neurilemmoma)
Antoni B Hypocellular area of schwannomas; has loose myxoid stroma
Asteroid bodies Star-shaped, eosinophilic intracytoplasmic inclusions Sarcoid and other granulomatous disorders
Balloon cells Clear-appearing cells with vesicular cytoplasm, and small
Banana bodies Crescentic golden yellow-brown (ochre) fibers , in dermis
Beanbag cells Histiocytes that have engulfed WBCs, RBCs, and nuclear debris
Birbeck granules Only seen on electron microscopy; classically appear as tennis
Caterpillar bodies
Cholesterol clefts Elongated, needle-shaped clear spaces once occupied by
Cigar bodies
Civatte/colloid/cytoid
bodies
Clover leaf (flower) cells Atypical T-lymphocytes with a cloverleaf or flower-like nucleus;
Comma-shaped bodies Comma-shaped electron dense membranes seen within
Corps ronds/grains
Cowdry A body Intranuclear inclusions (eosinophilic globules) surrounded by
Cowdry B body Intranuclear inclusions
Donovan bodies Intracytoplasmic “safety pin”-shaped bacteria in
Dutcher body Pseudo-intranuclear pink collection of immunoglobulin within
Flame figures Major basic protein from eosinophils deposited on collagen Wells syndrome, dermal hypersensitivity reaction (exaggerated
Floret cells Multinucleated giant cells with peripherally located overlapping
Gamma-Favre body Intracytoplasmic basophilic inclusions within endothelial cells Lymphogranuloma venereum ( Chlamydia trachomatis)
Gaucher cells Glucocerebroside-laden histiocytes (“crinkled tissue paper-like
and low cellularity
hyperchromatic nucleus w/ pseudonuclear inclusions
(cytophagocytosis)
racket structures or rods
Eosinophilic material comprised of BMZ material (PAS1 and
collagen IV1), found in roof of blisters and basal layer of
epidermis
cholesterol (cholesterol, itself, is removed during processing)
Oval yeast (PAS1 and GMS1)
Apoptotic keratinocytes (eosinophilic) Lichen planus classically, but seen in all interface dermatitides
seen mainly in peripheral blood smear (.tissue)
histiocytes (electron microscopy)
Two special types of dyskeratotic keratinocytes:
Ronds: single or grouped, round keratinocytes with a peri-
nuclear halo, brightly eosinophilic cytoplasm, and pyknotic nucleus; found in spinous layer .stratum corneum
Grains: smaller, attened basophilic keratinocytes resembling
parakeratosis; found in granular layer/stratum corneum
halo
macrophages
plasma cells
nuclei (resembles flower) and “smudgy”/indistinct chromatin
histiocytes”)
Schwannoma (neurilemmoma)
Balloon cell nevus, balloon cell melanoma (has classic features of
melanoma in junctional component)
Endogenous ochronosis (alkaptonuria) . exogenous
ochronosis (from hydroquinone)
Endogenous ochronosis is as a result of deposition of
homogentisic acid on collagen and cartilage
Subcutaneous panniculitis-like T-cell lymphoma, lupus profundus,
and hemophagocytic lymphohistiocytosis (historical term:
cytophagic histiocytic panniculitis)
Pathognomonic of Langerhans cells and LCH cells
Langerin (CD207) is the major component of Birbeck granules
→ Langerin immunostain is the most specic stain (.CD1a)
for Langerhans cells and LCH cells
Histiocytes in Langerhans cell histiocytosis can carry BRAF
V600E mutation, a potential therapeutic target
PCT, EPP
Caterpillar bodies are composed of basement membrane
proteins including collagen IV; same material as Kamino bodies
(Spitz nevi)
Within adipocytes (radiating pattern): SQ fat necrosis of
newborn, sclerema neonatorum, and poststeroid
panniculitis
Within dermis: NXG (.NL), plane xanthoma, and eruptive
xanthoma
Within arterioles: cholesterol embolism (brin thrombus
surrounds cholesterol)
*Don’t confuse cholesterol clefts with keratin granuloma
Sporotrichosis
May also see “sporothrix asteroid” bodies 5 yeast with radiat-
ing pink hyaline material (immune complexes on yeast surface)
HTLV-induced adult T-cell leukemia/lymphoma (pathognomonic)
Classically associated with benign cephalic histiocytosis (but
also seen in juvenile xanthogranuloma)
Darier’s disease, warty dyskeratoma, Grover’s, Hailey-Hailey
(less prominent), acantholytic dyskeratotic acanthoma (trunk is
#1 site), papular acantholytic dyskeratosis (multiple lesions on
vulva, mistaken for condyloma), and PRP (focally)
HSV, VZV, and CMV (“owl’s eye” endothelial cells)
Poliovirus . adenovirus
Granuloma inguinale (Klebsiella granulomatis)
Classically seen in malignant B-cell processes: B-cell
lymphoma, multiple myeloma, and Waldenström
macroglobulinemia
Mnemonic: Dutcher 5 Dead (a/w malignant process), versus Russell
bodies (a/w benign conditions; “happy, pregnant plasma cells”)
arthropod assault, drug), and bullous pemphigoid (rarely)
Neutrophilic processes (esp. PNGD, RA) can have bluish-
purple “ame gure-like” structures as a result of neutrophilic debris deposited on collagen
Pleomorphic lipoma
Gaucher disease
392
7.1 Essential Concepts in Dermatopathology
Table 7.2 High-Yield Dermpath Bodies/Cells—cont'd
Body Description Associated Disease(s)/Comments
Ghost/shadow cells
(pilomatricoma)
Ghost cells (pancreatic
panniculitis)
Globi Amphophilic, encapsulated collections of mycobacteria Lepromatous leprosy
Glomus bodies Specialized A-V shunts that bypass capillaries; mostly found on
Guarnieri body Eosinophilic cytoplasmic inclusions Smallpox
Hallmark (horseshoe)
cells
Henderson-Paterson
bodies
Kamino bodies Collections of amorphous eosinophilic/hyaline BMZ material
Koilocytes Keratinocytes with viral cytopathic changes ( perinuclear halo,
Langhans giant cells Histiocytic giant cells with a peripheral (“ horse-shoe”)
Mariner’s wheel
Max-Joseph (Caspary-
Joseph) spaces
Medlar bodies Thick-walled clusters of brown round yeast forms (“copper
Michaelis-Gutmann
body
Miescher’s radial
granuloma
Mikulicz cells Foamy histiocytes containing gram-negative rods (Klebsiella
Mulberry cells Large pink/red-colored fat cells with a central nucleus
Morula
Negri body Neuronal inclusion Rabies
Odland (lamellar) bodies Oval granules w/ lamellar organization seen w/ electron
Papillary mesenchymal
bodies
Psammoma body Concentric, calcified laminated spheres Meningioma, mesothelioma, ovarian cancer, papillary thyroid
Pustulo-ovoid bodies
of Milian
Reed-Sternberg cells Large atypical lymphoid cells derived from germinal center B
Reed-Sternberg-like
cells
Anucleate, eosinophilic, keratinized cells with a ghost-like
outline where the nucleus previously resided; often surrounded
by transitional cells and basaloid cells (derived from matrix
cells of hair follicle)
Blue-purple calcium outlines remnants of necrotic lipocytes Pancreatic panniculitis
fingers and toes; responsible for temperature regulation
Markedly atypical, enlarged T lymphocytes with a
horseshoe-shaped nucleus
Large, pink-to-purple intracytoplasmic inclusions (Fig. 7.1) Molluscum contagiosum
(PAS1 and collagen IV1) in tips of dermal papillae and
within epidermis
shrunken hyperchromatic nucleus, and irregular nuclear
contours)
arrangement of nuclei
Central round yeast (60 mm) w/ multiple radiating buds
Focal clefts at DEJ formed by extreme damage to basal layer
from interface dermatitis
pennies”)
Round, calcified, and laminated bacterial remnants Malakoplakia; bodies can be highlighted with calcium stain (von
Small granuloma composed of radially arrayed histiocytes
around a central cleft; located in fat septae
rhinoscleromatis)
(vs. peripheral in normal adipocytes) and a multivacuolated,
granular, eosinophilic cytoplasm
Organism (2–11 mm) with numerous internal septations →
appears similar to morula stage of embryogenesis or like a
“soccer ball”; PAS1 and GMS1
microscopy; contain phospholipids, glycoproteins and acid
phosphatases; found in upper spinous and granular layer;
major role in barrier function and keratinocyte cohesion
Condensed clusters of fibroblasts adjacent to basaloid
epithelial follicular buds; recapitulates appearance of normal
hair bulb (dermal papilla-hair matrix)
Round eosinophilic cytoplasmic inclusions comprised of
lysosomes/Golgi material (PAS1 and diastase-resistant)
cells; characteristic bilobed nucleus w/ prominent central
nucleolus within each nucleus → “owl’s eye” appearance;
CD301, CD151, and PAX-51 (B-cell origin)
Appear similar to Reed-Sternberg cells on H&E but are T cells;
CD31, CD41, CD301, and CD15–
Pilomatricoma
Clinically have a “tent sign” (seen better when skin over tumor is
stretched)
Usually sporadic but may be associated with certain forms of
myotonic dystrophy, Gardner syndrome, Rubinstein-Taybi syndrome (beta-catenin mutation)
Other leprosy buzzword: Virchow cells (pale, foamy histiocytes
parasitized by Mycobacterium leprae)
Glomus tumor: solid nodular proliferation of glomus cells; favors
ngers and toes
Glomangiomas: ectatic vascular malformation with fewer glomus
cells than glomus tumor; widespread anatomic distribution
Anaplastic large cell lymphoma (ALCL) and LyP (type C)
Spitz nevi
Large aggregates of Kamino bodies are rarely (if ever) seen in
melanoma!
HPV
Unlike pap smears, true koilocytes are not always seen in HPV
skin infections → may just see vacuolated keratinocytes
and coarse keratohyalin granules
Classically associated with tuberculosis, but often seen in sar-
coidosis and other granulomatous diseases
Not to be confused with LangERhans cells!
Paracoccidioidomycosis (“South American Blastomycosis”,
Paracoccidioides brasiliensis)
Lichen planus
Exaggerated Max-Joseph spaces → bullous LP
Chromomycosis
DDx: pigmented hyphae are seen in phaeohyphomycosis
Kossa)
Erythema nodosum
Do not confuse with “Miescher’s granuloma” (aka actinic granu-
loma of O’Brien, or annular elastolytic giant cell granuloma)
Rhinoscleroma
Other rhinoscleroma buzzword: Russell bodies
Hibernoma
Tumor of brown fat; most common in adults on neck and upper
back
Protothecosis (an achloric alga)
Harlequin fetus (absent), Flegel disease (decreased or absent)
Present in trichoepithelioma, DTE , and trichoblastoma
Absent in BCC
cancer, and ovarian cancer
Granular cell tumor
Hodgkin lymphoma
LyP, ALCL
Continued
393
CHAPTER 7 • Dermatopathology
Table 7.2 High-Yield Dermpath Bodies/Cells—cont'd
Body Description Associated Disease(s)/Comments
Rocha-Lima bodies Intracytoplasmic inclusions within endothelial cells Oroya fever, verruga peruana
Russell bodies Intracytoplasmic immunoglobulin collections (eosinophilic)
stuffing the cytoplasm of plasma cells
Schaumann bodies Calcified laminated collections Sarcoid
Sézary cells Atypical lymphocytes with cerebriform nuclei (seen in
peripheral blood smear . tissue)
Signet ring cells Cell with eccentric nucleus and large pool of intracytoplasmic
mucin (pushes nucleus to periphery)
Sunburn cells Dyskeratotic keratinocytes scattered in upper and mid-
epidermis (. basal layer)
Touton giant cells Large, multinucleated histiocytes with wreath-like arrangement
of nuclei and peripheral cytoplasmic lipid
Verocay bodies Two stacked rows of elongated palisading nuclei
surrounding amorphous pink material (cytoplasmic
processes of Schwann cells); seen in hypercellular (Antoni A)
areas of schwannomas
Virchow cells Foamy histiocytes parasitized by acid-fast bacilli Lepromatous leprosy
von Hansemann cells Large histiocytes with granular eosinophilic cytoplasm; the
cytoplasm of these cells contains Michaelis-Gutmann bodies
Weibel-Palade bodies Cytoplasmic organelle of endothelial cells seen only with EM;
contains vWF and P-selectin
Rhinoscleroma, granuloma inguinale
Russell bodies are classically a/w benign diagnoses (“happy, pregnant
plasma cells”) versus malignant associations for Dutcher bodies
Sézary syndrome, MF
Any mucin-producing adenocarcinoma (usually metastatic,
if seen in skin)
Sunburns and phototoxic drug eruptions
JXG (and other xanthomas), dermatobroma (often contain
hemosiderin)
Boards pearl: Touton giant cells are ubiquitous in DF but not
seen in DFSP!
Schwannoma (neurilemmoma)
Other boards buzzword: globi (encapsulated amphophilic masses
of M. leprae)
Malakoplakia
von Willebrand disease is caused by qualitative or quantitative
vWF deficiency
394
Fig. 7.1 Molluscum contagiosum. Viral inclusions (Henderson-Paterson bodies) are prominent.