Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Granulomatous, necrobiotic and perforating dermatoses

Sarcoidosis Clinical features Sarcoidosis (Gr. sarkos , flesh; eidos , form), so named because its histologic features were originally thought to resemble a sarcoma (Boeck), is a common systemic disease of unknown etiology. It is characterized and defined by the presence of noncaseating granulomata, usually (but not invariably) affecting multiple organ systems. Manifestations are variable. Patients may present with: an acute and usually self-limiting variant, a…

Superficial and deep perivascular inflammatory dermatoses

Chronic superficial dermatitis Clinical features Chronic superficial dermatitis (digitate dermatosis, superficial scaly dermatitis, small-plaque parapsoriasis, persistent superficial dermatitis) is a not uncommon condition, which presents as erythematous scaly persistent patches, showing a predilection for the limbs and trunk. While the lesions may be round or oval, they often have a finger-like appearance, hence the alternative designation of digitate dermatosis ( Figs 8.1 and 8.2 ). The…

Lichenoid and interface dermatitis

The term ‘lichenoid’ refers to inflammatory dermatoses which are characterized by a bandlike lymphohistiocytic infiltrate in the upper dermis, hugging and often obscuring the dermal–epidermal interface. Lichen planus is the prototypic lichenoid dermatitis ( Box 7.1 ). Interface dermatitis refers to the presence of basal cell vacuolization (hydropic degeneration) and is often accompanied by single-cell keratinocyte apoptosis ( Box 7.2 ). These two terms are by…

Spongiotic, psoriasiform and pustular dermatoses

Eczematous Dermatitis This chapter discusses a number of disorders under the rubric eczematous dermatitis, also called eczema and spongiotic dermatitis. The term eczema refers to a group of disorders that share similar clinical and histologic features but may have different etiologies. Some object to a diagnosis of eczema since it does not reflect a specific disease but is a non-specific term that simply can be used…

Acantholytic disorders

Introduction The term acantholysis derives from the Greek akantha , a thorn or prickle, and lysis , a loosening. In its simplest definition, the term is used to reflect a primary disorder of the skin (and sometimes the mucous membranes) characterized by separation of the keratinocytes at their desmosomal junctions ( Fig. 5.1 ). A wide range of conditions are characterized by this feature, from inherited…

Inherited and autoimmune subepidermal blistering diseases

Blisters, which are clinically subdivided into vesicles (L. vesicula , dim. of vesica , bladder) and bullae (L. bubble), are defined as accumulations of fluid either within or below the epidermis and mucous membranes. Although somewhat arbitrary, the term ‘vesicle’ is applied to lesions less than 0.5 cm in diameter and ‘bulla’ to those greater than 0.5 cm. Subepidermal blisters, i.e., those that develop at the epidermal or…

Disorders of keratinization

Ichthyosis The term ichthyosis (Gr. ichthys , fish) is applied to a number of heterogeneous genetic disorders characterized by permanent and generalized abnormal keratinization. The clinical features range from mild involvement, often passed off as ‘dry skin’ (xerosis), through to severe widespread scaly lesions causing much discomfort and social embarrassment ( Fig. 3.1 ). The scales are shed as clusters rather than as single cells as…

Specialized techniques in dermatopathology

Specimen fixation, grossing/put-through, processing, embedding and sectioning The aim of fixation is to maintain clear and consistent lesional features and to preserve tissue in an optimal state suitable for a range of staining and ancillary histopathological techniques. Most fixation methods employed during tissue processing depend on chemical fixation of tissue in liquid reagents. Tissue fixation may also be accomplished by physical (heat, microwave, freeze-drying, and freeze…

The structure and function of skin

Introduction Skin is a double-layered membrane covering the exterior of the body and consists of a stratified cellular epidermis and an underlying dermis of connective tissue. In adults, the skin weighs over 5 kg and covers a surface area approaching 2 m 2 . The epidermis is mainly composed of keratinocytes and is typically 0.05–0.1 mm in thickness. The dermis contains collagen, elastic tissue and ground substance and is…

Thyroid and Parathyroid Glands

Thyroid Resection Thyroid surgery is usually performed to remove solitary nodules (benign or malignant), multinodular goiters, or, rarely, for the treatment of Graves’ disease. Thyroid resection specimens include total thyroidectomies, near-total thyroidectomies, hemithyroidectomies, lobectomies, and isthmusectomies. Many nodules will have been evaluated prior to excision by fine needle aspiration. RELEVANT CLINICAL HISTORY In addition to age and gender, clinical history is often necessary or helpful for…

Thymus

The thymus may be removed due to disease (both benign and malignant tumors), for the treatment of myasthenia gravis, or, rarely, incidentally during thoracic surgery (e.g., open heart surgery). If the specimen is of an anterior mediastinal mass, one must consider lymphoma and teratoma as well as thymic epithelial tumors. RELEVANT CLINICAL HISTORY In addition to age and gender, relevant clinical history is often necessary or…

Soft Tissue Tumors (Sarcomas)

Soft tissue tumors are among the most difficult neoplasms to diagnose. Often special studies (e.g., immunoperoxidase studies, fluorescence in situ hybridization [FISH], or cytogenetics) are required for the appropriate classification of these tumors and for reliable separation from carcinomas, melanomas, and lymphomas. RELEVANT CLINICAL HISTORY (IN ADDITION TO AGE AND GENDER) See Table 28.1 . Table 28.1 RELEVANT CLINICAL HISTORY HISTORY RELEVANT TO ALL SPECIMENS HISTORY…

Penis

. . The majority of penile carcinomas are squamous cell carcinomas arising in the glans (~50%), foreskin/prepuce (~20%; mucosal surface more commonly involved than outer surface), coronal sulcus (~5%), or, rarely, in other sites ( Fig. 27.1 ). About one-third are associated with Human Papilloma Virus (HPV) with type 16 followed by type 18 being most common. Amputations of the penis are almost always for the…

Paraganglioma

## ## The adrenal medullary paraganglioma, pheochromocytoma, is discussed in Chapter 8 . The extra-adrenal paragangliomas are classified according to their location and site of origin, which corresponds to the paravertebral sympathetic chain: Abdominal extra-adrenal paragangliomas Organ of Zuckerkandl Urinary bladder Paragangliomas of the head and neck Carotid body paraganglioma Jugulotympanic paraganglioma Vagal paraganglioma Laryngeal paraganglioma Aortic pulmonary paraganglioma You’re Reading a Preview Become a Clinical…

Neuropathology

## ## Neuropathology cases include all brain and spinal cord specimens, pituitary glands, muscle and nerve biopsies, and eyes. RELEVANT CLINICAL HISTORY In addition to age and gender, clinical history is often necessary or helpful for the evaluation of neuropathology specimens ( Table 25.1 ). Table 25.1 RELEVANT CLINICAL HISTORY FOR NEUROPATHOLOGY SPECIMENS HISTORY RELEVANT TO ALL SPECIMENS HISTORY RELEVANT FOR NEUROPATHOLOGY SPECIMENS Organ/tissue resected or…

Medical Devices and Foreign Material

All foreign material removed from within human tissue is generally sent for pathologic evaluation and documentation. These can include objects introduced due to trauma (e.g., bullets or shrapnel) or for medical treatment (e.g., implanted ventricular assist devices). Medical devices temporarily introduced for medical treatment, such as intravenous catheters, are generally not examined. Some of these specimens have legal significance (e.g., bullets) and others may be subject…

Lymph Nodes, Spleen, and Bone Marrow

## ## These organs are affected by a wide variety of neoplastic, infectious, and systemic diseases. These diseases can also arise in extranodal sites. RELEVANT CLINICAL HISTORY In addition to age and gender, clinical history is often necessary or helpful for the interpretation of specimens of lymph nodes, spleen, or bone marrow ( Table 23.1 ). Table 23.1 RELEVANT CLINICAL HISTORY FOR SPECIMEN FROM LYMPH NODES,…

Lung and Pleura

## Non-neoplastic diseases of the lung are usually diagnosed by bronchoalveolar lavage, transbronchial biopsies, and open lung biopsies. In institutions with lung transplant programs, chronically diseased recipient lungs (explants) are also submitted for examination and these patients are monitored by serial biopsies to exclude graft rejection. Symptomatic lung tumors may be sampled by fine-needle aspiration or endo/transbronchial biopsy for diagnosis. Patients without evidence of distant metastases…

Hernia Sac

Hernia sacs are common surgical specimens derived from the frequent repair of inguinal, femoral, abdominal, and umbilical hernias. The sacs usually consist of a small portion of fibroconnective tissue lined by mesothelial tissue. A hernia sac is essentially a biopsy of the mesothelial abdominal lining and, as such, reveals malignancy in 0.1% to 0.7% of cases. The majority of these patients have a history of malignancy,…

Head and Neck and Laryngeal Specimens

Head and neck specimens are often challenging due to the numerous complex structures and the variety of disease processes that involve them. Sinus Contents Functional endoscopic sinus surgery (FESS) is used as a treatment for patients with chronic sinusitis who have not responded to medical therapy. , The contents of the sinuses are examined and obstructing areas and polyps are removed. A subset of these patients…