Pseudobowenoid changes of the vulva is an HPV-induced lesion described on the vulva which has similar histologic changes to those seen in oral Heck’s disease (focal epithelial hyperplasia). Both conditions are induced by rare HPV variants. Histological feature characteristic for these entities include epithelial hyperplasia with broad rete ridges, koilocytes, and presence of mitosoid bodies.
Mitosoid figures from a representative case from the vulva are shown below.
Which types of HPV have been associated with this disease?
Lyme disease is caused by a spiroquete Borrelia burgdorferi. It is transmitted by the Ixodes tick. Histologically, erythema chronicum migrans is characterized by a non-specific lymphocytic perivascular and perineural inflammatory infiltrate, usually associated with plasma cells. What other condition can be also associated with Lyme disease?
Which form of leprosy is characterized by well formed perineural granulomas and absent bacilli?
Leprosy is caused by Mycobacterium leprae, which is an obligate intracellular gram-positive, weakly acid fast organism. The disease can present in many different forms, depending on the immune response of the patient. Which form of leprosy has the highest number of organisms found in the biopsy specimen?
Erythrasma is caused by an actinobacteria of the genus Corynebacterium (C. minutissimum). Which of the folling statements about skin biopsies in erythrasma is not true?
Erythrasma is a bacterial infection of the skin, which occurs symmetrically in intertriginous areas, and is one of the differential diagnoses for “normal skin” histology on H&E stain. Knowing that it is caused by an actinobacteria of the genus Corynebacterium, which species causes erythrasma?
The PD-L1/PD-1 immune “checkpoint” may be co-opted by tumors to turn off the anti-tumor host immune response. New anti-PD-1 or anti-PD-1 immunotherapies block this interaction, effectively “releasing the brakes” on the host immune system and allowing it to fight tumor. The expression of PD-L1 as detected by immunohistochemistry has been studied as a marker of response to anti-PD-1/PD-L1 immunotherapy.
Complete the following statement:
Patients whose tumors are negative for PD-L1....
Which domains to the p40 and p63 antibodies recognize, respectively?
The “gold standard” for the diagnosis of cutaneous vasculitis is:
The slide below shows a biopsy from a purpuric lesion on the leg of a 18 y/o man who recently recovered from an upper respiratory tract infection. The biopsy showed classic features of leukocytoclastic vasculitis. However, in some cases the biopsy of leukocytoclasitc vasculitis can be false-negative because it is taken too early or two late in the cycle of lesion development. The timing of biopsy is critical for highest diagnostic yield.
The lesion represented in this specimen was most likely biopsied within what time frame after appearance of the lesion?
81 y/o woman with history of lichen sclerosus presented with raised plaque on the vulva. A biopsy was performed. It showed so called differentiated vulvar intraepithelial neoplasia (VIN).
Which of the following is true about this entity?
75 y/o woman with an eroded plaque on the mons pubis. The images below show HE and panel of special studies performed on the biopsy of this lesion.
Which of the following is the correct diagnosis?
A 43 y/o woman presents with vulvar burning and pruritus. The biopsy shown below shows spongiotic and psoriasiform epidermal hyperplasia with focal intracorneal neutrophils. In this locations such findings are sufficient to be suspicious for psoriasis.
Which of the following statements is incorrect regarding vulvar psoriasis?
A 56 y/o female presented with vulvar pruritus involving labia. A biopsy was performed. It showed spongiotic dermatitis consistent with contact dermatitis.
Which of the following statements is incorrect regarding spongiotic eruptions of the vulva?
Inflammatory salivary gland conditions are far more common than neoplastic lesions. Of the inflammatory conditions, mucoceles are the most frequently encountered. Although the term “mucocele” often is used loosely to mean any cyst-like or true cyst filled with mucin, it is less confusing to use the term mucocele for mucous extravasation lesions not lined by epithelium, and salivary duct cyst for those caused by cystically dilated ducts; these latter cysts usually exhibit other reactive changes such as oncocytic or squamous metaplasia.
This was a blister-like lesion removed from the mandibular vestibule. Which is the correct answer?
The most common pigmented lesion of exogenous etiology of the oral mucosa is the amalgam tattoo caused by traumatic implantation of amalgam. As such, a scar is almost always present. Granules may be fine or coarse. When fine, they may be mistaken for fine melanin granules of a melanotic macule. The presence of abundant melanin pigment within the basal cells, lack of melanocytic hyperplasia and lack of scarring distinguishes a melanotic macule from amalgam tattoo.
This is a slate-grey macule on the mucosa.
The sections below show a biopsy of a slate-gray macule on the gingival mucosa in a 44 year old female showing typical features of amalgam tottoo
Which statement regarding this lesion is correct?
Gingival nodules are some of the most common biopsies encountered by the pathologist. These are generally reactive nodular proliferations of mesenchymal tissue composed primarily of fibrous tissue, metaplastic ossification, osteoclast-like giant cells, endothelial cells and blood vessels, or a combination of the above. Other nodules include tumors of odontogenic etiology including peripheral ameloblastoma and peripheral odontogenic fibroma.
This was a red papule removed from the gingival margin of a 12-year-old who was wearing orthodontic braces. Which is the correct diagnosis?
Frictional keratoses of the oral cavity generally take two forms. When they occur on the nonkeratinized mucosa, they are usually caused by chronic parafunctional habits such as lip or tongue chewing/nibbling. When they occur on the keratinized mucosa, they resemble lichen simplex chronicus of the skin. These should always be reported as being frictional/factitial keratoses or reactive keratoses. A diagnosis of parakeratosis or hyperkeratosis, NOS would be relegated to the category of leukoplakia, a premalignant condition that requires continued follow-up and surveillance biopsies, unlike frictional keratoses.
What does the following biopsy that was present bilaterally on the buccal mucosa represent?
Oral epithelial dysplasia should be evaluated not only based on cytologic changes of keratinocytes but also through low power features such as verrucous architecture, endophytic proliferation, and atrophy without inflammation. Cytologic features of dysplasia are similar to those seen in other squamous epithelium. In addition, human papilloma virus (HPV)-associated oral epithelial dysplasia show prominent apoptosis and karyorrhexis and are all associated with strong, continuous p16 staining and association with high risk HPV subtypes. But it is only if one recognizes the histopathology that a p16 study would be ordered.
What does the following lesion of the ventral tongue show?
The keratocystic odontogenic tumor (formerly odontogenic keratocyst) is now considered a cystic tumor because many cases show mutation of the PTCH gene, especially those associated with the basal cell carcinoma-jaw-cyst syndrome. The cyst is lined by parakeratinized stratitifed squamous epithelium that is generally uniformly 7-10 cells thick and shows palisading of the basal cell nuclei. This cyst must be distinguished from other keratinzing cysts because it has a recurrence rate of 30-50% depending on how it is treated, while other keratinizing cysts do not.
What is the the best diagnosis for this radiolucency removed from around an impacted third molar illustrated below? Please note that this cyst shows no evidence of parakeratosis.