DESCRIPTIVE TERMS IN

DERMATOPATHOLOGY
- KERATINIZATION [DIFFERENTIATION ] The process by which epidermal cells (Keratinocytes)
undergo maturation, as the cell migrates from the basal layer to the stratum corneum. There is :
- 1- gradual loss of nuclear function, with eventual loss of nuclei in the stratum corneum.
- 2- loss of cytoplasmic structures.
- 3-progressive formation of keratin filaments to form the cornified envelope
- PATTERNS OF KERATINIZATION
Orthokeratosis
Parakerotosis
Dyskeratosis
 ORTHOKERAT
OSIS

- It Is The Normal Keratinization Process, Which Leads To The Production Of A Stratum Corneum Composed Of Anucleate Squames

With A Loose Pattern (I.E. Basket Weave), Except For That Of The Palms And Soles Where The Normal Pattern Is Compact (I.E. The

Cornified Cells Are Closely Packed Together). The Basket Weave Pattern Is Because Of Loss Of Lipids During The Fixation.
Dyskeratosis
This term relates to some abnormality in the process of epidermal cell
keratinization.
The process occurs in two main contexts:
Firstly, in malignant and premalignant epithelial lesions, such as
Squamous cell carcinoma,
Bowen's disease and
Solar keratosis.
Secondly, in various forms of acantholytic disorder such as
Darier's disease.
In this condition, specific types of dyskeratotic cell include corps ronds and grains.
Benign familial Pemphigus (Hailey-Hailey disease).
Transient and persistent acantholytic dermatosis.
Warty dyskeratoma.
Solitary dyskeratoma.
Acantholytic dyskeratotic epidermal naevus
(Grover’s disease)- focal Acantholytic dyskeratosis.
Porokeratosis of Mantoux.
Condylamata accuminata of uterine cervix.
Chronic radiodermatitis.
Graft Versus Host disease.
Necrolytic migratory erythema with carcinoma of pancreas.
Familial dyskeratotic comedones.
Hereditary benign intraepidermal dyskeratosis
(Witkop- Von Sallman syndrome)- focal Acantholytic dyskeratosis.
Parakeratosis:
The retention of keratinocyte nuclei within the horny cell layer,
it represents a:
Disturbance of keratinization, and
is normally associated with an absence or reduction in thickness of the granular cell layer.
Closely associated either with:
Increased epidermal cell turnover or
with inflammatory changes in the epidermis itself.
It is commonly seen in :
-An earlier disturbance in the underlying
epidermis such as:
Psoriasis,
Subacute eczematous reactions, and
Pityriasis lichenoides.
-Dysplastic epithelial changes, such as:
Actinic keratoses and
Bowen's disease.
Acanthosis:
Increase in number of cells in the Malpighian or prickle
cell layer of the epidermis.
Features may be seen:
-Naevoid conditions.
-Virally induced papillomas.
-Chronic inflammatory conditions, for example Chronic
eczema, psoriasis.
- Pemphigus, Darier's disease.
-Malignant melanoma, Paget’s disease, Mycosis Fungoids
and Histiocytosis X.
*Pseudoacanthosis; increase thickness of the epidermis
due to enlarged keratinocytes.
*Pseudoepitheliomatous hyperplasia; reactive epidermal
proliferation
Acantholysis is the term used to describe loss of cohesion between
keratinocytes, due to breakdown of intercellular bridges.

Primary acantholysis:

Pemphigus and its variants.

Darier's disease.

Transient and persistent acantholytic dermatosis.

Warty dyskeratoma.

Secondary acantholysis:

Benign familial Pemphigus (Hailey-Hailey disease).

Bullous impetigo.

Viral disorders.

Solar keratoses.

Squamous cell carcinoma (some forms).

Grenz zone:
A zone of normal dermis between the epidermis and
pathological changes deeper in the dermis. This comes from
the German word for border.

Lepromatous leprosy.

Leukocytoclastic vasculitis.

Early stage 1ry CTCL.

Histiocytosis; Fat- storing hamartoma of dermal

dendrocytes.

Melanocytic Naevi and Malignant Melanoma.

Hypergranulosis:
Increase in thickness of the granular layer of
the epidermis.

-Chronic lichenification, and lichen planus

(commonly).
Hyperkeratosis:
Increased thickness of the stratum corneum.
-Keratodermas.
-Icthyotic disorders.
-Chronic Discoid Lupus Erythematosus.
- Kyrle’s disease.
Spongiosis ( Intercellular edema)
-Widening of the intercellular spaces between
keratinocytes due to fluid accumulation.
-Acute and Subacute eczema (characteristically).
(1) Langerhans cells in the epidermis
(2) Lymphocytes in the epidermis
(3) Spongiosis
(4) Hyperkeratosis & parakeratosis
(5) Elongated rete ridges
(6) Lymphocytes surrounding dermal vessels
 CORP GRAİNS AND CORP
RONDS
Acantholytic, dyskeratotic, basophilic cells.
Corps ronds have round nuclei with a
perinuclear halo. Grains have an elongeated
"grain shaped" nucleus. These cells are seen
in Darier's, Grover's and warty dyskeratoma.
Examples are 3 views of Darier's Disease
 EPİDERMOLYTİC
HYPERKERATOSİS
Also called granular degeneration. It is characterized by:

perinuclear clear spaces in the upper stratum malpighii

indistinct cellular boundaries

a markedly thickened granular layer with increased

numbers of keratohyalin granules and

hyperkeratosis

Example is a view of Epidermolytic Hyperkeratosis

 EPİDERMOTROPİSM
The presence of mononuclear cells in the epidermis

without spongiosis occuring in mycosis fungoides.

Example is a view of Mycosis Fungoides

 EPİTHELİOİD CELLS

Cells derived from macrophages, seen in

granulomas and characterized by a large
usually oval, pale, vesicular nucleus with a
clearly visible nuclear membrane. The
cytoplasm is abundant, ill-defined and slightly
eosinophilic. Example is a view of epithelioid
cells in a naked granuloma of Sarcoidosis
 EXOCYTOSİS

The presence of mononuclear cells in the

epidermis with spongiosis. Example is a

view of exocytosis in Acute Contact

Dermatitis
 FOAM CELL

A lipid-laden macrophage. Example is a view

of foam cells, low power (top) and high

power (bottom) in Verruciform Xanthoma

 GİANT CELLS

Large multinucleated cells.

Epidermal multinucleated giant cells are
characteristic of herpes virus infections. Histiocytic
giant cells whose nuclei form a horseshoe
arrangement are called Langhans type giant cells.
Touton type giant cells have a ring of nuclei
surrounding foamy cytoplasm with cytoplasm usually
also visible around the nuclei. Foreign-body giant
cells have a haphazard nuclear arrangement.
Example of giant cells in Foreign Body Reaction
(secondary to ruptured milium) (TOP) and Touton
giant cells in Juvenile Xanthogranuloma
(BOTTOM).
 GRANULOMA

A chronic proliferative lesion consisting of

mononuclear cells and epithelioid cells or

multinucleated giant cells or both. These cells lie

in groups and are often surrounded by lymphoid

cells. "Naked" granulomas have few to none of

these surrounding lymphoid cells.

Example of a "naked granuloma" in Sarcoidosis.

 HYALİN

Homogenous eosinophilic material that is

PAS-positive and diastase-resistant and has

glycoprotein as a major component.

Example of hyalin in Cylindroma

HYDROPİC DEGENERATİON OF BASAL CELLS

Also called liquefaction degeneration, it is a type of

degeneration causing vacuolization of the basal
cells. This process may lead to pigment
incontinence. It is seen in lupus erythematosus,
dermatomyositis, LS&A, ashy dermatosis and in
early lichen planus.
Example of hydropic degeneration of basal cells in
Lupus Erythematosus.
 MUNRO MİCROABSCESSES

Munro microabscesses are composed of

degenerated polymorphonuclear leukocytes

(PMN's) in the horny layer (stratum corneum) and

are seen in psoriasis and seborrheic dermatitis.

Example of Munro microabscesses in Psoriasis.

 SPONGİFORM PUSTULES OF KAGOJ

Spongiform pustules of Kagoj are multilocular

pustules in the upper stratum malpighii within a
sponge-like network made up of flattened
keratinocytes. They are seen in psoriasis, Reiter's
disease, geographic,tongue and rarely in
candidiasis.
Example of spongiform pustules of Kagoj in
Psoriasis.
 PAUTRİER MİCROABSCESS

Pautrier microabscesses are a collection of 3

or more atypical mononuclear cells within

the epidermis in mycosis fungoides.

Example of Pautrier microabscesses in

Mycosis Fungoides.
LACUNA

A slitlike intraepidermal vesicle or

bulla as is seen in Darier's disease.
Example of lacuna in Grover's
Disease.
LEUKOCYTOCLASİS AND NUCLEAR DUST

The disintegration of leukocytes

(primarily pmn's) resulting in nuclear
dust as seen in leukocytoclastic
vasculitis. Fragmented nuclei scattered
in the dermis, predominantly around
blood vesses. Seen in vasculitis.
Example of leukocytoclasis and
nuclear dust, low power (top) and high
power (bottom) in Leukocytoclastic
vasculitis.
MELANOPHAGE

A macrophage that has ingested melanin.

Example of melanophages in a
Combined nevus.
 NECROBİOSİS

Altered collagen that loses its normal

eosinophilic coloration and fibrillar
appearance, becoming slightly bluish and
"smudged".
Example of Necrobiosis in Necrobiosis
Lipoidica Diabeticorum (NLD).
PAPİLLO M ATOSİS

Upward proliferation of epidermis and

subepidermal papillae causing the surface
epidermis to show irregular undulation.
Example of papillomatosis in Verruca
Vulgaris (Top and Bottom).
PLEOMORPHİSM
The variation in the appearance of the
nuclei of the same cell type. If pronounced
and associated with large, irregular,
hyperchromatic nuclei it is termed anaplasia
and is often an indication of malignancy.
Example of pleomorphism in Superficial
Spreading Malignant Melanoma.
PSEUDOEPİTHELİOMATOUS
HYPERPLASİA
Extreme irregular acanthosis with downward

epidermal proliferation which may simulate

a well differentiated squamous cell

carcinoma. Example is a view of

Chromomycosis.
PSEUDOHORN CYST

Intraepidermal keratin-filled space

which due to the plane of sectioning
resembles a cyst, but actually
represents an epidermal invagination.
Example of Pseudohorn Cyst in
Seborrheic Keratosis.
SQUAMOTİZATİON

Replacement of the normally cuboidal

or columnar basal cells with polygonal

or flattened keratinocytes. This occurs

mainly in lichenoid tissue reactions.

Example of Squamotization in Lichen

Planopilaris
STORİFOR
M
A pattern of cellular arrangement which is
seen in certain fibrous tumors when the
elongated cells intersect or intertwine at
various angles so as to resemble the weaving
of a doormat.
Example of Storiform Pattern in
Dermatofibroma
.Villus
A dermal papilla extending into a
bulla, vesicle, or lacuna which is
covered with a single layer of
epidermal cells resulting from
suprabasalar acantholysis.
Example of Villus in Pemphigus
vulgaris
 BULLA
A cavity of at least 5 mm in diameter
forming within or below the epidermis.
Example is a sub-epidermal bulla in
Epidermolysis Bullosa