Diagnostic Pitfalls in Dermatopathology
Authors:
Miroslav Důra 1; Jiří Štork 1; Andrea Felšöová 2,3; Eva Sticová 2,4
Authors‘ workplace:
Dermatovenerologická klinika 1. LF UK a VFN, Praha
1; Pracoviště klinické a transplantační patologie, Institut klinické a experimentální medicíny, Praha
2; Ústav histologie a embryologie 2. LF UK, Praha
3; Ústav patologie 3. LF UK a FN Královské Vinohrady, Praha
4
Published in:
Čes.-slov. Patol., 59, 2023, No. 3, p. 96-103
Category:
Reviews Article
Overview
Dermatopathology is a distinct part of pathology revealing the rich association with soft tissue pathology and hematopathology. Regarding the number and diversity of the skin disorders, dermatopathology is a broad specialty encompassing hundreds of diseases.
The diagnostics in dermatopathology contains a range of specific features. The article summarizes several practically important pitfalls in dermatopathology. The adequate timing and locality selection for proper sampling are emphasized. The influence of the topical therapy on the histopathological picture is debated. The frequently used surgical procedures in the skin biopsy are presented. The most frequent incidental findings and artifacts in cutaneous pathology are discussed. Problematics of the alopecia examination and direct immunofluorescence are added.
Clinical-pathological correlation performed by the pathologist, and subsequently by the dermatologist, is the essential step in the diagnostic process. The knowledge transcending to the other specialty and reciprocal communication are prerequisite for the right diagnosis.
Keywords:
alopecia – clinical-pathological correlation – incidental finding – dermatopathology – artifact – direct immunofluorescence
Sources
- Ackerman AB, Ragaz A. The Lives of Lesions: Chronology in Dermatopathology. Masson, 1984. ISBN 978-0-8935-2095-3.
- Carlson JA. The histological assessment of cutaneous vasculitis. Histopathology 2010; 56(1): 3-23.
- Bolognia J, Jorizzo JL, Schaffer JV. Dermatology. 3rd Edition. Philadelphia: Elsevier/ Saunders, 2012: 2 vol. ISBN 978-0723435716.
- Misciali C, Dika E, Baraldi C, et al. Vascular leg ulcers: histopathologic study of 293 pa- tients. Am J Dermatopathol 2014; 36(12): 977-983.
- Requena L, Requena C. Histopathology of the more common viral skin infections. Actas Dermosifiliogr 2010; 101(3): 201-216.
- Jicha KI, Wang DM, Miedema JR, Diaz LA. Cutaneous lupus erythematosus/lichen planus overlap syndrome. JAAD Case Rep 2021; 17: 130-151.
- Martin LK, Rubin AI, Theocharous C, Mur- rell DF. Podophyllin reaction mimicking Bowen‘s disease in a patient with delusions of verrucosis. Clin Exp Dermatol 2008; 33(4): 443-445.
- Gill P, Richards K, Cho WC, et al. Localized cutaneous argyria: Review of a rare clinical mimicker of melanocytic lesions. Ann Diagn Pathol 2021; 54: 151776.
- Calonje E, Brenn T, Lazar AJ, Billings SD. McKee‘s Pathology of the Skin. 5th Edition. Amsterdam: Elsevier/Saunders, 2019; 2 vol.r ISBN 978-0-7020-6983-3.
- Rocha TOCD, Moya FG, Vilella VM, Lellis RF. Pagetoid dyskeratosis in dermatopathology. An Bras Dermatol 2021; 96(4): 454-457.
- Sabatier-Vincent M, Charles J, Pinel N, et al. Acantholytic dermatosis in patients treated by vemurafenib: 2 cases. Ann Dermatol Vene- reol 2014; 141(11): 689-693.
- Abbas O, Bhawan J. Syringometaplasia: variants and underlying mechanisms. Int J Dermatol 2016; 55(2): 142-148.
- El-Khoury J, Kurban M, Abbas O. Elastophagocytosis: underlying mechanisms and associated cutaneous entities. J Am Acad Der- matol 2014; 70(5): 934-944.
- Taqi SA, Sami SA, Sami LB, Zaki SA. A review of artifacts in histopathology. J Oral Maxillofac Pathol 2018; 22(2): 279.
- de Waal J. Skin tumour specimen shrinkage with excision and formalin fixation-how much and why: a prospective study and discussion of the literature. ANZ J Surg 2021; 91(12): 2744-2749.
- Friedman EB, Dodds TJ, Lo S, et al. Correlation between surgical and histologic margins in melanoma wide excision specimens. Ann Surg Oncol 2019; 26(1): 25-32.
- Hosler GA. Diagnostic Dermatopathology – a guide to ancillary tests blond the H&E. Lon- don: JP Medical Publishers, 2017. Print. ISBN: 978-1-909836-12-9.
- Stefanato CM. Histopathology of alopecia: a clinicopathological approach to diagnosis. Histopathology 2010; 56(1): 24-38.
- Elston DM, Stratman EJ, Miller SJ. Skin biopsy: Biopsy issues in specific diseases. J Am Acad Dermatol 2016; 74(1): 1-16; quiz 17-18.
- Reich A, Marcinow K, Bialynicki-Birula R. The lupus band test in systemic lupus erythematosus patients. Ther Clin Risk Manag 2011; 7: 27-32.
- Mehta M, Siddique SS, Gonzalez-Gonzalez LA, Foster CS. Immunohistochemical differences between normal and chronically in- flamed conjunctiva: diagnostic features. Am J Dermatopathol 2011; 33(8): 786-789.
- Terra JB, Meijer JM, Jonkman MF, Diercks GF. The n- vs. u-serration is a learnable crite- rion to differentiate pemphigoid from epider- molysis bullosa acquisita in direct immunofluorescence serration pattern analysis. Br J Dermatol 2013; 169(1): 100-105.
- Wongtada C, Kerr SJ, Rerknimitr P. Lupus band test for diagnostic evaluation in system- ic lupus erythematosus. Lupus 2022; 31(3):363-366.
Labels
Anatomical pathology Forensic medical examiner ToxicologyArticle was published in
Czecho-Slovak Pathology
![Issue 3](https://www.prolekare.cz/media/cache/resolve/journal_issue/media/image_pdf/bb64d3e5915b1217cb2fec97febd2e89.jpg)
2023 Issue 3
Most read in this issue
- Clinical and histopathological aspects of the most common inflammatory non-infectious skin diseases
- Stevens-Johnson syndrome and toxic epidermal necrolysis from pathologist’s point of view
- Tall cell carcinoma of the breast with reversed polarity - a report of three cases with a review of the literature
- Diagnostic Pitfalls in Dermatopathology