6
Color – Pink

  • Pink ball of spindle cells, 305
  • Pink material, 308
  • Pink dermis, 315
  • Epidermal necrosis, 317

    Myofibroma

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  • Pink ball of spindle cells (myofibroblasts)
  • Some nuclei resemble those of smooth muscle cells with some cigar shapes
  • Some nuclei resemble those of fibroblasts, with closely associated pink collagen
  • Increased vessels, often particularly at the periphery of the pink ball

    Key differences

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    (a)

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    (b)

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    (c)

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    (d)

    1. a, b   Angioleiomyoma: smooth muscle cells with abundant cytoplasm, perinuclear vacuole, interspersed vessels (see page 178)
    2. c, d   Myofibroma: cells resemble both fibroblasts and smooth muscle cells, peripheral vessels
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      (e)

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      (f)

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      (g)

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      (h)

    3. e, f   Scar, hypertrophic: can sometimes form a “pink ball”; fibroblasts with closely associated collagen that may be keloidal
    4. g, h   Schwannoma (neurilemmoma): encapsulated pink ball; cells are skinny and tapered; Verocay bodies and myxoid areas may be evident (see page 174)

      Amyloid

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  • Amorphous pink material in upper dermis
  • Plasma cells

    Cryoglobulinemia (type I)

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  • Glassy, smooth pink material within vessels
  • Minimal inflammation

    Erythema elevatum diutinum (extracellular cholesterolosis)

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  • Pink material in the dermis with clefting (later lesions)
  • Late stage has neutrophils interspersed with prominent fibrosis and “cholesterol clefts”
  • Palisading of neutrophils and nuclear dust around altered collagen (earlier lesions)
  • Swollen vessel walls and fibrin deposits (earlier lesions)

    Pilomatricoma

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  • Pink material with shadows of nuclei within, may have a “butterscotch” color (“pilomatrical keratin”)
  • Basaloid cells (not always present)
  • Calcification or ossification may be present
  • Giant cells often seen

    Proliferating pilar tumor

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  • Pink material that is dense keratin
  • Stratified squamous epithelium with no granular layer (tricholemmal differentiation)

    Sclerotic fibroma

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  • Pink material arranged in a fenestrated or clefted fashion
  • Hyalinized, relatively acellular collagen

    Key differences

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    (a)

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    (b)

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    (c)

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    (d)

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    (e)

    1. Amyloid: amorphous pink material, plasma cells
    2. Erythema elevatum diutinum (late stage): fibrosis with clefting and interspersed neutrophils
    3. Pilomatricoma: shadow cells, basaloid cells
    4. Proliferating pilar tumor: dense pink keratin, no granular layer between keratin and epithelium
    5. Sclerotic fibroma: clefts between strands of sclerotic collagen

    Radiation dermatitis

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  • Pink dermis
  • Atypical, bizarre fibroblasts within dermis
  • Dilated vessels with plump endothelial cells
  • Adnexal structures often absent

    Key differences

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    (a)

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    (b)

    1. Lichen sclerosus et atrophicus: pink band of dermis with inflammation below it (see also page 115)
    2. Radiation dermatitis: pink dermis with dilated vessels; atypical fibroblasts on higher power

    Aspergillosis

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  • Epidermal and dermal necrosis
  • Vessels necrotic with extravasated erythrocytes and visible fungal hyphae that are septate and branching

    Burn

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  • Epidermal necrosis with variable dermal change
  • Reversal of epidermal staining (more basophilic superficially than deep)
  • Acute lesions are non-inflammatory

    Erythema multiforme

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  • Epidermal necrosis below basket-weave stratum corneum

    Herpes simplex infection

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  • Epidermal necrosis with acantholytic cells and multinucleated cells
  • Follicular necrosis is a clue

    Nutritional deficiency (zinc deficiency, acrodermatitis enteropathica, essential fatty acid deficiency)

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  • Epidermal necrosis or pallor underlying parakeratosis
  • Basal layer relatively normal
  • Inflammation not prominent
  • Similar changes can be seen in necrolytic migratory erythema

    Key differences

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    (a)

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    (b)

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    (c)

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    (d)

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    (e)

    1. Aspergillosis: epidermal and dermal necrosis with fungi in areas of destroyed vessels
    2. Burn: epidermal necrosis, sharp demarcation from normal skin
    3. Erythema multiforme: basket-weave stratum corneum, apoptotic keratinocytes
    4. Herpes simplex infection: acantholysis and multinucleated cells with rimmed chromatin (margination)
    5. Nutritional deficiency: parakeratosis above epidermal necrosis, basal layer often unaffected