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Ukrаiniаn Medicаl Stomаtologicаl Аcаdemy THE DEPАRTАMENT OF PАTHOLOGICАL АNАTOMY WITH SECTIONSL COURSE MАNUАL for the foreign students GENERАL PАTHOMORPHOLOGY Poltаvа-2020 УДК:616-091(075.8) ББК:52.5я73 COMPILERS: PROFESSOR I. STАRCHENKO ASSOCIATIVE PROFESSOR O. PRYLUTSKYI АSSISTАNT A. ZADVORNOVA ASSISTANT D. NIKOLENKO Рекомендовано Вченою радою Української медичної стоматологічної академії як навчальний посібник для іноземних студентів – здобувачів вищої освіти ступеня магістра, які навчаються за спеціальністю 221 «Стоматологія» у закладах вищої освіти МОЗ України (протокол №8 від 11.03.2020р) Reviewers Romanuk A. - MD, Professor, Head of the Department of Pathological Anatomy, Sumy State University. Sitnikova V. - MD, Professor of Department of Normal and Pathological Clinical Anatomy Odessa National Medical University. Yeroshenko G. - MD, Professor, Department of Histology, Cytology and Embryology Ukrainian Medical Dental Academy. A teaching manual in English, developed at the Department of Pathological Anatomy with a section course UMSA by Professor Starchenko II, Associative Professor Prylutsky OK, Assistant Zadvornova AP, Assistant Nikolenko DE. The manual presents the content and basic questions of the topic, practical skills in sufficient volume for each class to be mastered by students, algorithms for describing macro- and micropreparations, situational tasks. The formulation of tests, their number and variable level of difficulty, sufficient volume for each topic allows to recommend them as preparation for students to take the licensed integrated exam "STEP-1". 2 Contents p. 1 Introduction to pathomorphology. Subject matter and tasks of 5 pathomorphology. Main stages of development of pathomorphology. Methods of pathanatomical diagnostics. Methods of pathomorphological research. 2 Morphological changes of cells as response to stressor and toxic damage 8 (parenchimatouse / intracellular dystrophies). -
Classification of Thyroid Tumors Benign Tumors - Adenoma 1
DERMATOPATHOLOGY PATHOLOGY OF ENDOCRINE SYSTEM Thyroid carcinoma, Hashimoto thyroiditis, Graves‘ disease, neuroendocrine tumor, Institute of Pathological Anatomy melanoma, pigmented naevus, psoriasis, eczema FM CU BA DERMATOPATHOLOGY • 10-year-old boy with a pigmented lesion on his shoulder, sharply demarcated from the surrounding skin, with a diameter of 2.3 cm, dark brown in color, without noticeable changes. CASE NO. 1 ➢Suggested examinations? ➢Your diagnosis? ➢Describe the microscopic finding. Pigmented nevus of the skin Congenital pigmented nevus of the skin PIGMENTED NEVUS • benign skin formation arising as a result of melanocyte accumulation • the most common skin lesion of the white race • most nevi form in childhood and adolescence Classification of nevi according to the position of growth in the skin • Junctional nevus - nests of melanocytes are found at the dermo-epidermal junction • Mixed nevus - nests of melanocytes are found at the junction but also in the dermis • Intradermal nevus - clusters of melanocytes are found in the upper part of the dermis WITHOUT connection with the epidermis Histological variants of pigmented nevus • Congenital nevus • Blue nevus • Halo nevus • Familial dysplastic nevus Mixed pigmented nevus Junctional pigmented nevus Intradermal pigmented nevus • 73-year-old patient was admitted to hospital for progressive weakness, shortness of breath. You notice that both the skin and the sclera are icteric. • laboratory hyperbilirubinemia, hypoalbuminemia and mineral imbalance, positive oncomarkers (S100) • abdominal ultrasound with spherical structures found in the liver parenchyma • personal medical history - malignant melanoma of the eye CASE NO. 2 30 years ago, CLL 3 years ago, now in remission ➢Suggested examinations? ➢Your diagnosis? ➢Complications? ➢Describe the microscopic finding. -
Spontaneous Regression of Divided Nevus of the Eyelid Evaluated by Dermoscopy Leaving a Hypopigmented Lesion
Case Report Spontaneous regression of divided nevus of the eyelid evaluated by dermoscopy leaving a hypopigmented lesion Danang Tri Wahyudi1, Izzah Aulia2, Aida S.D. Hoemardani1, Agassi Suseno Sutarjo1 1. Department of Dermatology and Venereology, Dharmais National Cancer Hospital, Jakarta, Indonesia 2. Department of Dermatology and Venereology Faculty of Medicine Universitas Indonesia/ Dr. Cipto Mangunkusumo National Central General Hospital Jakarta, Indonesia Email: [email protected] Abstract Background: Divided nevus, also known as “kissing nevus,” is a rare form of congenital melanocytic nevus that occurs on opposing margins of upper and lower eyelids. A paucity of literature on this rare anomaly exists, with most being case reports and series. Moreover, regression of this lesion was rarely reported. Case Illustration: We present a rare case of congenital divided nevus of the eyelid that regressed after eight years, confirmed with dermoscopy. A siX-year-old boy presented to the Dharmais National Cancer Hospital with two pigmented macules on the upper and lower right eyelid since birth. A year ago, the lesions started gradually disappearing and were replaced by a hypopigmented area. We evaluated the clinical and dermoscopic findings for two consecutive years. The dermoscopy showed pseudopigment networks, surrounded by a hypopigmented area resembling a halo. The pigmented lesions cleared with no residual lesions. Discussion: The dermoscopic findings of the patient resemble a solar lentigo characterized by pseudopigment networks, a feature caused by the relatively flattened rete ridge on the face. The hypopigmented area reflects a regression process, like the halo nevus, and is accompanied by leukotrichia of the eyelashes, a feature usually found in patients with vitiligo. -
Clinical Dermatology Notice
This page intentionally left blank Clinical Dermatology Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The editors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the editors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of such information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. a LANGE medical book Clinical Dermatology Carol Soutor, MD Clinical Professor Department of Dermatology University of Minnesota Medical School Minneapolis, Minnesota Maria K. Hordinsky, MD Chair and Professor Department of Dermatology University of Minnesota Medical School Minneapolis, Minnesota New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2013 by McGraw-Hill Education, LLC. -
Pigment and Hair Disorders
Pigment and Hair Disorders Mohammed Al-Haddab,MD,FRCPC Assistant Professor, Consultant Dermatologist, Dermasurgeon Objectives • To be familiar with physiology of melanocytes and skin color. • To be familiar with common cutaneous pigment disorders, pathophysiology, clinical presentation and treatment • To be familiar with physiology of hair follicle • To be familiar with common hair disorders, both acquired and congenital, their presentation, investigation and management • Reference is the both the lecture and the TEXTBOOK Skin Pigment • Reduced hemoglobin: blue • Oxyhemoglobin: red • Carotenoids : yellow • Melanin : brown • Human skin color is classified according to Fitzpatrick skin phototype. www.steticsensediodolaser.es www.ijdvl.com Vitiligo • Incidence 1% • Early onset • A chronic autoimmune disease with genetic predisposition • Complete absence of melanocytes • Could affect skin, hair, retina, but Iris color no change • Rarely could be associated with: alopecia areata, thyroid disease, pernicious anemia, diabetes mellitus • Koebner phenomenon Vitiligo • Ivory white macules and patches with sharp convex margins • Slowly progressive or present abruptly then stabilize with time • Focal • Segmental • Generalized (commonest) • Trichrome • Acral • Poliosis www.metro.co.uk www.dermrounds.com www.medscape.com www.jaad.org Vitiligo • Diagnosis usually clinically • Wood’s lamp for early vitiligo, white person • Pathology shows normal skin with no melanocytes Differential Diagnosis of Vitiligo • Pityriasis alba • leprosy • Hypopigmented pityriasis -
The Frequency of Superficial Mycoses According to Agents Isolated During a Ten-Year Period (1999-2008) in Zagreb Area, Croatia
Acta Dermatovenerol Croat 2010;18(2):92-98 CLINICAL ARTICLE The Frequency of Superficial Mycoses According to Agents Isolated During a Ten-Year Period (1999-2008) in Zagreb Area, Croatia Paola Miklić, Mihael Skerlev, Dragomir Budimčić, Jasna Lipozenčić University Department of Dermatology and Venereology, Zagreb University Hospital Center and School of Medicine, Zagreb, Croatia Corresponding author: SUMMARY Fungal infections involving the skin, hair and nails represent Paola Miklić, MD one of the most common mucocutaneous infections. Significant changes in the epidemiology, etiology and clinical pattern of mycotic University Department of Dermatology infections have been observed during the last years. The aim of this and Venereology retrospective study was to determine the incidence and the etiologic Zagreb University Hospital Center factors of superficial fungal infections in Zagreb area, Croatia, over a and School of Medicine 10-year period (1999-2008). A total of 75828 samples obtained from 67 983 patients were analyzed. Dermatomycosis was verified by culture in Šalata 4 17410 (23%) samples obtained from 16086 patients. Female patients HR-10000 Zagreb were more commonly affected than male (59% vs. 41%). Dermatophytes Croatia were responsible for 63% of all superficial fungal infections, followed by yeasts (36%) and molds (1%). Trichophyton (T.) mentagrophytes [email protected] (both var. interdigitalis and var. granulosa) was the most frequent dermatophyte isolated in 58% of all samples, followed by Microsporum Received: November 10, 2009 (M). canis (29%) and T. rubrum (10%). The most common clinical forms of dermatomycosis were onychomycosis (41%), tinea corporis (17%) Accepted: April 20, 2010 and tinea pedis (12%). Candida spp. was mainly isolated from fingernail debris. -
Therapies for Common Cutaneous Fungal Infections
MedicineToday 2014; 15(6): 35-47 PEER REVIEWED FEATURE 2 CPD POINTS Therapies for common cutaneous fungal infections KENG-EE THAI MB BS(Hons), BMedSci(Hons), FACD Key points A practical approach to the diagnosis and treatment of common fungal • Fungal infection should infections of the skin and hair is provided. Topical antifungal therapies always be in the differential are effective and usually used as first-line therapy, with oral antifungals diagnosis of any scaly rash. being saved for recalcitrant infections. Treatment should be for several • Topical antifungal agents are typically adequate treatment weeks at least. for simple tinea. • Oral antifungal therapy may inea and yeast infections are among the dermatophytoses (tinea) and yeast infections be required for extensive most common diagnoses found in general and their differential diagnoses and treatments disease, fungal folliculitis and practice and dermatology. Although are then discussed (Table). tinea involving the face, hair- antifungal therapies are effective in these bearing areas, palms and T infections, an accurate diagnosis is required to ANTIFUNGAL THERAPIES soles. avoid misuse of these or other topical agents. Topical antifungal preparations are the most • Tinea should be suspected if Furthermore, subsequent active prevention is commonly prescribed agents for dermatomy- there is unilateral hand just as important as the initial treatment of the coses, with systemic agents being used for dermatitis and rash on both fungal infection. complex, widespread tinea or when topical agents feet – ‘one hand and two feet’ This article provides a practical approach fail for tinea or yeast infections. The pharmacol- involvement. to antifungal therapy for common fungal infec- ogy of the systemic agents is discussed first here. -
Tinea Incognito
TINEA INCOGNITO http://www.aocd.org Tinea incognito is a localized skin infection caused by fungus, just like tinea corporis (ringworm) and tinea capitis (scalp ringworm). It is a skin infectious process that looks very different from other fungal infections, both the shape and the degree of involvement. Topical corticosteroid use is the culprit for the difference. Fungal infection, most often caused by Trichophyton rubrum, presents initially as a flat, scaly rash that gradually becomes a circular lesion with a raised border and the border is scaly as it advances. While the lesion enlarges, the center becomes brown or less pigmented. These skin findings comprise of the ringworm we typically see on the body. Lesions can be large or small. At this stage of the disease, if a topical corticosteroid is applied to the lesion, the local inflammation from the fungal infection will be decreased, so to alter the clinical presentation of the typical infection. And this secondary appearance is called tinea incognito. The most common site for this clinical transformation is the face and the back of the hand. The hand is a popular site for a lot of skin diseases, which is why tinea incognito is hard to diagnose and be differentiated from the others. Altered clinical picture of tinea incognito could resemble eczema, psoriasis and other diseases. What makes the clarification important is the difference in treatment approach. Corticosteroid makes tinea worse but helps the other ones. The new appearance of tinea incognito is quite different from other fungal infections. Instead of a localized lesion, it becomes much more extensive and loses its original circular shape, which is one of the most important clinical clues to diagnose fungal infection. -
Dermoscopy of Inflammatory Dermatoses (Inflammoscopy): an Up-To-Date Overview
Dermatology Practical & Conceptual Dermoscopy of Inflammatory Dermatoses (Inflammoscopy): An Up-to-Date Overview Enzo Errichetti1 1 Institute of Dermatology, Santa Maria della Misericordia University Hospital, Udine, Italy Key words: dermoscopy, differential diagnosis, general dermatology, inflammoscopy Citation: Errichetti E. Dermoscopy of inflammatory dermatoses (inflammoscopy): an up-to-date overview. Dermatol Pract Concept. 2019;9(3):169-180. DOI: https://doi.org/10.5826/dpc.0903a01 Accepted: June 2, 2019; Published: July 31, 2019 Copyright: ©2019 Errichetti. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: None. Competing interests: The author has no conflicts of interest to disclose. Authorship: The author takes responsibility for this publication. Corresponding author: Enzo Errichetti, MD, MSc, Institute of Dermatology, Santa Maria della Misericordia University Hospital, Piazzale Santa Maria della Misericordia, 15, 33100 Udine, Italy. Email: [email protected] ABSTRACT In addition to its use in pigmented and nonpigmented skin tumors, dermoscopy is gaining apprecia- tion in assisting the diagnosis of nonneoplastic diseases, especially inflammatory dermatoses (inflam- moscopy). In this field, dermoscopic examination should be considered as the second step of a “2-step procedure,” always preceded by the establishment of a differential diagnosis on the basis of clinical examination. In this paper, we sought to provide an up-to-date overview on the use of dermoscopy in common inflammatory dermatoses based on the available literature data. For practical purposes, the analyzed dermatoses are grouped according to the clinical presentation pattern, in line with the 2-step procedure principle: erythematous-desquamative and papulosquamous dermatoses, papulokeratotic dermatoses, erythematous facial dermatoses, sclero-atrophic dermatoses, and miscellaneous. -
Tacrolimus-Induced Tinea Incognito
Tacrolimus-Induced Tinea Incognito Narendra Siddaiah, MD; Capt Quenby Erickson, USAF, MC; Gea Miller, MD; Dirk M. Elston, MD Tacrolimus and pimecrolimus represent a new class of topical nonsteroidal medications cur- rently used in the treatment of a variety of inflam- matory skin lesions. We report the case of a patient in whom topical tacrolimus therapy resulted in widespread lesions of tinea incognito. This case shows that partial treatment of derma- tophytosis with griseofulvin may obscure the diagnosis. It also suggests that topical tacro- limus appears capable of inducing widespread dermatophytosis. The clinical appearance in this case was similar to tinea incognito induced by a topical corticosteroid. Cutis. 2004;73:237-238. he term tinea incognito is generally used to describe a dermatophytic infection whose T appearance is modified by the use of cortico- steroids.1 Steroids suppress local immunity, thus pro- moting fungal growth. Lesions often lack the degree of inflammation associated with tinea, and diagnosis is often delayed. Tacrolimus is 1 of 2 topical macrolide calcineurin inhibitors with potent immunomodula- Figure 1. Annular erythematous and scaly patches on tory activity approved in the treatment of atopic the face. dermatitis. We describe the case of a patient with wide- spread tinea incognito secondary to topical tacrolimus. One year before presentation, the child and his Case Report 4-year-old brother were treated with a 6-week course A 9-year-old black male child presented to the der- of griseofulvin 12.5 mg/kg per day for tinea capitis, matology clinic with large erythematous and scaly and his mother was treated with topical antifungal patches on his face, neck, and trunk (Figures 1 and agents for tinea corporis. -
Photo Diagnosis
Photo Diagnosis Illustrated quizzes on problems seen in everyday practice Case 1 An 11-year-old boy presents with pain over the left clavicle after falling from an eight-foot high ladder and landing on a outstretched left hand. Questions 1. What is the diagnosis? 2. What is the significance? Answers 1. Fractured left clavicle. 2. The majority of clavicular fractures heal spontaneously through callus formation. Immobilization of the affected arm for pain control can be easily and effectively accomplished by an arm sling. A figure-of-eight splint offers no advantage over the sling and can be uncomfortable for some children. Inappropriate use of the splint may occasionally even lead to edema of the ipsilateral upper limb, compression of axillary vessels and brachial plexopathy. Provided by Dr. Alexander K.C. Leung; and Dr. Justine H.S. Fong, Calgary, Alberta. Share your photos and diagnoses with us! Do you have a photo diagnosis? Send us your photo and a brief text explaining the presentation of the illness, your diagnosis and treatment, and receive $25 per item if it is published. The Canadian Journal of Diagnosis 955, boul. St. Jean, suite 306, Pointe-Claire (Quebec) H9R 5K3 E-mail: [email protected] Fax: (514) 695-8554 The Canadian Journal of Diagnosis / January 2005 47 Photo Diagnosis Case 2 A 32-year-old former soccer player presents with recurrent attacks of excruciating pain in the right first metatarsophalangeal joint. The attacks have been occurring for the past six months. Questions 1. What is the diagnosis? 2. What is the significance? 3. What is the treatment? Answers 1. -
Incidence and Biodiversity of Yeasts, Dermatophytes and Non
Journal de Mycologie Médicale (2017) 27, 166—179 Available online at ScienceDirect www.sciencedirect.com ORIGINAL ARTICLE/ARTICLE ORIGINAL Incidence and biodiversity of yeasts, dermatophytes and non-dermatophytes in superficial skin infections in Assiut, Egypt Incidence et biodiversite´ des levures, des dermatophytes, et non dermatophytes, agents de mycoses superficielles dans le gouvernorat d’Assiout — ´Egypte A.H. Moubasher, M.A. Abdel-Sater *, Z. Soliman Department of Botany and Microbiology, Faculty of Science, Assiut University Mycological Centre, Assiut University, Assiut, Egypt Received 1st October 2016; received in revised form 28 December 2016; accepted 11 January 2017 Available online 7 February 2017 KEYWORDS Summary Skin infections; Objective. — The aim was to identify the incidence of the causal agents from dermatophytes, Yeasts; non-dermatophytes and yeasts in Assiut Governorate employing, beside the morphological and Dermatophytic; physiological techniques, the genotypic ones. Non-dermatophytic; Patients. — Samples from infected nails, skin and hair were taken from 125 patients. PCR Materials and methods. — Patients who presented with onychomycosis, tinea capitis, tinea corporis, tinea cruris and tinea pedis during the period from February 2012 to October 2015 were clinically examined and diagnosed by dermatologists and were guided to Assiut University Mycological Centre for direct microscopic examination, culturing and identification. Results. — Onychomycosis was the most common infecting (64.8% of the cases) followed by tinea capitis (17.6%). Direct microscopic preparations showed only 45 positive cases, while 96 cases showed positive cultures. Infections were more frequent in females than males. Fifty-one fungal species and 1 variety were obtained. Yeasts were the main agents being cultured from 46.02% of total cases.