Tumors and Tumorlike

Conditions of the Skin

compiled by: ODI

 Seborrheic keratosis
with mild pigmentation
in the skin of a
senior pathologist.
Pseudohorny cysts are
evident.

compiled by: ODI

 Actinic Keratosis. Note
the hyperparakeratosis,
moderate malpighian
atypia, and dermal
inflammatory infiltrate.

compiled by: ODI

 Clinical Appearance of Bowen
Disease. A slightly elevated
red patch of irregular contours is
seen. This clinical appearance
conforms
to the syndrome originally
described by Bowen.

compiled by: ODI

 Microscopic Appearance
of Bowen Disease. The
atypia involves the full
thickness of the
epithelium. This example
also has focal
clear cell change.

compiled by: ODI

 Squamous Cell Carcinoma.
A, Tumor of the face with rolled
edges and depressed center.
B, Tumor of the leg with exophytic
appearance.

compiled by: ODI

 Deeply invasive,
well-
differentiated
squamous cell
carcinoma.

compiled by: ODI

 Squamous cell
carcinoma with
spindle
metaplastic
features.

compiled by: ODI

 Adenoid
(acantholytic)
squamous cell
carcinoma, resulting
in a pseudoglandular
appearance.

compiled by: ODI

 Verrucous
Carcinoma of Skin.
A, Typical
appearance of
lesion located in
sole of foot.
B, Papillomatous
growth associated
with hyperkeratosis
and pushing type of
invasion into the
underlying
dermis.
compiled by: ODI
Pseudoepitheliomatous hyperplasia following removal of a
benign nevus
compiled by: ODI
 Gross appearance of
basal cell carcinoma of
forehead. The
lesion is nodular and
pigmented.

compiled by: ODI

 Multiple basal cell
carcinomas in the
skin of the back of an
elderly patient.

compiled by: ODI

Typical nodular
appearance with
peripheral palisading of
cutaneous basal cell
carcinoma.

compiled by: ODI

 A and B, Clinical and
microscopic appearance
of pigmented
basal cell carcinoma.
Melanin is largely present
in macrophages located
in the stroma between
tumor lobules.

compiled by: ODI

 Highly organoid
appearance of
fibroepithelioma
of Pinkus.

compiled by: ODI

A and B, Low- and high-power
views of lymphoepithelioma-like
carcinoma.

compiled by: ODI

 Eccrine Poroma. The
tumor characteristically
grows in the form of
cords and nests of small
tumor cells attached to
the epidermis.

compiled by: ODI

 Hidradenoma. The lesion is
lobulated and shows a
prominent
clear cell component.

compiled by: ODI

 Syringoma. Small
glandular structures
with little “tails” are
typical of this entity.

compiled by: ODI

 Myoepithelioma of skin
consistent with sweat gland
origin. The tumor cells have
a typical hyaline cytoplasm.

compiled by: ODI

 Eccrine Dermal
Cylindroma.
Compact nests of
tumor
cells surrounded by
thick basement
membrane.

compiled by: ODI

 Eccrine Spiradenoma.
The lesion is highly
cellular and infiltrated
by lymphocytes.

compiled by: ODI

Clinical appearance of
multiple dermal eccrine
cylindroma
extensively involving the
scalp and other sites of the
head and neck.
This is sometimes referred
to as turban tumor.

compiled by: ODI

Clinical appearance of eccrine
spiradenoma of the knee
associated with a prominent
vascular component that
resulted in a
hemangioma-like appearance
clinically.

compiled by: ODI

 Aggressive Digital Papillary Adenocarcinoma.
A, Primary tumor with areas of back to back
glands as well as papillary areas.

B, Metastatic tumor involving a

lymph node.

compiled by: ODI

 Gross appearance of
resected specimen of sweat
gland carcinoma of the
axilla. The tumor grows in a
multinodular fashion and
shows several areas of
ulceration.

compiled by: ODI

 Typical
branching
configuration of
sweat gland
carcinoma.

compiled by: ODI

A and B, Sweat gland carcinoma of
myoepithelial type located in the toe.

compiled by: ODI

 A and B,
Microcystic
adnexal carcinoma
composed of nests
of keratinocytes in
a whorling
pattern. This
tumor was located
in skin of upper lip
in a 28-year-old
woman.

compiled by: ODI

 Microcystic adnexal
carcinoma.

compiled by: ODI

 Extramammary Paget Disease
of the Skin. A, The tumor
consists of intraepidermal
collections of neoplastic cells
with small hyperchromatic
nuclei and relatively abundant
cytoplasm. The tumor cells
typically spare the basal layer.

compiled by: ODI

 Extramammary Paget
disease
immunostained for
epithelial membrane
antigen.

compiled by: ODI

 Clear Cell Papulosis of
Skin. Large clear cells
arranged singly or in
small clusters are seen
in the basal portions of
the epidermis.

compiled by: ODI

Nevus Sebaceus of Jadassohn.
A, Gross appearance. B,
Microscopic appearance,
showing Epidermal
papillomatous hyperplasia and
increased number of sebaceous
glands.
compiled by: ODI
Sebaceous Adenoma. The tumor has a
distinctly lobular architecture. The light and
dark areas correspond to well-differentiated
sebaceous cells and generative cells,
respectively.

compiled by: ODI

 Sebaceous
Carcinoma. The
tumor is composed
of an increased
number of atypical
basaloid cells with
some cells exhibiting
evident sebaceous
differentiation.

compiled by: ODI

 Inverted Follicular
Keratosis. There are
numerous “keratotic
eddies.”

compiled by: ODI

 Organoid pattern in
trichoepithelioma with
islands of basaloid
cells surrounded by a
fibroblastic stroma. Focal
papillary mesenchymal
bodies are present.

compiled by: ODI

 Trichoblastoma. This
tumor is morphologically
similar to
trichoepithelioma and is
composed of islands of
basaloid epithelium
surrounded by a
fibroblastic stroma.

compiled by: ODI

 Desmoplastic
Trichoepithelioma.
This benign tumor is
not to be confused
with basal cell
carcinoma.

compiled by: ODI

 Trichilemmoma. The
tumor presents as an
endophytic lobular growth
of glycogen-rich clear cells.

compiled by: ODI

 highly organoid pattern of
trichofolliculoma.

compiled by: ODI

 Clinical appearance of
keratoacanthoma.

compiled by: ODI

 Low-power appearance of
keratoacanthoma

compiled by: ODI

 Keratinous cyst of
epidermal type
with secondary
inflammation.

compiled by: ODI

Gross appearance of keratinous cyst of
trichilemmal type.
Grumous material composed of pilar-type
keratin occupies the lumen.

compiled by: ODI

Keratinous cyst of pilar type showing
trichilemmal pattern
of keratinization.

compiled by: ODI

 Warty Dyskeratoma.
There is an inverted
proliferation of
keratinocytes with
prominent
acantholysis.

compiled by: ODI

 Cut surface of a
proliferating pilar tumor.
It has a multinodular
appearance, with both
an exophytic and an
endophytic component.

compiled by: ODI

 Low-power
appearance of
proliferating pilar
tumor. The
lobulated contour is
characteristic.

compiled by: ODI

 Gross appearance of
pilomatrixoma.

compiled by: ODI

 Microscopic Appearance of
Pilomatrixoma. The basal
cells keratinize as does cortex of
hair (without granular layer) and
produce “ghost” cells.

compiled by: ODI

 Typical Junctional
Nevus. Two large
theques of
melanocytes expand
the basal layer of the
epidermis.

compiled by: ODI

 Blue Nevus of the
Ordinary Type. The
cells are
spindleshaped and
heavily pigmented.

compiled by: ODI

 Large Cellular Blue Nevus.
A, A distinct nesting
pattern is present, with
most of the melanin
being located in
macrophages situated in
the intervening stroma. B,
Numerous oval to spindle
tumor
cells with indistinct
nucleoli. There is no
mitotic activity.

compiled by: ODI

 Spitz Nevus of Spindle Cell Type.
This example is predominantly
junctional in location.

compiled by: ODI

 A and B, Spitz
nevus of
epithelioid type.
The tumor cells
feature large
size, polygonal
shape,
occasional
multinucleation,
and a strongly
eosinophilic
cytoplasm.

compiled by: ODI

 Reed Nevus. The tumor
is heavily pigmented, in
contrast to the usual
type of Spitz nevus

compiled by: ODI

 Spitz nevus of the
spindle cell type that is
predominantly
intradermal.

compiled by: ODI

 Congenital nevus with central
hyperpigmented area. This
corresponded microscopically to
a pagetoid intraepidermal
proliferation of melanocytes.

compiled by: ODI

 Vascular
involvement in
congenital nevus.
This is not a sign
of malignancy.

compiled by: ODI

 A and B, Clinical
appearance of
dysplastic nevi in
patient with the
dysplastic nevus
syndrome.
These nevi are large,
have an irregular
outline, and feature a
variegated
appearance.

compiled by: ODI

 A and B, So-called
dysplastic nevus.
There is dermal
fibrosis,
inflammation, and
a proliferation
of melanocytes at
the
dermoepidermal
junction, with
bridging of rete
ridges.

compiled by: ODI

 Typical Clinical Appearance of
Halo Nevus. Heavily
pigmented center is
surrounded by sharply defined
oval area of depigmentation.
Pigmented nevus may be
situated in center, as here, or
be eccentric.

compiled by: ODI

 Halo Nevus. The low-power
view is that of an inflammatory
dermal nodule.

compiled by: ODI

 Balloon Cell Nevus. The
tumor cells are arranged in
nests and have a voluminous
pale cytoplasm.

compiled by: ODI

 Halo Nevus. High-
power view showing
residual melanocytes
amid a heavy
inflammatory infiltrate

compiled by: ODI

 Recurrent Nevus
Following Shave Excision.
There is an irregular
proliferation of
melanocytes along the
dermoepidermal junction,
associated with some
dermal fibrosis and
clusters of melanin-laden
macrophages. This lesion
should not be
overdiagnosed as
malignant
melanoma.
compiled by: ODI
 So-Called Lentigo
Maligna. The atypical
melanocytes are
present along the
basal layer individually
and in theques.

compiled by: ODI

 A, Pagetoid
appearance of
melanocytes in
superficially
spreading
malignant
melanoma.

compiled by: ODI

 B, Malignant
melanoma showing
transepidermal
migration. There is
also individual necrosis
of neoplastic
melanocytes. Some of
the melanin has
reached the horny
layer

compiled by: ODI

 Clinical appearance of
melanoma of
superficially spreading
type. The nodular light
area corresponds to a
focus of amelanotic
malignant
melanoma featuring
deep dermal invasion.

compiled by: ODI

 Malignant melanoma
in the region of the
Achilles tendon
showing prominent
spindling. This is a
common finding in
tumors at this
site.

compiled by: ODI

 Prominent
trabecular
pattern of growth
in melanoma.

compiled by: ODI

 Melanoma
containing highly
anaplastic tumor
cells.

compiled by: ODI

 Malignant Melanoma
With Nevoid Pattern of
Growth. A, Low-power
view showing a
polypoid configuration
suggestive of a benign
intradermal nevus. B,
High-power view showing
only minimal
atypicality of the tumor
cells. This tumor recurred
locally and eventually
metastasized to regional
lymph
nodes.
compiled by: ODI
 Myxoid Changes in
Malignant
Melanoma. This
secondary
alteration is more
common at
metastatic sites but
can also be seen in
the primary lesion.

compiled by: ODI

 Desmoplastic Malignant
Melanoma. The spindle
cells
have a deceptively bland
appearance. The
collections of
lymphocytes
are a characteristic
feature.

compiled by: ODI

 Malignant
melanoma of
skin
immunostained
for S-100
protein. Strong
nuclear and
cytoplasmic
reactivity is
present

compiled by: ODI

 HMB-45
immunoreactivi
ty in melanoma.

compiled by: ODI

 Area of Regression in
Malignant Melanoma.
There is
extensive dermal fibrosis,
epidermal atrophy,
numerous dermal
melanophages,
and dyskeratotic cells in
the dermoepidermal
junction. Viable
tumor was present in
other areas.

compiled by: ODI

 Metastatic malignant
melanoma with
secondary epidermal
involvement.

compiled by: ODI

 Isolated
melanoma cells in
sentinel lymph
node,
demonstrated
with HMB-45
immunostain.

compiled by: ODI

 Microscopic
Appearance of
Solar Lentigo.
There is
elongation of rete
ridges associated
with
hyperpigmentatio
n of the basal
layer.

compiled by: ODI

 Merkel Cell Carcinoma.
This unfortunate patient
had
involvement of almost the
entire face by an
extensively ulcerated
neoplasm
that failed to respond with
chemotherapy after an
initial diagnosis of
malignant lymphoma.

compiled by: ODI

 Merkel Cell
Carcinoma
Involving the
Hand. This
particular
lesion was
associated with
Bowen disease of
the overlying
epidermis.

compiled by: ODI

 Medium-power
view of Merkel
cell carcinoma.

Note the finely granular, dusty

quality of the chromatin and
the small
nucleoli.

compiled by: ODI

 Merkel cell
carcinoma
showing marked
degree of
epidermotropism.

compiled by: ODI

 Dot-like
immunoreactivity
for keratin in
Merkel cell
carcinoma.

compiled by: ODI

 Gross
appearance of
keloid of ear.
The lesion has a
polypoid
shape.

compiled by: ODI

 Pleomorphic
Fibroma. A large
triangular cell with
hyperchromatic
nuclei is encased
within dense
fibrous tissue.

compiled by: ODI

 Microscopic
appearance of
keloid, with
characteristic wide
bands of
hyalinized collagen.

compiled by: ODI

Benign Fibrous Histiocytoma of Skin. The tumor depicted in A
is predominantly fibrous, whereas that shown in B is mainly
composed of hemosiderin-laden macrophages.
compiled by: ODI
 Benign Fibrous
Histiocytoma. This
lesion is associated
with basaloid
proliferation of the
overlying skin. This
change does not
represent a basal
cell carcinoma.

compiled by: ODI

Aneurysmal Fibrous Histiocytoma. A, Low-power
appearance. The empty space in the center of the lesion
was occupied by blood. B, Higher-power view, showing
recent and old hemorrhage.
compiled by: ODI
 Epithelioid
fibrous
histiocytoma.

compiled by: ODI

 Clinical appearance of
atypical fibroxanthoma.
The lesion is
characteristically
elevated, reddish, and
ulcerated.

compiled by: ODI

 Low-power
view of atypical
fibroxanthoma.
The lesion is
typically
polypoid and
ulcerated.

compiled by: ODI

A and B, High-power views of atypical fibroxanthoma,
showing highly anaplastic cells in the dermis
surrounded by an inflammatory infiltrate.
compiled by: ODI
 ross appearance of
dermatofibrosarco
ma protuberans,
showing typical
bulging above the
skin.

compiled by: ODI

 Fibrosarcomatous
area in a
dermatofibrosarcom
a protuberans.
A storiform pattern
of growth is no
longer evident in this
component.

compiled by: ODI

 Storiform or cartwheel
pattern of
dermatofibrosarcoma
protuberans.

compiled by: ODI

 Typical pattern of
invasion of
subcutaneous fat by
dermatofibrosarcoma
protuberans.

compiled by: ODI

 Pigmented
dermatofibrosar
coma
protuberans
(Bednar
tumor).

compiled by: ODI

 Cutaneous
xanthoma
showing ill-defined
collection of
foamy
macrophages in
the dermis.

compiled by: ODI

 Juvenile
Xanthogranuloma.
Scattered
multinucleated
histiocytes are seen
among numerous
mononuclear
elements.

compiled by: ODI

 A spectacular
Touton giant
cell in a case of
juvenile
xanthogranulo
ma.

compiled by: ODI

 Clinical Appearance of
Rosai–Dorfman Disease of
the
Skin. In this case the lesion
presented in the form of
multiple elevated
erythematous nodules.

compiled by: ODI

 Microscopic Appearance of
Cutaneous Rosai–Dorfman
Disease. A polymorphic
infiltrate composed of
lymphocytes, plasma
cells, and histiocytes is present.
As is often the case in
extranodal lesions,
there is a moderate degree of
fibrosis.

compiled by: ODI

 Dermal Nerve
Sheath Myxoma.
The tumor is
characterized
by bland spindled
cells arranged in
discrete myxoid
nodules separated
by fibrous septae.

compiled by: ODI

 Cellular
Neurothekeoma.
The tumor cells
are arranged
in compact nests.

compiled by: ODI

 Cutaneous
Perineurioma. The
very elongated shape
of the tumor cells
and the whorling
arrangement are
typical features of
this
benign peripheral
nerve sheath tumor.

compiled by: ODI

 Palisaded
Encapsulated
Neuroma. The
fascicular
pattern
is well
developed. This
lesion should
not be confused
with leiomyoma
of skin.

compiled by: ODI

compiled by: ODI
 A, Clinical appearance of
infantile hemangioma
(benign
hemangioendothelioma).
B, Benign
hemangioendothelioma.
Note marked
hypercellularity and lobular
configuration. C, Cavernous
hemangioma of skin.
Vessels are markedly
dilated and result in
elevation of the overlying
atrophic epidermis.
compiled by: ODI
 Arteriovenous
Hemangioma.
Large vessels
with arterial,
venous, and
hybrid features
occupy the
dermis.

compiled by: ODI

 Microvenular
Hemangioma. The
vessels, which
contain
a muscle wall, are
widely scattered in
between the dermal
collagen fibers

compiled by: ODI

 lomeruloid
hemangioma in a
patient with
POEMS syndrome.
Microscopic
appearance of the
individual lesions
is reminiscent
of renal glomeruli.

compiled by: ODI

 Hobnail
Hemangioma.
The endothelial
cells protrude
intothe vessel
lumina.

compiled by: ODI

 Clinical
appearance of
typical
pyogenic
granuloma.

compiled by: ODI

 Superficial
Lymphangioma of
Skin. Cystically
dilated
vascular spaces
are lined by
flattened
endothelial cells.

compiled by: ODI

 Low-power
microscopic
view of typical
pyogenic
granuloma.

compiled by: ODI

 Epithelioid hemangioma
is benign cutaneous
vascular
tumor largely composed
of vessels lined by
epithelioid endothelial
cells.
An associated infiltrate of
eosinophils and
lymphocytes is usually
present.

compiled by: ODI

 So-Called
Capillary or
Vascular Lobule.
This formation
is almost always
an indicator of a
benign process.

compiled by: ODI

Clinical Appearance of Kaposi Sarcoma. A, Diffuse
violaceous lesions in skin of foot and ankle. This is the most common
location of the classic form. B, Early lesion of Kaposi sarcoma in an HIV-
infected patient. compiled by: ODI
 Low-power view of a
lesion of Kaposi
sarcoma having a
prominent polypoid
shape that simulates
pyogenic granuloma.

compiled by: ODI

 Microscopic
Appearance of
Kaposi Sarcoma.
Elongated
spindle cells
showing minimal
atypia are separated
by slits containing
red blood cells.

compiled by: ODI

 Early changes of
Kaposi sarcoma,
manifested by
vascular
proliferation in
the dermis. These
changes often
center around skin
adnexae.

compiled by: ODI

 Immunoreactivity
for HHV8 latent
nuclear antigen.

compiled by: ODI

 Kaposiform
Hemangioendoth
elioma in an Infant.
The lesion is
composed of
uniform spindled
cells arranged in
fascicles. There
are no hyaline
bodies and the
tumor cells are
negative for HHV8.

compiled by: ODI

 Bacillary Angiomatosis.
A, Note epithelioid
appearance of the
endothelial cells in the
proliferating vessels
and neutrophilic
infiltrate with marked
karyorrhexis. B, An
amphophilic granular
material
is seen in the stroma,
due to the
accumulation of
myriads of
microorganisms.
compiled by: ODI
Angiosarcoma of Skin. A, Dissection of dermal collagen fibers by neoplastic vessels.
B, Freely anastomosing vessels lined by atypical cells. C, Papillary projections.
compiled by: ODI
 Cutaneous
Lymphoid
Hyperplasia. Note
the numerous
hyperplastic
vessels with plump
endothelial cells.

compiled by: ODI

A, In this case of cutaneous lymphoid hyperplasia, there are distinct reactive
germinal centers with a polarized appearance surrounded by a reactive proliferation
of T-cells. B, The reactive germinal centers contain tingible body macrophages.
compiled by: ODI
 Marginal Zone
B-Cell
Lymphoma of
Skin. There is a
proliferation of
neoplastic
monocytoid
tumor cells
colonizing a
germinal
center.

compiled by: ODI

 Malignant
Lymphoma of
Skin. The lesion
appears in the
form of
markedly
erythematous
nodules on the
face.

compiled by: ODI

 Panoramic view of
follicular
lymphoma of the
skin, showing
its deep location,
nodular
architecture, and
sparing of papillary
dermis
and epidermis.

compiled by: ODI

 Clinical
appearance of
mycosis
fungoides
showing
infiltrative
plaques over
virtually entire
body.

compiled by: ODI

 Epidermotropism
of neoplastic
lymphoid cells in
mycosis
fungoides.

compiled by: ODI

 So-called
Pautrier
microabscess in
mycosis
fungoides.

compiled by: ODI

 High-power view
of mycosis
fungoides cell,
showing marked
nuclear
irregularities.

compiled by: ODI

 Clinical
Appearance of
Lymphomatoid
Papulosis.
Multiple lesions
are present, the
larger ones
showing
ulceration.

compiled by: ODI

 Low-power
view of
lymphomatoid
papulosis
showing heavy
dermal infiltrate
with epidermal
thinning.

compiled by: ODI

 Lymphomatoid
Papulosis Type
A. High-power
view,
showing large
atypical
lymphoid cells
admixed with
eosinophils.

compiled by: ODI

 Panniculitis-
Like T-Cell
Lymphoma.
Note the
rimming
of individual
melanocytes by
atypical
lymphoid cells.

compiled by: ODI

 Angiotropic
Malignant
Lymphoma. The
dermal vessels
are packed with
malignant
lymphoid cells.

compiled by: ODI

 Hamartoma of the
Scalp With Ectopic
Meningothelial
Elements. A,
Meningothelial cells
are present in the
deep dermis, some of
them arranged in
clusters and others
individually among
collagen
fibers. B, Positive
immunostain for
epithelial membrane
antigen (EMA).
compiled by: ODI
 Squamous cell
carcinoma of
uterine cervix
metastatic to
skin of arm.

compiled by: ODI

 Metastatic
Adenocarcinoma
of Breast to Skin.
The tumor cells
are filling the
vascular
lumen of a dermal
lymphatic vessel.

compiled by: ODI