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Invisible or nearly invisible dermatopathologic diagnoses Hafeez Diwan, MD, PhD Baylor College of Medicine

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Page 1: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Invisible or nearly invisible dermatopathologic diagnoses

Hafeez Diwan, MD, PhDBaylor College of Medicine

Page 2: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Disclosures

Nothing to discloseNo conflicts of interest

Page 3: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Categorization of invisibility

Invisible because it is there but subtleInvisible because it is something else

Page 4: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Epidermis/Stratum corneum

Page 5: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 6: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 7: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 8: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Epidermis/Stratum Corneum

Fungus – Tinea

Page 9: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 10: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 11: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

SANDWICH SIGN

Page 12: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

PAS POSITIVE FUNGI

Page 13: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

44 year-old female with mole on right foot

Page 14: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 15: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 16: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 17: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 18: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 19: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 20: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 21: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 22: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 23: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Epidermis/Stratum Corneum

Fungus – TineaErythrasma – Corynebacterium minutissimumGranular parakeratosis

Page 24: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

HISTORY

The patient is 43-year-old pregnant female who presented with a few deeply pigmented macules on the left sole.

Page 25: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 26: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 27: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 28: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 29: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 30: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 31: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 32: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

ADDITIONAL HISTORYPatient had been tarring driveway with her husband but didn’t think she had been exposed to the material.

Page 33: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 34: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Epidermis/Stratum Corneum

Fungus – TineaErythrasma – Corynebacterium minutissimumGranular parakeratosisExogenous pigment

Page 35: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 36: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 37: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 38: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 39: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Epidermis/Stratum Corneum

Fungus – TineaErythrasma – Corynebacterium minutissimumGranular parakeratosisExogenous pigmentCD8-positive (hypopigmented) mycosis fungoides

Page 40: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Mid-back biopsy from a baby

Page 41: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 42: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 43: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 44: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 45: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

The quality of the keratin

Ichthyosis

Page 46: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Epidermis/Stratum corneum

Look carefullyIf you don’t see anything, do a GMS or PAS stainLook for the sandwich signLook at the granular layer (especially if the biopsy is from the axilla)Look at the quality of the keratin

Page 47: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 48: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 49: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 50: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Dermis

Lichen amyloid

Page 51: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 52: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 53: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 54: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 55: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Dermis

Lichen amyloidMacular amyloid

Page 56: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 57: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 58: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Dermis

Lichen amyloidUrticaria

Page 59: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 60: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 61: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Dermis

Lichen amyloidUrticariaUrticaria pigmentosa (mastocytosis)

Page 62: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 63: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 64: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 65: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 66: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 67: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 68: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Telangiectasia macularis eruptiva perstans (TMEP) – another mastocytosis

Stains for mast cells: Giemsa, Toluidine blue, CD117, mast cell tryptase

Page 69: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 70: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 71: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 72: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Dermis

Lichen amyloidUrticariaUrticaria pigmentosa (mastocytosis)Nodular amyloid

Page 73: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 74: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 75: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 76: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Dermis

Lichen amyloidUrticariaUrticaria pigmentosa (mastocytosis)Nodular amyloidNevus of Ota

Page 77: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 78: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 79: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 80: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 81: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Dermis

Lichen amyloidUrticariaUrticaria pigmentosa (mastocytosis)Nodular amyloidNevus of OtaScleredema

Page 82: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Scleredema

Diabetics, post-infectious, or ?blood dyscrasiaIll-defined plaquesHistology – square biopsy, edemaMucin stain may be helpful

Page 83: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 84: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 85: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 86: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 87: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 88: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Dermis

Lichen amyloidUrticariaUrticaria pigmentosa (mastocytosis)Nodular amyloidNevus of OtaScleredemaAnetoderma

Page 89: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 90: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 91: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 92: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 93: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 94: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Dermis

Lichen amyloidUrticariaUrticaria pigmentosa (mastocytosis)Nodular amyloidNevus of OtaScleredemaAnetodermaConnective tissue nevus

Page 95: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 96: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Dermis

Lichen amyloidUrticariaUrticaria pigmentosa (mastocytosis)Nodular amyloidNevus of OtaScleredemaAnetodermaConnective tissue nevus/White fibrous papulosis of neck

Page 97: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Invisible because it is something else

Page 98: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 99: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 100: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 101: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 102: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 103: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

CK7

Page 104: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Cam 5.2

Page 105: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Extramammary Paget disease

Page 106: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 107: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

“Dark” Paget’s

Page 108: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 109: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 110: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 111: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Metastatic renal cell carcinoma

Page 112: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Keratin

Page 113: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 114: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 115: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 116: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 117: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 118: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 119: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 120: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 121: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 122: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Leishmaniasis mimicking squamous cell carcinoma

Page 123: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 124: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 125: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 126: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 127: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Kaposi sarcoma mimicking dermatofibroma

Page 128: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 129: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 130: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 131: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 132: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 133: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 134: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 135: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 136: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 137: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 138: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 139: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

Kaposi sarcoma mimicking stasis

Page 140: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

HISTORY

38 year-old female with lesions on tongue, foot and hands.Clinical impression: Lichen planus

Page 141: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 142: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 143: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 144: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 145: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 146: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 147: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look
Page 148: Invisible or nearly invisible dermatopathologic diagnoses...Epidermis/Stratum corneum Look carefully If you don’t see anything, do a GMS or PAS stain Look for the sandwich sign Look

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