Introduction:
Eosinophilic material deposited subepidermally is found in macular amyloidosis and lichen amyloidosus; derived from epidermal keratin. Nodular amyloidosis is associated with immunoglobulin light chains, secondary amyloidosis with acute phase C protein from the serum.
Histology:
Amyloidosis of the skin is characterised by accumulation of eosinophilic, amorphous material (optical microscopy) subepidermally, within the papillary dermis. Usually focal degeneration of keratinocytes in the basal layer is present as well (amyloid is formed by keratin filaments from apoptotic keratinocytes).
In macular amyloidosis the amount of amyloid is low and epidermal reaction is not prominent. In lichen amyloidosus there is hyperkeratosis and acanthosis.
In nodular amyloidosis the light chains of immunoglobulins are accumulated.
In systemic (secondary) amyloidosis the amyloid accumulates within the walls of blood vessels.
Special stains are used for amyloid staining: congo red (brick red in transmitted light, polarisation, fluorescence); thioflavins (fluorescence); in nodular amyloidosis antibodies against light chains may be positive.
Pictures
Amyloidosis:
Amyloidosis, HE 10x (165)
Staining with congo red:
Amyloidosis, Congo red 10x (166)
Detail:
Amyloidosis, HE 40x (167)
Fluorescence, anti-IgG:
Amyloidosis macular, anti-IgG, FITC, Evans 40x (485)
Fluorescence, Thioflavin S:
Amyloidosis macular, Thioflavin S 40x (486)
Amyloidosis, Thioflavin S 20x (1902)
Amyloidosis, thioflavin T 40x (1904)
Macular amyloidosis:
Amyloidosis macular, HE 20x (4394)
Macular amyloidosis, HE and special staining:
Amyloidosis, macular, HE 20x (1179)
Amyloidosis, macular, Pagoda 20x (1180)
Macular amyloidosis, larger deposits:
Amyloidosis, HE 10x (1181)
Amyloidosis, HE 40x (1182)
Amyloidosis, Pagoda 10x (1183)
Amyloidosis, Pagoda 40x (1184)
Lichen amyloidosis:
Amyloidosis lichenoid, HE 10x (1399)
Amyloidosis lichenoid, Pagoda 10x (1400)
Lichen amyloidosus:
Lichen amyloidosus, HE 60x (10683)
Macular amyloidosis:
Amyloidosis macular, HE 40x (2264)
Nodular amyloidosis of the penis:
Amyloidosis nodular, Congo red 40x (4049)
Nodular amyloidosis:
Amyloidosis nodular, HE 20x (5080) [zoomify]
Amyloidosis:
Amyloidosis nodular, HE 60x (10985)
Amyloidosis nodular, Congo red 60x (10986)
Systemic amyloidosis (large deposits):
Amyloidosis systemic, HE 20x (5082) [zoomify]
Post-friction amyloidosis:
Amyloidosis macular, HE 40x (4793) [zoomify]
Amyloidosis macular, Pagoda 40x (4794) [zoomify]
Generalized acquired amyloidosis:
Acquired general amyloidosis of the skin, HE 60x (6243)
Pictures
Secondary (systemic] amyloidosis
Systemic amyloidosis, HE 10x (1185)
Systemic amyloidosis, Pagoda 10x (1186)
Introduction:
There are 6 types of cutanous mucinosis (generalized myxedema of hypothyreoidism, pretibial myxedema in thyreotoxicosis, lichen myxedematosus , reticular erythematous mucinosis, self-healing juvenile cutaneous mucinosis, scleredema). Mucin is accumulated in some tumors as well (myxoma).
Skleromyxedema is characterized by fibroblastic proliferation within the areas with mucin deposits.
Clinical signs:
Histology:
The increase in dermal mucin is inconspicuous.
Pictures
Myxedema (thyroid hypofunction):
Myxedema, HE 40x (4030)
Myxedema, alcian blue 40x (4028)
Myxedema, Halle 40x (4029)
Another case:
Myxedema, HE 20x (5212)
Myxedema, HE 20x (5213)
Myxedema, HE 20x (5204)
Clinical signs:
Pictures
Pretibial myxedema, larger nodules:
Pretibial myxedema, CLINIC (840)
Histology:
Large amounts of mucin in the dermis:
Pictures
Pretibial myxedema:
Pretibial myxedema, HE 5x (456)
Stained with alcian blue:
Pretibial myxedema, alcian blue 5x (455)
Pretibial myxedema, alcian blue 40x (454)
Another case:
Pretibial myxedema, HE 20x (2538)
Pretibial myxedema, alcian blue 20x (2536)
Pretibial myxedema, Halle 20x (2537)
Another case:
Pretibial myxedema, HE 20x (4952) [zoomify]
Pretibial myxedema, alcian blue 20x (4951) [zoomify]
Another case:
Pretibial myxedema, HE 60x (10717)
Introduction:
Pretibial myxedema is observed in patients treated for thyroid gland hyperfunction. The patients are usually euthyroid at the time of the occurrence of myxedema. Excessive thyroid stimulating hormone (TSH) probably stimulates fibroblasts of the lower extremities. Mucinous deposits are formed predominantly by hyaluronic acid and chondroitin sulphate.
Although the shins are the most common site, the deposits can occur on the arms, neck, in the scars, etc.
History:
33-year-old man presented with tough nodules on the anterior aspects of lower legs of 2 months duration. The last year he was treated for thyreotoxicosis by levothyroxium, thiamazolum and bisoprolol and he was preparing for thyroid gland surgery. Further he had exophthalmia and strabismus since childhood (after meningitis) and hepatopathy.
Clinical signs:
Bilaterally on the anterior aspects of the lower legs asymptomatic pink or skin colored tough nodules 2 – 4 cm in diameter, slightly elevated.
Mild edema of the lower legs, excoriations and hyperpigmentations
Palpable enlarged thyroid gland, exophthalmia.
Pictures
Pretibial myxedema:
Pretibial myxedema, CLINIC (6157)
Histology:
Dermis is thickened with mucin deposits (alcian blue strongly positive), collagen fibres are widely separated by mucin. No inflammation.
Pictures
Pretibial myxedema, HE and alcian blue:
Myxedema, pretibial in thyreotoxicosis, HE 40x (6104)
Myxedema, pretibial in thyreotoxicosis, alcian blue 40x (6103)
Clinical signs:
Histology:
Slight lymfohistiocytic infiltrate; intradermal deposits of mucin, sometimes inconspicuous.
Pictures
Stained with HE, alcian blue and colloid iron (Halle):
Reticular erythematous mucinosis, HE 10x (604)
Reticular erythematous mucinosis, alcian blue 10x (605)
Reticular erythematous mucinosis, Halle 10x (606)
Reticular erythematous mucinosis, HE 40x (607)
Reticular erythematous mucinosis, alcian blue 40x (608)
Reticular erythematous mucinosis, Halle 40x (609)
Another case:
Reticular erythematous mucinosis, HE 5x (1471)
Reticular erythematous mucinosis, HE 20x (1470)
Another case:
Reticular erythematous mucinosis, HE 20x (2123)
Reticular erythematous mucinosis, HE 40x (2124)
Another case:
Reticular erythematous mucinosis, HE 40x (5988)
Reticular erythematous mucinosis, alcian blue 40x (5987)
Another case:
Reticular erythematous mucinosis, REM, HE 20x (5281)
Reticular erythematous mucinosis, REM, HE 20x (5257)
Reticular erythematous mucinosis, HE 10x (1662)
Reticular erythematous mucinosis, alcian blue 10x (1660)
Reticular erythematous mucinosis, HE 40x (1663)
Reticular erythematous mucinosis, alcian blue 40x (1661)
Another case:
Reticular erythematous mucinosis, REM, HE 20x (4594) [zoomify]
Reticular erythematous mucinosis, REM, HE 20x (4593) [zoomify]
Another case:
Reticular erythematous mucinosis, REM, HE 60x (10720)
Clinical signs:
Histology:
Prominent accumulation of dermal mucin, plump stellate fibroblasts.
Pictures
Papular mucinosis:
Papular mucinosis, HE 40x (3126)
Papular mucinosis, alcian blue 40x (3125)
Another case:
Papular mucinosis, HE 20x (5223)
Papular mucinosis, alcian blue 20x (5224)
Papular mucinosis, HE 20x (5203)
Papular mucinosis, HE 2.5x (1556)
Papular mucinosis, HE 20x (1555)
Papular mucinosis, alcian blue 10x (1554)
Another case:
Focal mucinosis, HE 20x (4858) [zoomify]
Focal mucinosis, alcian blue 20x (4857) [zoomify]
Lichen myxedematosus:
Lichen myxedematosus, HE 20x (4756)
Lichen myxedematosus, alcian blue 20x (4754) [zoomify]
Clinical signs:
Pictures
Scleredema adultorum
Scleroderma, CLINIC (1080)
Histology:
Epidermis is usually thinned. Prominent deposits of mucin in the upper part of the dermis accompanied by widespread proliferation of fibroblasts.
Pictures
Scleromyxedema:
Scleromyxedema, HE 40x (2323)
Scleromyxedema, Halle 40x (2322)
Scleromyxedema, alcian blue 40x (2321)
Another case:
Scleromyxedema, HE 20x (4598) [zoomify]
Scleromyxedema, alcian blue 20x (4597)
Scleromyxedema, HE 20x (4600) [zoomify]
Scleromyxedema, alcian blue 20x (4599)
Scleromyxedema:
Scleromyxedema, HE 60x (12530)
Scleromyxedema, Halle 60x (12529)
Clinical signs:
Histology:
Localized accumulation of mucin within the reticular dermis, accompanied with some proliferation of fibroblasts; epidermis is flattened or normal; small cysts are sometimes present.
Clinical signs:
Histology:
Myxoid variant near the nail (fibroblasts, mucin), ganglionic variant with connective tissue wall, often communicates with the distal interphalangeal joint.
Pictures
Myxoid cyst (myxoid type):
Myxoid cyst, HE 60x (14059)
Introduction:
Deposits of calcium in dermatomyositis is mentioned in the chapter on dermatomyositis.
Pictures
Subepidermal calcifying nodule:
Subepidermal calcifying nodule, HE 5x (399)
Subepidermal calcifying nodule, HE 5x (400)
Subepidermal calcifying nodule, HE 10x (396)
Subepidermal calcifying nodule, HE 20x (397)
Subepidermal calcifying nodule, HE 40x (398)
Sometimes roundish, homogenous nodules are present, often with foreign
body reaction:
Subepidermal calcifying nodule, compact, HE 5x (179)
Subepidermal calcifying nodule, compact, HE 10x (177)
Subepidermal calcifying nodule, compact, HE 40x (178)
Calcifying nodule:
Calcified nodule, HE 20x (13986)
Calcinosis cutis:
Calcinosis cutis, HE 20x (4120)
Calcinosis cutis:
Calcinosis cutis, HE 60x (10649)
Idiopathic cutaneous calcinosis:
Calcinosis cutis, HE 40x (12342)
Calcifying epidermal cysts of the vagina:
Calcificating cysts of the vagina, HE 40x (6205)
Clinical signs:
Histology:
Multiple, roundish calcium deposits, foreign body reaction.
Pictures
Calcinosis scroti:
Subepidermal calcifying nodule, HE 5x (2106)
Subepidermal calcifying nodule, HE 20x (2105)
Calcinosis scroti, HE 40x (2097)
Idiopathic calcinosis of the scrotum:
Idiopathic scrotal calcinosis, HE 20x (4674) [zoomify]
Clinical signs:
Histology:
Deposits of calcium in the dermis, often with foreign body type reaction.
Pictures
Tumoriform calcinosis, lesion of the neck, 6×10 cm:
Calcinosis cutis, tumoriform, HE 10x (6038)
Clinical signs:
Histology:
Calcium deposits within the walls of blood vessels.
Pictures
Calciphylaxis:
Calciphylaxis, HE 40x (2221)
Special staining for calcium (von Kossa):
Calciphylaxis, Kossa 40x (2222)
Histology:
Large masses of calcium deposits with foreign body reaction.
Pictures
Calcifying nodules and plaques of a child, located on the back,
with white or yellowish discharge:
Dystrofic dermal calcifications, HE 20x (2663)
Dystrofic dermal calcifications, HE 40x (2664)
Clinical signs:
Histology:
Small, roundish intradermal tumors of regular, lamellar bone; usually with fat bone marrow. Sometimes osteoblasts and osteoclasts are present.
Pictures
Osteoma of the skin:
Osteoma, HE 20x (4092)
Osteoma of the skin:
Cutaneous osteoma, HE 60x (10706)
Cutaneous osteoma, HE 60x (10707)
Osteoma of the skin:
Osteoma, HE 20x (13904)
Clinical signs:
Pictures
Progressive osseous heteroplasia, child:
Progressive osseous heteroplasia, CLINIC (4046)
Progressive osseous heteroplasia, CLINIC (4047)
Histology:
Deposits of calcium and osteomas within the dermis.
Pictures
Progressive osseous heteroplasia:
Progressive osseous heteroplasia, HE 20x (2730)
Plate-like osteoma cutis:
Plate-like osteoma cutis, HE 60x (12836)
Introduction:
Herogenous group of diseases characterized by increased level of uratic acid in the blood, caused by overproduction of purines, increased catabolism of nucleic acids, decreased excretion of uric acid (idiopathic gout, about 80%) or decreased degradation of purines.
Clinical signs:
Histology:
Epidermis normal or ulcerated. Usually large deposits of amorphous, amphophilic or slightly basophilic material with parallel, needle shaped clefts within the dermis and subcutis. Lymphohistiocytic infiltrate, often with granulomatous foreign-body reaction. Sometimes calcifications or ossifications are present as well.
For better visualisation fixation in 100% ethanol is preferred; the crystals are birefingent. If the tissue is fixed with formaldehyde, the crystals usually dissolve. The fixation fluid can be tested for presence of urates (murexid reaction).
Pictures
Gout:
Gout, HE 5x (2066)
Gout, HE 20x (2067)
Gout, HE 40x (2068)
Murexid reaction, result on the bottom of a china dish:
Gout, Macro (2135)
Gout, Macro (2136)
Large deposits (clinically diagnosed as a tumor), crystals are preserved:
Gout, HE 10x (4056)
Gout, HE 40x (4057)
Gout, HE 40x (4058)
Gout:
Gout, HE 20x (4498) [zoomify]
Gout:
Gout, HE 40x (13008)
Gout, bursa olecrani:
Gout, bursa olecrani, HE 40x (6113)
Gout, tophi, ear:
Gout, ear, HE 20x (14023)
Introduction:
Intradermal deposits of iron (hemosiderin) are usually associated with hemorrhage (purpura, stasis dermatitis), siderosis around foreign bodies. Skin pigmentation in hemochromatosis is caused by epidermal melanin, but hemosiderin is present as well.
Pictures
Traumatic hematoma, heels:
Haematoma, Macro (3711)
Haematoma, Macro (3712)
Haematoma, Macro (3713)
Histology:
Hemosiderin deposits within the dermis can be stained by Prussian blue staining.
Pictures
Hemosiderin:
Hemosiderin, HE 10x (265)
Special stain for iron (Perls) — hemosiderin is stained blue:
Hemosiderin, Prussian blue 10x (264)
Similar case in higher magnification:
Hemosiderin, HE 40x (267)
Hemosiderin, Prussian blue 40x (266)
Black heel, hemosiderin within the cornified layer:
Black heel, HE 20x (4222)
Another case:
Black heel, HE 20x (4428) [zoomify]
Another case:
Black heel, HE 20x (4790) [zoomify]
Another case:
Black heel, HE 20x (5085) [zoomify]
Black heel, benzidin 20x (5084) [zoomify]
Traumatic hematoma, nail:
Nail hematoma, HE 20x (5214)
Nail hematoma, toe (clinical suspition for melanoma):
Nail hematoma, HE 20x (13900)
Siderosis of the fat in a small child treated for malignancy
(etiology unknown):
Siderosis of the fat, after blastoma; chemotherapy, HE 20x (5414)
Introduction:
Blue tatoo is done by introducing carbon into the dermis.
In addition to black (blue) tatoo mercury (red), chromium (green), cadmium (yellow) and cobalt (blue) and many others pigments are used.
Clinical signs:
Pictures
Tatoo, chest:
Tatoo, CLINIC (929)
Traumatic tatoo, face:
Tatoo, CLINIC (1138)
Tatoo, arm:
Tatoo, CLINIC (3354)
Tatoo, CLINIC (3355)
Histology:
Color pigments are deposited within the macrophages or as free tissue deposits.
Carbon does not usually cause any tissue reaction. Granules of carbon are black and cannot be bleached by peroxide (as opposed to melanin).
Pictures
Tatoo:
Tatoo, HE 10x (406)
Tatoo, HE 20x (407)
Tatoo, HE 40x (408)
Another case:
Tatoo, HE 10x (1714)
Tatoo, HE 40x (1715)
Another case:
Tatoo, HE 20x (5425)
Cosmetic tatoo, red (lip):
Tatoo, red, HE 10x (411)
Tatoo, red, HE 40x (412)
Tatoo, red, HE 40x (413)
Tatoo, red, HE 100x (4)
Red tatoo:
Tatoo, HE 20x (1716)
Green tatoo:
Tatoo, green, HE 10x (409)
Tatoo, green, HE 40x (410)
Yellow tatoo:
Tatoo, yellow, HE 20x (1720)
Tatoo, yellow, HE 40x (1721)
Multicolor tatoo (black, yellow, red):
Multicolor tatoo, HE 20x (5261)
Tatoo:
Tatoo, HE 40x (13258)
Tatoo, combined with verruca vulgaris:
Tatoo and verruca vulgaris, HE 20x (5262)
Tatoo, verruca vulgaris, HE 10x (1717)
Traumatic tatoo (pencil):
Tatoo, pencil, HE 20x (4303)
Traumatic tatoo (dirt):
Tatoo (traumatic, dirt), HE 20x (5288)
Clinical signs:
Histology:
So called amalgam tatoo are amalgam deposits within the gums, characterised by black pigment granules and dark impregnation of the collagen fibres.
Pictures
Amalgam tatoo:
Amalgam tatoo, HE 10x (1177)
Amalgam tatoo, HE 40x (1178)
Another case of amalgam tatoo:
Amalgam tatoo, oral mucosa, HE 20x (4393)
Another case:
Amalgam tatoo, HE 40x (4906) [zoomify]
Another case:
Amalgam tatoo, HE 60x (14031)
Clinical signs:
Pictures
Argyria
Argyrosis, CLINIC (964)
Argyrosis, hands, CLINIC (4217)
Histology:
Tiny black granules of silver in the dermis, especially around sweat glands.
Pictures
Argyrosis:
Argyrosis, HE 100x (4875)
Argyrosis:
Argyrosis, HE 20x (4206) [zoomify]
Argyrosis, sweat glands:
Argyrosis, HE 40x (4207)
Argyrosis, HE 63x (4214)
Argyrosis, smooth muscle:
Argyrosis, HE 40x (4210)
Introduction:
Titanium is common prosthetic material. Titanium particles can be released into surrounding tissues.
Histology:
Histologically appears as black pigmentation.
Pictures
Soft tissue, titanium pigmentation:
Titanium pigmentation, HE 40x (10711)
Titanium pigmentation, HE 40x (10712)
Clinical signs:
Histology:
Pale, foamy dermal deposits; inflammation is usually slight or none.
Clinical signs:
Histology:
Deposits of yellow brown pigment within the dermis, esp. within the collagen; small granular deposits can be found in endothelium, histiocytes and sweat glands.
Brown pigmentation of cartilage and connective tissue.
Pictures
Ochronosis:
Ochronosis, HE 10x (1508)
Ochronosis, HE 40x (1509)
Alkaptonuria; cartilage, aorta, lung:
Alkaptonuria, cartilage, HE 20x (72734)
Alkaptonuria, aorta, HE 40x (72733)
Alkaptonuria, lung, HE 40x (72735)
Clinical signs:
Histology:
Deposits of amorphous, bluish material within the papillary dermis; thin layer of connective tissue separates the epidermis and the deposits; thin arteficial cleft may separate the colloid from surrounding stroma.
Pictures
Colloid milium:
Colloid milium, HE 5x (1460)
Colloid milium, HE 20x (1459)
Another case:
Colloid milium, Milium colloidale, HE 20x (4854)
Colloid milium, Milium colloidale, HE 20x (4855)
Another case:
Colloid milium, Milium colloidale, HE 20x (4856) [zoomify]
Clinical signs:
Air in the subcutis causes acute swelling
,
which usually disappears spontaneously.
Pictures
Subcutaneous emphysema:
Subcutaenous emphysema, CLINIC (1982)