High-Yield Dermatopathology for Residents: High-Yield Kodachromes

In a focused session for dermatopathology residents, Dr. Jillian Weston discussed the analysis of histological patterns visible in Kodachrome images, aiming to enhance diagnostic recognition. The presentation emphasized distinct, specific patterns tied to certain diagnoses, contrasting earlier and upcoming talks focused on differential diagnosis. Key examples included herpes simplex virus and varicella-zoster virus, characterized by the 'three Ms'—multinucleation, margination, and molding in keratinocytes. Dr. Weston illustrated each pattern through high-powered images, clarifying details like the presence of multiple nuclei and chromatin changes, alongside soft signs like ulceration. Another case covered was Epidermodysplasia Varusiformis (EDV), marked by enlarged keratinocytes in the granular and spinous layers, highlighted by a blue-gray cytoplasm. Comparisons were drawn between EDV and Epidermolytic Hyperkeratosis (EHK), with distinctions based on cytoplasmic color and structural changes in keratinocytes. The final discussed diagnosis, sclerotic fibroma or storiform collagenoma, was defined by thickened collagen bundles in an irregular arrangement within the dermis. The session aimed to boost residents' understanding and retention of dermatopathological patterns through visual engagement and clinical reasoning.