QUESTION 5-1. The microanatomy of the subcutaneous layer is supplied by arteries and arterioles in the ______ portion and venules and veins in the _______ portion.
D) Centrilobular, Centrilobular
QUESTION 5-2. A 27-year-old female presents with abdominal pain, arthralgias, diarrhea, fever, headache, and rapid onset of symmetric crops of exquisitely tender, bright-red nodules on the ankles, knees, and anterior shins. One of the nodules is biopsied to reveal a mixed inflammatory infiltrate involving the fibrous trabeculae of the subcutis composed of neutrophils, lymphocytes, and eosinophils. Extravasated red blood cells are noted. The infiltrates extend to the peripheries of the fat lobules with little infiltration into the fat. Over a period of 6 weeks the nodules resolve with a bruise-like appearance. No ulcers ever appeared. Which of the following regarding this patient’s disease is INCORRECT?
A) In regard to pathogenesis, this is a nonspecific hypersensitivity reaction that in children is most commonly preceded by streptococcal infections and in adults is associated with drugs, sarcoidosis, tuberculosis, and inflammatory bowel disease.
B) Late stage lesions of this condition reveal widened fibrotic septae with clusters of mononuclear cells arranged in radial arrays with multinucleation.
C) In late stage lesions, gradual obliteration of fat lobules by septal fibrosis is commonly seen.
D) Fat necrosis with saponification is a characteristic feature of this disease.
E) Although vasculitis is not a major feature, low-grade vascular injury and thrombophlebitis may be encountered in these lesions.
QUESTION 5-3. A 67-year-old hypertensive female with a history of venous stasis presents with striking induration of the lower third portions of both legs. The areas are circumferential, erythematous, and wood-like in consistency. A biopsy is performed and reveals marked septal fibrosis with encroachment on the fat lobules. Septal lymphocytic infiltrates admixed with pigmented macrophages are present. A section from the center of the fat lobule is illustrated below. Which of the following regarding this disease is INCORRECT?
Reproduced, with permission, from Wolff K, Johnson RA, Saavedra AP. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology. 7th ed. New York, NY: McGraw-Hill Education; 2013.
A) The most specific finding for this condition is lipomembranous fat necrosis since these lesions are attributed to ischemia.