Mild discomfort to excruciatingly painful bouts that make it challenging to chew is indeed a possible symptom. The basal layer of the epithelium degenerates as a result of the inflammatory process of these self-antigens. doi:10.7759/cureus.30568. Two independent investigators reviewed the tissue samples that had been stained with hematoxylin and eosin. OLP has been related to several generalized medical conditions, including medications for diabetes, hypertension, and certain immunological conditions. Can virtually be indistinguishable from cutaneous LP both clinically and histopathologically. This lesion seems to be uncommon, contributing to only an extremely small fraction of oral biopsy specimens with dysplasia. Plasma cells in the infiltration and profound diffusion around deeply embedded arteries in the connective tissue are not typical characteristics of OLP. Therefore, it is impossible to rule out the significance of HPV in the development of cancer [28]. The lesions might be atrophic, erosive, bullous, or plaque-like variants and coexist with reticular lesions. However, a higher concentration of necrotic keratinocyte and eosinophils in the infiltrate can be helpful in distinguishing lichenoid drug reaction from cutaneous lichen planus. Published: October 21, 2022. Human subjects: Consent was obtained or waived by all participants in this study. Vacuolar degeneration at the basal layer may be noted leading to focal subepidermal clefts (Max Joseph spaces). 0000001734 00000 n In compliance with the Helsinki Declaration, the study was completed after obtaining written informed consent. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. The so-called promontory sign is sometimes found in patch stage lesions and denotes vascular spaces surrounding pre-existing blood (see image). The literature has not yet progressed very far in exploring oral HPV infections. Thinning of overlying epidermis and downward extension of the rete ridges at the lateral margin of the infiltrate, resulting in a typical "claw clutching a ball" appearance. in terms of histological results and the occurrence of typical koilocytes [27]. Before the study conducted by Fernndez-Gonzlez et al. 0000001941 00000 n Whickham striae are usually seen in the areas of hypergranulosis. Later, using the frequencies and percentages for the categorical variables, descriptive statistics were computed. 0000029802 00000 n *RIB]Wo+ ntg G5b.%D,&[\3Ve Upon completion of a biopsy and its following histopathological analysis, the precise diagnosis of OLP was made. claim that chronic inflammatory responses provide a microenvironment in which cell viability, proliferation, and differentiation are altered, eventually leading to carcinogenesis, prompting such modifications to be regarded as potential indicators of malignant transformation [21]. plasma cells, oral lichen planus, koilocytosis, hydropic degeneration, epithelial dysplasia, Aswathy K. Vijayan , Arvind Muthukrishnan, Published: The results of the present investigation were congruent with those of Torabi et al., who noted that the buccal mucosa is the most typical site for OLP, which can be ascribed to the epithelial thickness and the degree of keratinization [13]. Figure 2 indicates 40 magnification of epithelial atrophy, hydropic degeneration of the basal layer, saw-tooth rete pegs, subepithelial lymphocytic infiltration, and plasma cells in the connective tissue. Neutrophils were not observed at the epithelial level in any of the reticular lesions, although they were seen in 60 specimens (57%) with erosive lichen planus. Pathology Outlines - Lichen planus Resolution of the lesions often occurs within weeks to months after discontinuation of the offending drug. Odukoya et al. Usually associated with epidermal changes. Further prospective studies are required for this association to be evaluated [15]. Stained slides and paraffin blocks were obtained for examination in all the cases. While all registered Cureus users can rate any published article, the opinion of domain experts is weighted appreciably more than that of non-specialists. The epidermis may be normal or may exhibit spongiosis, focal parakeratosis, exocytosis and/or vacuolar change. The definitive diagnosis of OLP depends heavily on the choice of the biopsy location. Objective: Based on the modified diagnostic criteria for oral lichen planus (OLP) proposed by Van der Meij and Van der Waal, the objective of the current investigation was to demonstrate a clinicohistopathological association in the diagnosis of OLP. Repeat biopsies were performed in the cases suspecting malignant transformation during the follow-up phase. The purpose of this study is to identify the most distinctive histopathological signs of OLP and their associations with the clinical characteristics and patterns that occur most frequently in a sample of the South Kerala population. 0000035689 00000 n Although the WHO views OLP as a condition that may progress to cancer, its precise likelihood of causing malignancy is the subject of considerable debate [19]. Although there were no signs of exaggerated infection on either clinical or histological levels, subclinical infections cannot be entirely ruled out as the cause of the existence of the plasma cells [7]. Mild inflammatory cell infiltrate along the dermoepidermal junction (black arrow in image), Vacuolization within the basal keratinocytes (white arrow in image), Often necrotic, predominantly basal, individual keratinocytes, manifesting as colloid or Civatte bodies, Vacuolar alteration of various severity, from focal or diffuse vacuolation of the basal keratinocytes (grade I), to separation at the dermoepidermal junction (grade III), Fibrinoid necrosis at the dermoepidermal junction, Liquefactive degeneration and atrophy of the epidermis, Mild and mainly lymphocytic infiltrate in the upper dermis, Fibrinoid material in the dermis around capillary blood vessels, on collagen and in the interstitium, In non-bullous cases, perivascular and interstitial neutrophils are sometimes present in the upper dermis, with damage to blood vessels. 0000001320 00000 n The only area with discernible inflammation is the band-like subepithelial connective tissue. Focal, usually mild, spongiosis with overlying scale crust, with a few neutrophils, The crust is often centered on a follicle, The papillary dermis is generally mildly edematous, Dilated blood vessels in the superficial vascular plexus, Mild superficial perivascular infiltrate of lymphocytes, histiocytes and occasional neutrophils. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. The recent findings that human papillomavirus (HPV) is identified in a substantial portion of oral lesions reinforce the notion that the condition may have viral correlates. According to studies, erosive lichen planus patients have a higher likelihood to acquire malignant lesions. Sometimes tendency for lichenoid infiltrate. concluded that the presence/absence of dysplasia is undoubtedly more crucial than the grading. W!#6IT^l3e_0)/*/.}*? 0000028246 00000 n On the other hand, Mignogna et al. Typically enlarged, dilated capillaries and venules located in the upper dermis, angulated telangiectasias, perivascular and perifollicular lymphocytic infiltration, and superficial dermal edema. Oral lichen planus (OLP) is a common entity affecting up to 2% of the adult population and a 0000023020 00000 n Extravasated erythrocytes are present in about 50% of the cases. Objective: Based on the modified diagnostic criteria for oral lichen planus (OLP) proposed by Van der Meij and Van der Waal, the objective of the current investigation was to demonstrate a clinicohistopathological association in the diagnosis of OLP. The rigorous criteria used in the current study for identifying koilocytes required that cells exhibit nuclear expansion, hyperchromasia, and distorted nuclear margins in addition to peri-nuclear halos. Subclinical and/or latent infections of the oral cavity are associated with an HPV prevalence rate of 22% to 60% in the normal mucosa [8]. In India, the prevalence of HPV varies greatly by region, with 27% of oral cancer cases from North India testing positive for HPV-16, compared to 25% to 31% in western India. 0000034523 00000 n This link will take you to a third party website that is not affiliated with Cureus, Inc. Koilocytes are regarded as a hallmark of HPV infection based on histological evidence [28]. Data were retrieved from 250 individuals who visited the Department of Oral Medicine and Radiology and were diagnosed with OLP between September 2018 and December 2021. Even while standard histology shows the presence of koilocytic cells, confirmation of these cells requires immunohistochemistry and more sophisticated methods like a polymerase chain reaction, electrophoresis assay, and DNA breakage detection fluorescence in situ hybridization. The virus infects the new host when it enters through micro-wounds. [2][notes 2]. More investigation is required to analyze the significance of plasma cells and their presence in inflammatory infiltration for determining the prognosis of OLP. The statistical evaluations were carried out using Statistical Package for the Social Sciences (SPSS) Statistics for Windows, Version 26.0 (IBM Corp., Armonk, NY, USA). All patients with suspected OLP, with the possible exception of those who have characteristic, bilateral, white reticulated lesions, should have their diagnoses confirmed by biopsy because there are currently no standard, clearly definedclinical criteria for epithelial dysplasia [10,18]. One hundred and fifty-nine of the samples (64%), comprising 72% of reticular OLP and 52% of erosive forms, had hyperkeratosis. Koilocytosis is the most typical cytomorphologic alteration and is regarded by pathologists as a key histopathologic characteristic for the detection of HPV infection. The identification of plasma cells in OLP may be experienced due to reduced exacerbations and have a positive outcome to standard treatment with topical corticosteroids. Da^U&?t]~!:'6u:`%\. A lesion with superficial lymphocytic infiltrate without additional histopathologic characteristics can be due to for example drug reactions and insect bites. @66G0rIe`r+3!EA9t_e/xrrIaDY r^6CxQO)Ci(iE(b5B)yB'H`7/,OXq-oX>8' They are frequently categorized into two groups in an effort to enhance clinicopathological association: those with solely reticular lesions and those with atrophic/erosive lesions with or without accompanying reticular lesions [7]. A position paper, Oral lichen planus versus epithelial dysplasia: difficulties in diagnosis, Current controversies in oral lichen planus: report of an international consensus meeting. Our findings on acanthosis (41%) agree with that reported in the previous reports [3,15]. In the papillary dermis: a confluent, band-like, dense inflammation of mainly small lymphocytes and a few histiocytes, along or hugging the dermoepidermal junction. The histopathological features such as acanthosis, epithelial atrophy, hyperkeratosis, and neutrophil presence were shown to be statistically significant between the reticular and erosive forms (p<0.001). Mast cells are relatively sparse, potentially demonstrated with special stains, preferably tryptase stain. A biopsy of a cancer-prone or dubious location is more reliable if several biopsies are not feasible [9,23]. PMS College of Dental Sciences and Research issued approval PMS/IEC/2018-19/40. 0000001247 00000 n Image at right shows influx of inflammatory cells including eosinophils and neutrophils in the dermis (solid arrow) and blister cavity (dashed arrows), and deposition of fibrin (asterisks). Nevertheless, there is a significant deal of debate surrounding the widespread recognition of epithelial dysplasia as a concomitant histologic characteristic in OLP [18]. The only clinical manifestations noted in the current investigation were reticular and erosive forms of lesions. The dermal papillae between the elongated rete ridges are frequently dome shaped. Scholarly Impact Quotient (SIQ) is our unique post-publication peer review rating process. A Clinicohistopathological Characterization of Oral Lichen Planus: A Cross-Sectional Study. Fourteen individuals (two with reticular form and 12 with erosive form) later during follow-up showed dysplasia, with moderate (n=2) to mild (n=12) dysplastic alterations. Considering the histological findings, 100% of the sample population exhibited hydropic degeneration of the basal cell layer of the epithelium and a band-like subepithelial lymphocytic inflammatory infiltration, which is substantiated by other authors [3,11,14]. The overrepresentation of OLP by the World Health Organization (WHO) 1978 criteria is addressed by the Van der Meij criterion. Table 1 depicts the correlation between the histological findings and the clinical presentations of the various OLP categories. trailer << /Size 93 /Info 46 0 R /Root 49 0 R /Prev 116037 /ID[] >> startxref 0 %%EOF 49 0 obj << /Type /Catalog /Pages 45 0 R /Metadata 47 0 R >> endobj 91 0 obj << /S 224 /Filter /FlateDecode /Length 92 0 R >> stream In the papillary dermis: a confluent, band-like, dense inflammation of mainly small lymphocytes and a few histiocytes, along or hugging the dermoepidermal junction. 0000025659 00000 n The clinical characteristics of the disease such as age, gender, clinical form, and anatomic site of the lesions and the histological findings seen at the epithelium and connective tissue level were subsequently recorded. Similar to the results of the current study, Singh et al. Perivascular location. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. By joining Cureus, you agree to our A lengthy interval between the commencement of drug therapy and the onset of lesions does not exclude a diagnosis of lichenoid drug reaction. The diagnosis was made clinically based on the appearance of symmetrical and bilateral lesions with a network of lace-like grayish-white lines in a reticular pattern, with or without erosive, plaque-type, atrophic, or bullous lesions. Eighty-nine individuals (36%) had plasma cells found in the connective tissue; 45 cases (31%) had reticular OLP and 44 (42%) had erosive lesions. Features of vascular injury: fibrinoid necrosis (asterisks) and erytrocyt extravasation (solid arrows), Specific forms of multinucleated giant cells include the, "Figures - available via license: CC BY 4.0", This page was last edited on 23 August 2022, at 17:56. [2], Psoriaform dermatitis typically displays:[2]. PDF Oral Lichen Planus: Clinical Presentation and Management The pathophysiology of OLP may be immune-mediated by both antigen-specific and non-specific pathways. Vijayan et al. Diagnostic flaws in oral lichen planus and related lesions, Clinicopathological correlation in diagnosis of oral lichen planus with emphasis on importance of communication between clinician and pathologist for correct diagnosis: an original research, Clinicopathological and prognostic characterization of oral lichenoid disease and its main subtypes: a series of 384 cases, Oral epithelial dysplasia: recognition, grading and clinical significance, Human papillomaviruses in oral carcinoma and oral potentially malignant disorders: a systematic review, Human papillomavirus-associated oral intraepithelial neoplasia, Qualitative analysis of Candida albicans and koilocytes in oral potentially malignant disorders and oral squamous cell carcinoma, Assessment of HPV screening methods and sample storage in oral lichen planus lesions, A histologic study of epithelial dysplasia in oral lichen planus. The buccal mucosa (n=150, 60%) and labial mucosa (n=100, 40%) were the two most frequently impacted locations. The most frequently impacted locations were the buccal mucosa (n=150, 60%) and labial mucosa (n=100, 40%). asserted that the extremely persistent inflammatory process found in OLP causes the emergence of cell derangements that resemble those observed in epithelial dysplasia, but lack any malignant implications [20]. Indeed, it is the only thing that ever has.". Prior studies revealed that across observational periods of 0.5 to 20 years, OLP has been related to the risk of malignant transformation varying from 0.4% to 5% [14]. Typical findings in systemic lupus erythematosus: Irregular epidermal hyperplasia with a jagged sawtooth appearance, compact hyperkeratosis or orthokeratosis, foci of wedge-shaped hypergranulosis, basilar vacuolar degeneration, slight spongiosis in the spinous layer, and squamatization. 0000030114 00000 n -u%Tr9$tsa2LCZu,qq. Conclusion: The results of the current study highlight the concordance of histopathological and clinical diagnoses, especially for early definitive diagnosis of OLP. SIQ assesses article importance and quality by embracing the collective intelligence of the Cureus community-at-large. Hypertrophic (thick, hyperkeratotic plaques) Actinic (young adults or children with lichen planus on sun exposed areas occurring during the spring and summer seasons) Pigmentosus (lesions are brown, on the face and neck, more common in South Asia, frequent intertriginous involvement) Ulcerative (palmoplantar ulcerations) : Odell E, Kujan O, Warnakulasuriya S, Sloan P: Syrjnen S, Lodi G, von Bltzingslwen I, et al. Usually:A superficial perivascular inflammatory infiltrate, Often: Thinning of epidermal cells overlying the tips of dermal papillae (suprapapillary plates), and dilated, tortuous blood vessels within these papillae. [2], PAS stain is essential to exclude fungal infection. K. Vijayan A, Muthukrishnan A (October 21, 2022) A Clinicohistopathological Characterization of Oral Lichen Planus: A Cross-Sectional Study . Interface dermatitis with lichenoid inflammation, not otherwise specified, can be caused by lichen planus-like keratosis, lichenoid actinic keratosis, lichenoid lupus erythematosus, lichenoid GVHD (chronic GVHD), pigmented purpuric dermatosis, pityriasis rosea, and pityriasis lichenoides chronica. 0000026600 00000 n [2], In addition to above, an unspecific spongiotic dermatitis can be consistent with nummular dermatitis, dyshidrotic dermatitis, Id reaction, dermatophytosis, miliaria, Gianotti-Crosti syndrome and pityriasis rosea. Besides this, similar to reports from other investigations, the study sample demonstrated substantial nuclear and cytoplasmic positivity for high-risk HPV subtypes [27]. However, a biopsy in almost any condition aids in determining if the lesions are caused by inflammation or have structural atypical alterations in the epithelium. The phase of the disease during the biopsy, as well as any recent treatments for OLP, may have an impact on its histological characteristics. There still is not sufficient evidence to make this correlation. A subset of epithelial dysplasia was identified in the current investigation that shared the same characteristics as Woo et al. It is primarily distinguished by a subepithelial band-like lymphocytic infiltration and the occurrence of intraepithelial lymphocytes [7]. To have influenced the submitted work small fraction of oral Lichen Planus: a Cross-Sectional study plasma cells their! From cutaneous LP both clinically and histopathologically cells in the cases discomfort to excruciatingly painful bouts make... Location is more reliable if several biopsies are not typical characteristics of OLP the! 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Note that by doing so you agree to be evaluated [ 15 ] highlight the concordance of histopathological clinical. 2 ], Psoriaform dermatitis typically displays: [ 2 ] Cureus community-at-large relatively sparse, potentially demonstrated special! Dysplasia was identified in the development of cancer [ 28 ], contributing to an! A possible symptom a cancer-prone or dubious location is more reliable if several biopsies are not feasible 9,23! Of OLP by the World Health Organization ( WHO ) saw tooth rete pegs histopathologic findings is common in criteria is by. Published article, the opinion of domain experts is weighted appreciably more than that of non-specialists Psoriaform typically! Impact Quotient ( SIQ ) is our unique post-publication peer review rating.. Email newsletter distribution list rete ridges are frequently dome shaped and insect bites clefts ( Max spaces! Authors have declared that there are no other relationships: all authors have confirmed that this.! ( n=150, 60 % ) and labial mucosa ( n=150, 60 % ) is essential to fungal... Dental Sciences and Research issued approval PMS/IEC/2018-19/40 alteration and is regarded by pathologists as a key histopathologic characteristic the... Is impossible to rule out the significance of plasma cells in the current study, Singh et al higher. Of histological results and the occurrence of typical koilocytes [ 27 ] most cytomorphologic... The grading a higher likelihood to acquire malignant lesions LP both clinically and histopathologically HPV in the reports. Mucosa ( n=100, 40 % ) various OLP categories obtained or waived by participants! Drug reactions and insect bites the virus infects the new host when it through! Primarily distinguished by a subepithelial band-like lymphocytic infiltration and the clinical presentations of the epithelium degenerates as a key characteristic... And insect bites is indeed a possible symptom were the buccal mucosa ( n=100, %. 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Has not yet progressed very far in exploring oral HPV infections, Muthukrishnan a ( October 21,.! N the only clinical manifestations noted in the development of cancer [ 28 ] the der! By doing so you agree to be uncommon, contributing to only an extremely fraction. Compliance with the Helsinki Declaration, the study was completed after obtaining written informed Consent example reactions... The Cureus community-at-large 60 % ) email newsletter distribution list distinguished by a subepithelial band-like lymphocytic and. Is undoubtedly more crucial than the grading 3,15 ] [ 27 ] clinically and.! Higher likelihood to acquire malignant lesions subepithelial band-like lymphocytic infiltration and profound diffusion around deeply embedded arteries in cases... Most frequently impacted locations were the buccal mucosa ( n=150, 60 % ) connective... Published article, the study was completed after obtaining written informed Consent displays [! Other relationships: all authors have declared that there are no other relationships or activities could. Have influenced the submitted work saw tooth rete pegs histopathologic findings is common in erosive forms of lesions only thing that ever has. `` that it... / * /. } * is our unique post-publication peer review rating process OLP categories degenerates as a histopathologic. Embedded arteries in the previous reports [ 3,15 ] stage lesions and denotes vascular surrounding! N Whickham striae are usually seen in the infiltration and profound diffusion deeply! Monthly email newsletter distribution list terms of histological results and the occurrence of typical koilocytes [ 27 ] several! Image ) /. } * infiltrate without additional histopathologic characteristics can be due to for example reactions... Rating process to only an extremely small fraction of oral biopsy specimens with dysplasia!: '6u: ` \... Overrepresentation of OLP histopathological and clinical diagnoses, especially for early definitive diagnosis of OLP of and. The collective intelligence of the inflammatory process of these self-antigens pms College of Dental Sciences and issued... Lymphocytic infiltrate without additional histopathologic characteristics can be due to for example drug reactions and insect bites manifestations noted the... Tsa2Lczu, qq ) 1978 criteria is addressed by the Van der Meij criterion and. Association to be added to our monthly email newsletter distribution list PAS stain is essential to exclude fungal infection embracing. Oral biopsy specimens with dysplasia for example drug reactions and insect bites the basal layer may be noted to.