0000028246 00000 n Similar to the results of the current study, Singh et al. 0000029802 00000 n 0000001713 00000 n The Shapiro-Wilk test was applied to ascertain whether the data followa normal distribution. 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. 0000026600 00000 n Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. qoUe#v,f)V,cV\|6aNoBco~pCq\|sT]Rxx{>GRlJMJVNRTMh#UQs"&)6T&$E"YUhk*[rhjgg:JU~+ v\ylajta=kp=~ideunZAgagQ}B66}mYq2qDlv&-~}4TL''!CSFNNdj:ajgs?=Rx+(I$ Lfoq.t{S[Iv.EvqVeEk ;-'C #?vtvD TATzt$V|2eZuo7=uzxOvoSh\z%=,(wzv.#bazba^v4e_zBVJZ>-];vu;@;'.CnWo>t?&d +<8U4| e >0RCqtfh9'#I_e`[7 t#F ^98ZkOLVV1UjNs concluded that the presence/absence of dysplasia is undoubtedly more crucial than the grading. 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]. In the hypertrophic subtype, the associated hyperkeratosis, parakeratosis, hypergranulosis, papillomatosis, acanthosis, and hyperplasia markedly increased with thicker collagen bundles forming in the dermis. 494 September 2002, Vol. [2] In cases of post-inflammatory hyperpigmentation, it is important to exclude potentially harmful mimics such as a regressed melanocytic lesion or lichenoid pigmented actinic keratosis. The inflammatory component in OLP is intense and is the result of a response to the antigens produced by the basal keratinocytes. Usually superficial dermal edema with perivascular lymphocytic infiltrate, with exocytosis. 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. 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]. In 57% of the erosive cases, neutrophils were found at the epithelial level, but none were found in the reticular pattern. 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. These characteristically have a superficial perivascular inflammatory infiltrate, and can be classified by type of cell infiltrate: Variable degree of epidermal spongiosis and vesicle formation, filled with proteinaceous fluid containing lymphocytes and histiocytes. Regular epidermal hyperplasia, elongation of the rete ridges, hyperkeratosis, and parakeratosis. Mild discomfort to excruciatingly painful bouts that make it challenging to chew is indeed a possible symptom. Keratinocytes of the epithelium are frequently affected by HPV infection. There is some exocytosis of inflammatory cells but not as prominent as in nummular dermatitis, Psoriasiform hyperplasia, initially slight, with mild spongiosis, Usually numerous yeast-like organisms in the surface keratin. Whickham striae are usually seen in the areas of hypergranulosis. A provisional diagnosis of OLP was established in the event of bilateral expression of the reticular pattern, with no history of amalgam restorations, the application of new medicaments or dentifrices, either with or without a history of usage of tobacco products, in addition to the aforementioned histopathological findings [22]. Published: October 21, 2022. T-cell aggregation in the superficial lamina propria, rupture of the basement membrane, T-cell migration within the epithelium, and apoptosis of keratinocytes are the possible outcomes of the interaction of these pathways. Published via the Advanced Sciences Academic Channel Channel. Consequently, 41% of the study sample had acanthosis. 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. Eisen [10] established that epithelial dysplasia was consistently seen in several repeat oral biopsies taken from a multitude of these patients. 0000025659 00000 n Eighty-nine individuals (36%) had plasma cells found in the connective tissue; 45 cases (31%) had reticular OLP and 44 (42%) had erosive lesions. 0000025638 00000 n Necrotic keratinocytes can be observed in the basal layer of the epidermis and at the dermal-epidermal junction. Although the erosive type is less frequent than the reticular form, it is more pertinent for patients since lesions are frequently bothersome [5]. The quality and accuracy of DNA obtained from oral mucosa employing multiple collection and storage techniques remain a subject of debate [29]. This might be the case because, as certain authors contend, the epithelium is thicker in the reticular forms and thinner in the erosive forms, rendering the erosive lesions more vulnerable to ulceration and atrophy [3,17]. 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]. 0000011516 00000 n By joining Cureus, you agree to our A lesion with superficial lymphoeosinophilic infiltrate without additional histopathologic characteristics can be due to for example drug reactions and insect bites. For comprehensive, accurate, and especially early diagnosis of OLP, the concordance of histopathological and clinical diagnoses becomes essential. Often visible fungus. Furthermore, inadequate immunosuppression, which is mediated by transforming growth factor-beta, may contribute to the chronic characteristic feature of this condition [5]. High ratings should be reserved for work that is truly groundbreaking in its respective field. Raj AT, Behura SS, Sarode SC, Sarode GS, Awan KH, Patil S: Fernndez-gonzlez F, Vzquez-lvarez R, Reboiras-lpez D, Gndara-vila P, Garca-Garca A, Gndara-Rey JM: Rad M, Hashemipoor MA, Mojtahedi A, Zarei MR, Chamani G, Kakoei S, Izadi N: Boar-Alvarez P, Prez Sayns M, Garcia-Garcia A, et al. As above. Activation of matrix metalloproteinase and degranulation of mast cells are examples of non-specific pathways in OLP. Even though the majority of patients had numerous oral sites of involvement, they were excluded due to the stringent exclusion criteria. PMS College of Dental Sciences and Research issued approval PMS/IEC/2018-19/40. Mast cells are relatively sparse, potentially demonstrated with special stains, preferably tryptase stain. 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]. The clinical and/or histological assessment was regarded as not typical but only compatible in the lack of any one of these traits and was thus excluded from the diagnosis of OLP [2]. [2][notes 2]. In atrophic LP, loss of the rete ridges and dermal fibrosis is prominent. Males and females reported initial diagnoses on average at 35.5 and 39.1 years old, respectively. doi:10.7759/cureus.30568. Clinical signs of erosive lichen planus include atrophic and erythematous patches that are frequently encircled by thin striae that radiate outward. W!#6IT^l3e_0)/*/.}*? The study limitations are that the sample size is small and longitudinal evaluation was not done for the subjects as the OLP cases require a long-term follow-up. Besides this, similar to reports from other investigations, the study sample demonstrated substantial nuclear and cytoplasmic positivity for high-risk HPV subtypes [27]. 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. 0000011055 00000 n One hundred and fifty-nine of the samples (64%), comprising 72% of reticular OLP and 52% of erosive forms, had hyperkeratosis. 0000035130 00000 n [2][notes 2], An interface dermatitis with vacuolar alteration, not otherwise specified, may be caused by viral exanthems, phototoxic dermatitis, acute radiation dermatitis, erythema dyschromicum perstans, lupus erythematosus and dermatomyositis.[2]. The lesions might be atrophic, erosive, bullous, or plaque-like variants and coexist with reticular lesions. 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. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. 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. Hence, some of the distinctive features such as hyperkeratosis, hypergranulosis, or dense lymphocytic dermal-epidermal infiltrate may not be present. 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. In the papillary dermis: a confluent, band-like, dense inflammation of mainly small lymphocytes and a few histiocytes, along or hugging the dermoepidermal junction. Minimal dermal inflammation and exocytosis of inflammatory cells are present. Patientswho had a history of systemic disorders, were smokers or heavy drinkers, had immune-mediated hypersensitivity reactions to tooth restorations, or were taking any medications such as oral hypoglycemics or angiotensin-converting enzyme inhibitors were also precluded. Hb```f````c`eg@ ~V('3`g``4?gKt#8~,*NiX6H(:lR1~[UBoy)& CUE=(l bLj&eP pYN No vasculitis. Other signs depend on fungus species. Presence of amyloid, possibly with direct immunofluorescence and Congo red staining. LP lesion may resolve with residual hyperpigmentation caused by a persistent increase in the number of melanophages in the papillary dermis. H|U{Tw!! !#H*U>@UD,@@R^B!o *a)E npGWau{9wf~sop Peer review began: September 22, 2022 0000002132 00000 n Anything above 5 should be considered above average. A Can virtually be indistinguishable from cutaneous LP both clinically and histopathologically. Privacy Policy doi:10.7759/cureus.30568, Received by Cureus: September 17, 2022 This link will take you to a third party website that is not affiliated with Cureus, Inc. [3], it was assumed that the clinical behavior of OLP was not associated with the existence of plasma cells, which raises concerns about the accuracy of the OLP diagnosis [15]. 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. Often vacuolar degeneration of basal keratinocytes and apoptotic bodies (colloid or Civatte bodies). Gross pathological findings observed in carcasses and gastrointestinal tract in sheep implanted with plastic bags for 6 weeks are presented in Table 1.Two out of four sheep implanted with 258 g and 387 g of plastic bags had ascites and generalized oedema and emphysema of the subcutaneous tissues throughout the carcass.All sheep implanted with plastic bags had atrophy of the muscles and body . A subset of epithelial dysplasia was identified in the current investigation that shared the same characteristics as Woo et al. The development of epithelial dysplasia, in particular, has caused substantial debate regarding the potential malignant evolution of OLP. Therefore, it is impossible to rule out the significance of HPV in the development of cancer [28]. 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. Odukoya et al. However, there are limited data on the association between the histopathological and clinical diagnosis of OLP, particularly in developing nations like India [3,7,9,10]. Of the 250 patients, with ages ranging from 15 to 74, 48% and 52% were males and females, respectively. Subepidermal vesicles and blisters associated with accumulation of neutrophils at the papillary tips. While all registered Cureus users can rate any published article, the opinion of domain experts is weighted appreciably more than that of non-specialists. Figure 1 depicts 10 magnification of epithelial hyperkeratosis, acanthosis, saw-tooth rete pegs, and subepithelial lymphocytic infiltration. 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. Learn more here. 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]. The results of the current study highlight the significance of taking into account clinicopathologic conclusions when establishing a definitive diagnosis. 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 statistical evaluations were carried out using Statistical Package for the Social Sciences (SPSS) Statistics for Windows, Version 26.0 (IBM Corp., Armonk, NY, USA). Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. Da^U&?t]~!:'6u:`%\. 48 0 obj << /Linearized 1 /O 50 /H [ 1320 414 ] /L 117125 /E 35918 /N 6 /T 116047 >> endobj xref 48 45 0000000016 00000 n Consequently, to objectively confirm the final diagnosis, a number of exclusion criteria were included such as appropriate bilateral clinical manifestations and the occurrence of at least a mild reticular feature. Basal keratinocytes release the antigen in OLP, and CD8+ cytotoxic T lymphocytes destroy keratinocytes specifically in response to the antigens. [2] If negative, an unspecific lymphohistocytic dermatosis may be caused by drug reactions and viral infections. Although the present study documented two cases of mild dysplasia and 12 cases of moderate dysplasia, Odell et al. Usually associated with epidermal changes. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The pathophysiology of OLP may be immune-mediated by both antigen-specific and non-specific pathways. It happens in areas of marked hypergranulosis with prominence of the sawtooth pattern of rete ridges. 0000024683 00000 n Cases were eliminated from the analysis if they failed to satisfy both the clinical and the histological characteristics unique to OLP established by the Van der Meij and Van der Waal criteria [11]. Epidermis, papillary dermis, and superficial vascular plexus: Without epidermal changes. Further prospective studies are required for this association to be evaluated [15]. Clinically compatible with lichen planus is a term used to describe lesions that resemble an OLP but do not match the aforementioned requirements [3,6]. Cells in the outermost surface layer go through a process known as koilocytosis, which involves nuclear degradation and perinuclear cytoplasmic vacuolation. Koilocytes were reported in 84 cases (34%), which included 35 (24%) reticular cases and 49 (47%) erosive lesions. 0000034523 00000 n The reticular variant is more common and is marked by definite erythematous borders around Wickham's striae, which are lacy white streaks. [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. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. This article incorporates material from the article Dermatitis at Patholines, which is licensed under the Creative Commons Attribution 4.0 International (CC BY 4.0) license. The literature has not yet progressed very far in exploring oral HPV infections. However, documentation of HPV infections is also becoming a key predictor for determining the prognostic value of head and neck cancer in recent times [8]. The phase of the disease during the biopsy, as well as any recent treatments for OLP, may have an impact on its histological characteristics. The epidermis may be normal or may exhibit spongiosis, focal parakeratosis, exocytosis and/or vacuolar change. It is primarily distinguished by a subepithelial band-like lymphocytic infiltration and the occurrence of intraepithelial lymphocytes [7]. Clinical management and malignant transformation. Epidermal changes are less common in lichenoid drug eruptions when compared to classic lichen planus. [1], A superficial or shave biopsy is regarded as insufficient. Another histological finding of OLP that was not compatible with the previous study [3] was the detection of saw-tooth ridges found in 60% of the sample. It is crucial to note that 14 individuals (two with reticular form and 12 with erosive form) showed dysplasia, which was shown to be statistically highly significant. s 99LX) K7ZpRxD3`AG*"@PO86!@ G 0000022999 00000 n Upon completion of the histopathological analysis, the precise diagnosis of OLP was made. 0000020599 00000 n This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Neutrophilic and lymphohistiocytic infiltrate and edema. The cases evaluated in this study can be securely classified as OLP in their entirety as the diagnoses were made in accordance with the accepted OLP criteria. The histopathologic and clinical diagnoses were consistent according to Cohen's kappa, which was 0.787. stated that epithelial atrophy has been reported to be a potential biomarker in malignant transformation, even if moderate-to-mild dysplasia might not always reflect premalignant potential [30]. More research studies are warranted to validate the trend of epithelial dysplasia in OLP associated with HPV and also to explore the course of the lesions that might be affected by this trait. 0000029051 00000 n 0000001941 00000 n Both epithelial erosion and the deep extension of the inflammatory process were strongly associated with plasma cells in these patients. 0000023020 00000 n [2], Psoriaform dermatitis typically displays:[2]. Early viral genes cause basal cells to divide more rapidly, which causes hyperplasia in the superficial layers of the epithelium. Later, using the frequencies and percentages for the categorical variables, descriptive statistics were computed. also found that oral submucous fibrosis, leukoplakia, OLP, and squamous cell carcinoma had higher incidences of koilocytes. The SIQ for this article will be revealed. The histopathological features such as acanthosis, epithelial atrophy, hyperkeratosis, presence of neutrophils, koilocytes, and epithelial dysplasia were shown to be statistically significant between the clinical forms (p<0.001). : Singh P, Singh S, Singh A, Saxena S, Saxena S, Vijay P: Poulopoulos A, Hempel M, Karakitsos G, Fakis A, Andreadis D. 0000022092 00000 n The virus infects the new host when it enters through micro-wounds. plasma cells, oral lichen planus, koilocytosis, hydropic degeneration, epithelial dysplasia, Aswathy K. Vijayan , Arvind Muthukrishnan, Published: Oral lichen planus (OLP) is a frequent condition affecting the skin and mucous membrane of the oral cavity which is of unknown cause [1]. The overrepresentation of OLP by the World Health Organization (WHO) 1978 criteria is addressed by the Van der Meij criterion. A lesion with superficial lymphocytic infiltrate without additional histopathologic characteristics can be due to for example drug reactions and insect bites. The two clinical manifestations that were most frequently seen were reticular (n=145, 58%) and erosive types (n=105, 42%). Unless else specified in boxes, reference is: "My approach to superficial inflammatory dermatoses", "Handlggning av hudprover provtagningsanvisningar, utskrningsprinciper och snittning (Handling of skin samples - Instructions for sampling, cutting and incision", "Skin inflammatory (nontumor) > Spongiotic, psoriasiform and pustular reaction patterns > Seborrheic dermatitis", "Skin inflammatory (nontumor) > Lichenoid and interface reaction patterns > Lupus: systemic lupus erythematosus (SLE)", "Cutaneous and Mucosal Lichen Planus: A Comprehensive Review of Clinical Subtypes, Risk Factors, Diagnosis, and Prognosis", "Lichen amyloidosus: A study of clinical, histopathologic and immunofluorescence findings in 30 cases", "Cytokines and cytokine profiles in human autoimmune diseases and animal models of autoimmunity", "Complement Activation in Inflammatory Skin Diseases", "Histopathologic Diagnosis of Fungal Infections in the 21st Century", "Histology of erythema annulare centrifugum", "Assessment of diagnostic strategy for early recognition of bullous and nonbullous variants of pemphigoid", "An unusual presentation of ocular rosacea", "Non-AIDS Associated Kaposi's Sarcoma: Clinical Features and Treatment Outcome", "The diagnosis and treatment of dermatitis herpetiformis", "Linear IgA Disease: A Rare Complication of Vancomycin", Journal of Cutaneous Medicine and Surgery, "Nonepithelial skin tumors with multinucleated giant cells", Creative Commons Attribution 4.0 International (CC BY 4.0) license, https://en.wikipedia.org/w/index.php?title=Histopathologic_diagnosis_of_dermatitis&oldid=1106215378. The definitive diagnosis of OLP depends heavily on the choice of the biopsy location. The entire study sample (100% reticular and erosive patterns) showed signs of hydropic degeneration in the layer of basal cells and the appearance of a clearly defined band-like region of inflammatory infiltration that is restricted to the superficial part of the connective tissue and is primarily made up of lymphocytes. 0000035689 00000 n Vijayan et al. Parakeratotic mounds at the edge of follicular ostia. Characteristically parakeratosis, a dermal eosinophilic infiltrate, and a perivascular lymphocytic infiltrate affecting the reticular dermis. Repeat biopsies were performed on some of the lesions during the follow-up phase with the consent of the patient, particularly in the more critical cases such as worsening of the symptomatic form, changing from reticular to erosive form, or suspecting malignant transformation.