Early vulvar lichen sclerosus: a histopathological challenge

Regauer, Sigrid; Liegl, Bernadette; Reich, Olaf

doi:10.1111/j.1365-2559.2005.02209.x

Cited by 112 publications

(108 citation statements)

References 24 publications

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“…Regauer et al (2) described the histologic features of early LS. They state that the epidermis can be normal or acanthotic; intraepithelial lymphocytes are observed with or without spongiosis.…”

Section: Methodsmentioning

confidence: 99%

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Diagnosis of Vulval Inflammatory Dermatoses: A Pathological Study With Clinical Correlation

Leonard

Naveen

Hazel

2009

International Journal of Gynecological Pathology

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Diagnosis of vulval inflammatory disease is difficult. In this study, we reviewed 31 vulval biopsies from 23 patients with clinical follow-up. We devised 2 scoring systems from recent publications to determine whether these could help to distinguish between lichen sclerosus (LS) and lichen planus (LP). We found that scoring systems could help in distinguishing LS from LP but that they were no better than using some select pathologic criteria, and were much more time-consuming. Most cases of LS had characteristic dermal sclerosis. LP cases had a characteristic band-like inflammatory infiltrate and did not always have features such as pointed rete ridges, wedge-shaped hypergranulosis and cytoid bodies as observed in nonvulval sites. Eczema was the third most common dermatosis in the study and had features that could also be observed in LS, such as acanthosis, abnormal collagen, and ectatic blood vessels. However, dermal sclerosus was not observed. Loss of dermal elastin fibers was observed in both LS and LP and thus did not help in discriminating between the 2 conditions. Oral LP elsewhere in the body was common and was observed in 20% of both the LS and LP group. A small proportion of patients did not fit into any category. We believed that it was important not to label patients as having a disease unless specific features were observed. It may be in their best interests to be called nonspecific rather than being put in the wrong disease category.

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Section: Methodsmentioning

confidence: 99%

“…Early lesions may lack the characteristic sclerotic band. Several researchers have attempted to establish criteria to diagnose early LS (2) and others to distinguish LS from LP (3). We have used criteria derived from their papers to investigate vulval biopsies.…”

mentioning

confidence: 99%

Diagnosis of Vulval Inflammatory Dermatoses: A Pathological Study With Clinical Correlation

Leonard

Naveen

Hazel

2009

International Journal of Gynecological Pathology

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“…In the early stages of LS not only the symptoms and clinical signs, but also the histologic picture may be uncharacteristic [70]. The histologic features in early LS are quite subtle and may overlap with those seen in psoriasis or LP, with luminal hyperkeratosis and hypergranulosis of the adnexal structures, mild irregular, occasionally psoriasiform acanthosis, and focal basement membrane thickening.…”

Section: Diagnosismentioning

confidence: 99%

Diagnosis and Treatment of Lichen Sclerosus

2012

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Lichen sclerosus (LS) is a chronic, inflammatory, mucocutaneous disorder of genital and extragenital skin. LS is a debilitating disease, causing itch, pain, dysuria and restriction of micturition, dyspareunia, and significant sexual dysfunction in women and men. Many findings obtained in recent years point more and more towards an autoimmune-induced disease in genetically predisposed patients and further away from an important impact of hormonal factors. Preceding infections may play a provocative part. The role for Borrelia is still controversial. Trauma and an occlusive moist environment may act as precipitating factors. Potent and ultrapotent topical corticosteroids still head the therapeutic armamentarium. Topical calcineurin inhibitors are discussed as alternatives in the treatment of LS in patients who have failed therapy with ultrapotent corticosteroids, or who have a contraindication for the use of corticosteroids. Topical and systemic retinoids may be useful in selected cases. Phototherapy for extragenital LS and photodynamic therapy for genital LS may be therapeutic options in rare cases refractory to the already mentioned treatment. Surgery is restricted to scarring processes leading to functional impairment. In men, circumcision is effective in the majority of cases, but recurrences are well described. Anogenital LS is associated with an increased risk for squamous cell carcinoma of the vulva or penis. This review updates the epidemiology, clinical presentation, histopathology, pathogenesis, and management of LS of the female and male genitals and extragenital LS in adults and children.

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“…Of all biopsies, six were not classified as lichen sclerosus/differentiated VIN. A total of 29 biopsies were diagnosed as lichen sclerosus, of which 1 was classified as early lichen sclerosus (categorized as lichen sclerosus), 22 and 3 were classified as lichen sclerosus with hyperplasia ( Figure 1b). Five lichen sclerosus biopsies had basal cellular atypia (Figure 2), and two biopsies were classified as lichen sclerosus with hyperplasia and basal cellular atypia.…”

Section: Lichen Sclerosus With Progressionmentioning

confidence: 99%

Differentiated vulvar intraepithelial neoplasia is often found in lesions, previously diagnosed as lichen sclerosus, which have progressed to vulvar squamous cell carcinoma

et al. 2011

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Lichen sclerosus is considered to be the precursor lesion of vulvar squamous cell carcinoma, of which only 2-5% progress to squamous cell carcinoma. Differentiated vulvar intraepithelial neoplasia (VIN) has been proposed to be the direct precursor lesion, but this is a recently recognized, and a difficult to diagnose, entity, which may easily be mistaken for a benign dermatosis. The aim of this study was to test the hypothesis that of all lesions that have been diagnosed as lichen sclerosus in the past, a part might currently be diagnosed as differentiated VIN, and to identify histopathological differences between lichen sclerosus lesions with and without progression to vulvar squamous cell carcinoma. All lichen sclerosus slides were revised by two expert gynecopathologists and histopathological characteristics were documented. After revision of lichen sclerosus biopsies without progression (n ¼ 61), 58 were reclassified as lichen sclerosus. Revision of lichen sclerosus biopsies with progression yielded concordant diagnoses in 18 of 60 cases (30%). Of 60 lesions, 25 (42%) were reclassified as differentiated VIN. The median time from differentiated VIN to vulvar squamous cell carcinoma was shorter (28 months) than that from lichen sclerosus to vulvar squamous cell carcinoma (84 months) (Po0.001). Lichen sclerosus that progressed to squamous cell carcinoma, but did not meet the criteria for differentiated VIN, more often showed parakeratosis (P ¼ 0.004), dyskeratosis (Po0.001), hyperplasia (P ¼ 0.048) and basal cellular atypia (P ¼ 0.009) compared with lichen sclerosus without progression. In conclusion, differentiated VIN diagnosis has been frequently missed and is associated with rapid progression to squamous cell carcinoma. Patients with lichen sclerosus with dyskeratosis and parakeratosis, hyperplasia and/or basal cellular atypia should be kept under close surveillance as these lesions also tend to progress to squamous cell carcinoma.

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Early vulvar lichen sclerosus: a histopathological challenge

Cited by 112 publications

References 24 publications

Diagnosis of Vulval Inflammatory Dermatoses: A Pathological Study With Clinical Correlation

Diagnosis of Vulval Inflammatory Dermatoses: A Pathological Study With Clinical Correlation

Diagnosis and Treatment of Lichen Sclerosus

Differentiated vulvar intraepithelial neoplasia is often found in lesions, previously diagnosed as lichen sclerosus, which have progressed to vulvar squamous cell carcinoma

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