Be Aware of Erosive Lichen Planus as Mimicker of Dysplasia in the Vulva

Summary and Comment |
March 15, 2016

Be Aware of Erosive Lichen Planus as Mimicker of Dysplasia in the Vulva

  1. Angelica Selim, MD

Histologic overlap between differentiated vulvar intraepithelial neoplasia and erosive lichen planus may require a multidisciplinary conference for resolution.

  1. Angelica Selim, MD

Differentiated vulvar intraepithelial neoplasia (dVIN) is a precursor lesion that can arise from inflammatory diseases like lichen sclerosus (LS) and lichen planus (LP). Around 33% of dVIN evolves to invasive squamous cell carcinoma. This study explores the histologic overlap between LP, erosive type (ELP) and dVIN.

Histologic features, immunohistochemical stains (p53 and p16), and copy variant analyses were performed on samples from five patients with ELP and dVIN (mean age, 76). All ELP patients complained of pain, and 90% exhibited LS. ELP samples showed epithelial thinning, lack of maturation, and nuclear changes of enlargement, pleomorphism, and hyperchromasia. Wild-type p53 was the most frequent pattern seen in inflammatory and dysplastic cases (3 ELP cases and only 1 dVIN). All were negative for p16. A similar copy number pattern was noted in ELP patients and controls, while dVIN had many copy number changes.

Comment

Erosive vulvitis can occur in ELP. The difficulty in differentiating vulvar regenerative atypia in ELP from evolving neoplasia can be seen in other organs, like the oral cavity. The pathologist needs to avoid confusing maturation disarray and nuclear changes with dysplasia. Immunohistochemical stains are of limited value for this conundrum; null p53 supports dysplasia in a minority of cases. Although studying the copy number changes can be helpful, it is expensive, delays diagnosis, and is not broadly available. Multidisciplinary conferences between clinicians and pathologists are best for resolving challenging cases. The presence of circumferential or symmetric flat erosion on mucosa suggests ELP, while an erythematous plaque indicates dVIN.

Editor Disclosures at Time of Publication

  • Disclosures for Angelica Selim, MD at time of publication Grant / Research support NIH/NCI, The Plastic Surgery Foundation

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