Clinicopathologic comparison of vulvar and extragenital lichen sclerosus: Histologic variants, evolving lesions, and etiology of 141 cases

J. Andrew Carlson, Philina M Lamb, John Malfetano, Robert A. Ambros, Martin C. Mihm

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

Lichen sclerosus (LS) is a persistent inflammatory dermatosis of unknown etiology with a predilection for the vulva, where it is a risk factor for carcinoma. We performed a clinicopathologic study on 121 cases of vulvar LS and 20 of extragenital LS, and we reviewed 49 vulvectomy specimens with IS to define morphologic findings, identify the earliest lesions, and correlate outcomes with histologic findings. The vulvar LS lesions were pruritic/burning, white/red, ill-defined patches predominately affecting the labia, perineum, introitus, and perianal region. The extragenital LS lesions were asymptomatic, pink to ivory white, coalescing macules or patches with well-defined borders. All of the LS cases showed dermal sclerosis, vacuolar interface changes, and a lymphocytic infiltrate underlying the sclerosis, but vulvar LS showed changes of lichen simplex chronicus or spongiotic dermatitis, dermal eosinophils, and a frequent absence of atrophy. The presence of eosinophilic spongiosis, marked lymphocyte exocytosis, dermal eosinophils, and excoriations predicted poor symptomatic response to treatment. Patch testing is recommended for these individuals as these findings suggest an allergic contact dermatitis. Examination of vulvectomy specimens revealed either a lichenoid interface or a spongiotic dermatitis in continuity with pathognomonic LS. Additionally, in these contiguous regions, we identified histologic changes that might represent evolving lesions of LS, suggesting a multifactorial etiology. In conclusion, vulvar LS was significantly different clinicopathologically from extragenital LS, and if only classic features of LS were used for pathologic diagnosis, many cases of vulvar LS would be missed. Therefore, we proposed as the minimal histologic criterion for LS the presence of a vacuolar interface reaction pattern in conjunction with dermal sclerosis (homogenized and hyalinized eosinophilic collagen bundles) of any thickness intervening between the inflammatory infiltrate and epithelium and or vessel walls.

Original languageEnglish (US)
Pages (from-to)844-854
Number of pages11
JournalModern Pathology
Volume11
Issue number9
StatePublished - Sep 1998
Externally publishedYes

Fingerprint

Vulvar Lichen Sclerosus
Lichen Sclerosus et Atrophicus
Sclerosis
Skin
Dermatitis
Eosinophils
Neurodermatitis
Perineum
Allergic Contact Dermatitis
Vulva
Exocytosis
Skin Diseases
Atrophy
Collagen
Epithelium

Keywords

  • Allergic contact dermatitis
  • Classification
  • Diagnosis
  • Lichen sclerosus

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Clinicopathologic comparison of vulvar and extragenital lichen sclerosus : Histologic variants, evolving lesions, and etiology of 141 cases. / Carlson, J. Andrew; Lamb, Philina M; Malfetano, John; Ambros, Robert A.; Mihm, Martin C.

In: Modern Pathology, Vol. 11, No. 9, 09.1998, p. 844-854.

Research output: Contribution to journalArticle

Carlson, J. Andrew ; Lamb, Philina M ; Malfetano, John ; Ambros, Robert A. ; Mihm, Martin C. / Clinicopathologic comparison of vulvar and extragenital lichen sclerosus : Histologic variants, evolving lesions, and etiology of 141 cases. In: Modern Pathology. 1998 ; Vol. 11, No. 9. pp. 844-854.
@article{bdb788002d6e4a3c8531c837c15eade0,
title = "Clinicopathologic comparison of vulvar and extragenital lichen sclerosus: Histologic variants, evolving lesions, and etiology of 141 cases",
abstract = "Lichen sclerosus (LS) is a persistent inflammatory dermatosis of unknown etiology with a predilection for the vulva, where it is a risk factor for carcinoma. We performed a clinicopathologic study on 121 cases of vulvar LS and 20 of extragenital LS, and we reviewed 49 vulvectomy specimens with IS to define morphologic findings, identify the earliest lesions, and correlate outcomes with histologic findings. The vulvar LS lesions were pruritic/burning, white/red, ill-defined patches predominately affecting the labia, perineum, introitus, and perianal region. The extragenital LS lesions were asymptomatic, pink to ivory white, coalescing macules or patches with well-defined borders. All of the LS cases showed dermal sclerosis, vacuolar interface changes, and a lymphocytic infiltrate underlying the sclerosis, but vulvar LS showed changes of lichen simplex chronicus or spongiotic dermatitis, dermal eosinophils, and a frequent absence of atrophy. The presence of eosinophilic spongiosis, marked lymphocyte exocytosis, dermal eosinophils, and excoriations predicted poor symptomatic response to treatment. Patch testing is recommended for these individuals as these findings suggest an allergic contact dermatitis. Examination of vulvectomy specimens revealed either a lichenoid interface or a spongiotic dermatitis in continuity with pathognomonic LS. Additionally, in these contiguous regions, we identified histologic changes that might represent evolving lesions of LS, suggesting a multifactorial etiology. In conclusion, vulvar LS was significantly different clinicopathologically from extragenital LS, and if only classic features of LS were used for pathologic diagnosis, many cases of vulvar LS would be missed. Therefore, we proposed as the minimal histologic criterion for LS the presence of a vacuolar interface reaction pattern in conjunction with dermal sclerosis (homogenized and hyalinized eosinophilic collagen bundles) of any thickness intervening between the inflammatory infiltrate and epithelium and or vessel walls.",
keywords = "Allergic contact dermatitis, Classification, Diagnosis, Lichen sclerosus",
author = "Carlson, {J. Andrew} and Lamb, {Philina M} and John Malfetano and Ambros, {Robert A.} and Mihm, {Martin C.}",
year = "1998",
month = "9",
language = "English (US)",
volume = "11",
pages = "844--854",
journal = "Modern Pathology",
issn = "0893-3952",
publisher = "Nature Publishing Group",
number = "9",

}

TY - JOUR

T1 - Clinicopathologic comparison of vulvar and extragenital lichen sclerosus

T2 - Histologic variants, evolving lesions, and etiology of 141 cases

AU - Carlson, J. Andrew

AU - Lamb, Philina M

AU - Malfetano, John

AU - Ambros, Robert A.

AU - Mihm, Martin C.

PY - 1998/9

Y1 - 1998/9

N2 - Lichen sclerosus (LS) is a persistent inflammatory dermatosis of unknown etiology with a predilection for the vulva, where it is a risk factor for carcinoma. We performed a clinicopathologic study on 121 cases of vulvar LS and 20 of extragenital LS, and we reviewed 49 vulvectomy specimens with IS to define morphologic findings, identify the earliest lesions, and correlate outcomes with histologic findings. The vulvar LS lesions were pruritic/burning, white/red, ill-defined patches predominately affecting the labia, perineum, introitus, and perianal region. The extragenital LS lesions were asymptomatic, pink to ivory white, coalescing macules or patches with well-defined borders. All of the LS cases showed dermal sclerosis, vacuolar interface changes, and a lymphocytic infiltrate underlying the sclerosis, but vulvar LS showed changes of lichen simplex chronicus or spongiotic dermatitis, dermal eosinophils, and a frequent absence of atrophy. The presence of eosinophilic spongiosis, marked lymphocyte exocytosis, dermal eosinophils, and excoriations predicted poor symptomatic response to treatment. Patch testing is recommended for these individuals as these findings suggest an allergic contact dermatitis. Examination of vulvectomy specimens revealed either a lichenoid interface or a spongiotic dermatitis in continuity with pathognomonic LS. Additionally, in these contiguous regions, we identified histologic changes that might represent evolving lesions of LS, suggesting a multifactorial etiology. In conclusion, vulvar LS was significantly different clinicopathologically from extragenital LS, and if only classic features of LS were used for pathologic diagnosis, many cases of vulvar LS would be missed. Therefore, we proposed as the minimal histologic criterion for LS the presence of a vacuolar interface reaction pattern in conjunction with dermal sclerosis (homogenized and hyalinized eosinophilic collagen bundles) of any thickness intervening between the inflammatory infiltrate and epithelium and or vessel walls.

AB - Lichen sclerosus (LS) is a persistent inflammatory dermatosis of unknown etiology with a predilection for the vulva, where it is a risk factor for carcinoma. We performed a clinicopathologic study on 121 cases of vulvar LS and 20 of extragenital LS, and we reviewed 49 vulvectomy specimens with IS to define morphologic findings, identify the earliest lesions, and correlate outcomes with histologic findings. The vulvar LS lesions were pruritic/burning, white/red, ill-defined patches predominately affecting the labia, perineum, introitus, and perianal region. The extragenital LS lesions were asymptomatic, pink to ivory white, coalescing macules or patches with well-defined borders. All of the LS cases showed dermal sclerosis, vacuolar interface changes, and a lymphocytic infiltrate underlying the sclerosis, but vulvar LS showed changes of lichen simplex chronicus or spongiotic dermatitis, dermal eosinophils, and a frequent absence of atrophy. The presence of eosinophilic spongiosis, marked lymphocyte exocytosis, dermal eosinophils, and excoriations predicted poor symptomatic response to treatment. Patch testing is recommended for these individuals as these findings suggest an allergic contact dermatitis. Examination of vulvectomy specimens revealed either a lichenoid interface or a spongiotic dermatitis in continuity with pathognomonic LS. Additionally, in these contiguous regions, we identified histologic changes that might represent evolving lesions of LS, suggesting a multifactorial etiology. In conclusion, vulvar LS was significantly different clinicopathologically from extragenital LS, and if only classic features of LS were used for pathologic diagnosis, many cases of vulvar LS would be missed. Therefore, we proposed as the minimal histologic criterion for LS the presence of a vacuolar interface reaction pattern in conjunction with dermal sclerosis (homogenized and hyalinized eosinophilic collagen bundles) of any thickness intervening between the inflammatory infiltrate and epithelium and or vessel walls.

KW - Allergic contact dermatitis

KW - Classification

KW - Diagnosis

KW - Lichen sclerosus

UR - http://www.scopus.com/inward/record.url?scp=0345267111&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0345267111&partnerID=8YFLogxK

M3 - Article

C2 - 9758364

AN - SCOPUS:0345267111

VL - 11

SP - 844

EP - 854

JO - Modern Pathology

JF - Modern Pathology

SN - 0893-3952

IS - 9

ER -