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→‎Lichen sclerosus: split out
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==Lichen sclerosus==
==Lichen sclerosus==
*[[AKA]] ''chronic atrophic vulvitis'' - vulvar lesion.
{{Main|Lichen sclerosus}}
*[[AKA]] ''balanitis xerotica obliterans'' (BXO) - penile lesion.<ref name=pmid12602704>{{cite journal |author=Finkbeiner AE |title=Balanitis xerotica obliterans: a form of lichen sclerosus |journal=South. Med. J. |volume=96 |issue=1 |pages=7–8 |year=2003 |month=January |pmid=12602704 |doi= |url=}}</ref>
 
===General===
*Associated with [[differentiated vulvar intraepithelial neoplasia]] - '''important'''.
**Approximately 50% of [[vulvar cancer]] associated with lichen sclerosus.
 
Clinical:
*Pruritis -> leads to scratching.
*Chronic condition.
*Usu. post-menopausal women.
*May lead to labial fusion.
 
Treatment:
*Steroids - high dose initially, then a maintenance therapy to prevent relapse.
 
Notes:
*'''Mixed vulvar dystrophy''' = lichen sclerosus + squamous cell hyperplasia.<ref name=pmid9491669>{{Cite journal  | last1 = Kini | first1 = U. | title = Squamous cell carcinoma of the vulva in association with mixed vulvar dystrophy. A brief report with review of literature. | journal = Indian J Cancer | volume = 34 | issue = 2 | pages = 92-5 | month = Jun | year = 1997 | doi =  | PMID = 9491669 }}</ref>
 
===Microscopic===
Features:<ref>URL: [http://www.pathologyoutlines.com/vulva.html#lichensclerosis http://www.pathologyoutlines.com/vulva.html#lichensclerosis]. Accessed on: 19 April 2011.</ref>
*Loss of rete ridges.
*Severe [[hyperkeratosis]].
**Hyperkeratosis = stratum corneum thickened.
*Fibrosis of dermis with loss of adnexal structures - '''key feature'''.
**May appear pale - directly deep to the epidermis.<ref>URL: [http://www.webpathology.com/image.asp?n=2&Case=538 http://www.webpathology.com/image.asp?n=2&Case=538]. Accessed on: 25 August 2011.</ref>
*Inflammation - often with eosinophils.
**May be prominent - in the ''inflammatory phase'' of the disease.<ref name=pmid9537476>{{Cite journal  | last1 = Fung | first1 = MA. | last2 = LeBoit | first2 = PE. | title = Light microscopic criteria for the diagnosis of early vulvar lichen sclerosus: a comparison with lichen planus. | journal = Am J Surg Pathol | volume = 22 | issue = 4 | pages = 473-8 | month = Apr | year = 1998 | doi =  | PMID = 9537476 }}</ref>
 
DDx:
*[[Morphea profunda]] - deep fibrosis.
*[[Differentiated vulvar intraepithelial neoplasia]] - commonly co-exists with lichen sclerosus.
*[[Lichen planus]] (LP) - esp. for the ''inflammatory phase of lichen sclerosus''.
**LP has wedge shaped hypergranulosis, lacks basilar [[exocytosis]], no epidermal atrophy.<ref name=pmid9537476/>
*Cutaneous [[amyloidosis]] - classically has "cracked" appearance.
 
====Images====
<gallery>
Image:Lichen_sclerosus_-_low_mag.jpg | Lichen sclerosus - low mag. (WC/Nephron)
Image:Lichen_sclerosus_-_high_mag.jpg | Lichen sclerosus - high mag. (WC/Nephron)
Image:Lichen_sclerosus_-_very_high_mag.jpg | Lichen sclerosus - very high mag. (WC/Nephron)
</gallery>
www:
*[http://www.flickr.com/photos/euthman/2329061374/in/set-72057594114099781 Lichen sclerosus + syringoma (flickr.com)].
*[http://www.webpathology.com/image.asp?n=2&Case=538 Lichen sclerosus (webpathology.com)].
 
===Sign out===
<pre>
VULVA, BIOPSY:
- LICHEN SCLEROSUS.
</pre>
 
<pre>
FORESKIN, CIRCUMCISION:
- BALANITIS XEROTICA OBLITERANS.
</pre>
 
====Micro====
=====Inflammtory phase of lichen sclerosus=====
The sections show skin with a lymphoplasmacytic predominant interface dermatitis with hyperkeratosis. Spongiosis is present. Scattered inflammatory cell are found with the basal aspect of the epidermis; however, they do not form clusters. No mitotic activity is appreciated.
 
Focal hypergranulosis and focal parakeratosis is present. Numerous Civatte bodies are identified.
 
The focal hypergranulosis is not wedge-shaped. There are no pointed rete ridges. There is no basal squamatization.
 
=====Sclerotic phase of lichen sclerosus=====
The sections show skin with loss of the rete ridges, hyperkeratosis and marked fibrosis of the superficial dermis. Few, scattered lymphocytes are seen in the dermis.
 
A granular layer is present. There is no basal nuclear atypia. There is no acanthosis.
 
=====Sclerotic phase of lichen sclerosus with active inflammation=====
The sections show skin with loss of the rete ridges, a thin epidermis, hyperkeratosis and marked fibrosis of
the superficial dermis. Numerous lymphocytes are seen scattered between the collagen fibres
in the deeper aspect of the dermis.
 
A granular layer is present. There is no basal nuclear atypia.


==Bartholin cyst==
==Bartholin cyst==
Michael
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