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Difference between revisions of "Lichen sclerosus"
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| Caption = Lichen sclerosus. [[H&E stain]]. | | Caption = Lichen sclerosus. [[H&E stain]]. | ||
| Synonyms = balanitis xerotica obliterans (old term for lesion on glans penis) | |||
| Micro = fibrosis of dermis with loss of adnexal structures - '''key feature''', loss of the rete ridges, (severe) [[hyperkeratosis]], inflammation - often with eosinophils | | Micro = fibrosis of dermis with loss of adnexal structures - '''key feature''', loss of the rete ridges, (severe) [[hyperkeratosis]], inflammation - often with eosinophils | ||
| Subtypes = | | Subtypes = | ||
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| Gross = | | Gross = | ||
| Grossing = | | Grossing = | ||
| Site = [[vulva]], [[penis]] | | Site = [[vulva]], [[penis]], [[urethra]] | ||
| Assdx = [[differentiated vulvar intraepithelial neoplasia]], [[vulvar squamous cell carcinoma]] | | Assdx = [[differentiated vulvar intraepithelial neoplasia]], [[vulvar squamous cell carcinoma]] | ||
| Syndromes = | | Syndromes = | ||
| Clinicalhx = | | Clinicalhx = | ||
| Signs = | | Signs = | ||
| Symptoms = | | Symptoms = pruritus | ||
| Prevalence = | | Prevalence = | ||
| Bloodwork = | | Bloodwork = | ||
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'''Lichen sclerosus''' is a relatively common chronic condition classically associated with the [[vulva]]. On the vulva is also known as ''chronic atrophic vulvitis''. | '''Lichen sclerosus''' is a relatively common chronic condition classically associated with the [[vulva]]. On the vulva is also known as ''chronic atrophic vulvitis''. | ||
On the | On the glans [[penis]] it was referred to as '''balanitis xerotica obliterans''', abbreviated '''BXO'''.<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><ref name=pmid24268357>{{Cite journal | last1 = Stewart | first1 = L. | last2 = McCammon | first2 = K. | last3 = Metro | first3 = M. | last4 = Virasoro | first4 = R. | title = SIU/ICUD Consultation on Urethral Strictures: Anterior urethra-lichen sclerosus. | journal = Urology | volume = 83 | issue = 3 Suppl | pages = S27-30 | month = Mar | year = 2014 | doi = 10.1016/j.urology.2013.09.013 | PMID = 24268357 }}</ref> | ||
==General== | ==General== | ||
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Clinical: | Clinical: | ||
* | *Pruritus -> leads to scratching. | ||
*Chronic condition. | *Chronic condition. | ||
*Usu. post-menopausal women. | *Usu. post-menopausal women. | ||
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*Lichenoid inflammatory infiltrate - often with eosinophils; may destroy the dermal-epidermal junction leading to blister formation. | *Lichenoid inflammatory infiltrate - often with eosinophils; may destroy the dermal-epidermal junction leading to blister formation. | ||
**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> | **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> | ||
Notes: | |||
*May have [[angiokeratoma]]-like changes.<ref name=pmid19187108>{{Cite journal | last1 = Luzar | first1 = B. | last2 = Neil | first2 = SM. | last3 = Calonje | first3 = E. | title = Angiokeratoma-like changes in extragenital and genital lichen sclerosus. | journal = J Cutan Pathol | volume = 36 | issue = 5 | pages = 540-2 | month = May | year = 2009 | doi = 10.1111/j.1600-0560.2008.01091.x | PMID = 19187108 }}</ref> | |||
DDx: | DDx: | ||
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==Sign out== | ==Sign out== | ||
<pre> | |||
Foreskin, Circumcision: | |||
- Lichen sclerosus. | |||
- NEGATIVE for malignancy. | |||
</pre> | |||
===Block letters=== | |||
<pre> | <pre> | ||
VULVA, BIOPSY: | VULVA, BIOPSY: | ||
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Note: | Note: | ||
*''BXO'' afflicts the | *''BXO'' afflicts the glans penis. | ||
===Micro=== | ===Micro=== | ||
==== | ====Inflammatory 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. | 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. | ||