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Shi WJ, Nguyen J, Song W, Wang HY, Lin GY, Fadare O, Lei L. Isolated Monoclonal T-Cell Receptor Gene Rearrangement in a Lung Adenocarcinoma Harboring MET Exon 14 Skipping: Diagnostic Pitfall. Int J Surg Pathol 2024:10668969241266927. [PMID: 39155593 DOI: 10.1177/10668969241266927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
In the diagnostic workup of poorly differentiated tumors, T-cell receptor (TCR) clonality has long been considered as evidence of T-cell lymphoma. MET exon 14 skipping (METex14) is a mutation typically seen in lung adenocarcinoma. Herein, we present the first report of METex14 lung adenocarcinoma with isolated monoclonal TCRγ gene rearrangement. A 69-year-old woman presented to an outside hospital with pleural effusions. A pleural decortication demonstrated malignant cells positive for CD30 and CD138 but negative for BerEP4, KRT5, and EMA. An equivocal HHV8 staining was interpreted as positive, leading to the erroneous outside diagnosis of primary effusion lymphoma. Additional workup at our institution revealed a lack of HHV8 and T-cell markers but the presence of TCRγ clonality, pankeratin, and TTF1 expression. Repeat TCRγ testing on the in-house biopsy was negative for clonality. Next-generation sequencing detected METex14, confirming the diagnosis of lung adenocarcinoma. The potential diagnostic pitfall and prognostic/predictive implications are discussed.
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Affiliation(s)
- Wangpan Jackson Shi
- Department of Pathology and Laboratory Medicine, University of California San Diego, La Jolla, California, USA
| | - Joshua Nguyen
- Department of Pathology and Laboratory Medicine, University of California San Diego, La Jolla, California, USA
| | - Wei Song
- Department of Pathology and Laboratory Medicine, University of California San Diego, La Jolla, California, USA
| | - Huan-You Wang
- Department of Pathology and Laboratory Medicine, University of California San Diego, La Jolla, California, USA
| | - Grace Y Lin
- Department of Pathology and Laboratory Medicine, University of California San Diego, La Jolla, California, USA
| | - Oluwole Fadare
- Department of Pathology and Laboratory Medicine, University of California San Diego, La Jolla, California, USA
| | - Li Lei
- Department of Pathology and Laboratory Medicine, University of California San Diego, La Jolla, California, USA
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D'Souza SL, Ravikumar G, Antony M, Tirumale R. Vulvar Lichenoid Dermatoses With Emphasis on the Distinction Between Lichen Sclerosus and Lichen Planus: A 10-Year Study. J Low Genit Tract Dis 2024; 28:189-197. [PMID: 38518217 DOI: 10.1097/lgt.0000000000000789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
OBJECTIVES Lichen planus (LP) and lichen sclerosus (LS) are the most common vulvar lichenoid dermatoses. The diagnostic challenges are due to site-specific variation in microscopic appearance and small-sized biopsies. Authentication of diagnostic criteria to distinguish LS and LP to uncover any resemblance or divergence in presentation of these conditions is attempted. METHODS Cases of vulvar LP and LS diagnosed between January 2012 to December 2022 were included. The clinical details included age, presenting symptoms, examination findings, and other organ involvement. Histopathological analysis of epidermal, dermal, and adnexal findings was done. RESULTS There were 28 cases of vulvar LP and 72 cases of LS, with a median age of 51 and 60 years, respectively. Depigmentation and atrophy were the major clinical features in LS, whereas ulcers/erosions and erythema were more prevalent in LP with a significantly higher incidence of oral involvement. The most diagnostic feature in LS was diffuse dermal sclerosis (76.8%) and interstitial pattern of inflammation (81.4%), whereas the characteristic features in LP cases was a lichenoid pattern of inflammation (85.7%), necrotic keratinocytes, and lymphocytic exocytosis. In 44.4% of LS, unconventional features like compact orthokeratosis, parakeratosis, thickened/wedge-shaped hypergranulosis, and sawtooth rete pegs were noted. Lichen sclerosus with lichenoid inflammation (21.4%) mimicked LP, from which it was distinguished by presence of thickened or diminished granular layer with basal melanin absence (60%) and dermal homogenization (80%). CONCLUSION Although the classical, well-established variant of LS poses no diagnostic difficulty, the unconventional variant may mimic LP. Identification of the subtle histological clues demonstrated in this study can help to arrive at the correct diagnosis.
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Affiliation(s)
| | - Gayatri Ravikumar
- Department of Pathology, St. John's Medical College, Bangalore, India
| | - Meryl Antony
- Department of Dermatology, St. John's Medical College and Hospital, Bangalore, India
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Pyle HJ, Evans JC, Vandergriff TW, Mauskar MM. Vulvar Lichen Sclerosus Clinical Severity Scales and Histopathologic Correlation: A Case Series. Am J Dermatopathol 2023; 45:588-592. [PMID: 37462209 DOI: 10.1097/dad.0000000000002471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
ABSTRACT Several vulvar lichen sclerosus (VLS) clinical severity scales have recently been proposed. In this prospective case series, we characterized histopathology in the context of clinical severity in 6 treatment-naïve postmenopausal patients with VLS. The Vulvar Quality of Life Index (VQLI) and an adaptation of the 2018 International Society for the Study of Vulvovaginal Disease Delphi consensus VLS severity score were administered. Vulvar skin punch biopsies were obtained to measure inflammatory density, constituent inflammatory cells, thickness of the stratum corneum and other epidermal layers, dermal edema, and dermal sclerosis. Clinicopathologic correlations were assessed. Two cases demonstrated sparse inflammatory densities, 1 case demonstrated patchy and nodular inflammatory density, 1 case demonstrated dense lichenoid inflammatory density, and 2 cases demonstrated dense lichenoid and epitheliotropic inflammatory densities. Those patients who reported severe pruritus demonstrated the greatest lymphocytic inflammatory densities on histopathological examination. Both cases of ulceration or erosion were associated with severe VQLI scores. Severe VQLI scores were also associated with trends for higher average thickness of the epidermal layers and of dermal sclerosis. Altogether, histopathologic grading of biopsy sites may reflect clinical severity in patients with VLS.
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Affiliation(s)
- Hunter J Pyle
- Departments of Dermatology; Pathology; and Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
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Giuliani E, Rollo F, Cota C, Gheit T, Galati L, McKay-Chopin S, Tedesco M, Migliano E, Benevolo M, Morrone A, Donà MG, Latini A. Alpha, Beta, and Gamma Human Papillomaviruses in Genital Lichen Sclerosus: A Retrospective Cross-Sectional Study. J Low Genit Tract Dis 2023; 27:236-241. [PMID: 37052458 DOI: 10.1097/lgt.0000000000000741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND Lichen sclerosus (LS) is an inflammatory disease mostly arising at the genital level. It is unclear whether human papillomaviruses (HPVs) have an etiological significance in LS, and data on their prevalence in patients with LS are controversial. OBJECTIVES The authors assessed alpha, beta, and gamma HPV prevalence in patients with genital LS. The association of HPV positivity with demographic and clinical factors was also investigated. METHODS One hundred thirty-two formalin-fixed, paraffin-embedded LS samples (2016-2020) were retrieved from the archives of a pathology department. Alpha HPVs were genotyped with the INNO-LiPA HPV Genotyping Extra II kit. Beta and gamma HPVs were searched by multiplex Polymerase Chain Reaction. Immunostaining for p16 INK4a was performed on high-risk HPV-positive samples. RESULTS Patients had a median age of 61 years, were mostly women ( n = 73, 55.3%), and with an early disease stage ( n = 79, 59.8%). Alpha HPVs were detected in 12/132 cases (9.1%). Among the 5 high-risk HPV-positive cases, only 2 displayed a strong and diffuse p16 INK4a staining. Beta genus was the most prevalent (35/132, 26.5%) and HPV5 was the most frequent beta genotype (25/132, 18.9%). There were 3 gamma HPV-positive cases among those with a valid result (3/131, 2.3%). Multiple infections with genotypes belonging to different genera were infrequent (3/131, 2.3%). No significant differences in the prevalence of the individual genera were observed according to sex and disease stage. CONCLUSIONS Of the 3 HPV genera, beta genus showed the highest prevalence. Further research is needed to clarify whether the presence of beta HPVs in genital LS has a clinical significance.
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Affiliation(s)
- Eugenia Giuliani
- Scientific Direction, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Francesca Rollo
- Pathology Department, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Carlo Cota
- Genetic Research Unit, Dermatological Molecular Biology and Dermatopathology, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Tarik Gheit
- International Agency for Research on Cancer (IARC), Lyon, France
| | - Luisa Galati
- International Agency for Research on Cancer (IARC), Lyon, France
| | | | - Marinella Tedesco
- Plastic Surgery, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Emilia Migliano
- Plastic Surgery, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Maria Benevolo
- Pathology Department, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Aldo Morrone
- Scientific Direction, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Maria Gabriella Donà
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Alessandra Latini
- STI/HIV Unit, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
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Preti M, Joura E, Vieira-Baptista P, Van Beurden M, Bevilacqua F, Bleeker MCG, Bornstein J, Carcopino X, Chargari C, Cruickshank ME, Erzeneoglu BE, Gallio N, Heller D, Kesic V, Reich O, Stockdale CK, Esat Temiz B, Woelber L, Planchamp F, Zodzika J, Querleu D, Gultekin M. The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD) and the European Federation for Colposcopy (EFC) consensus statements on pre-invasive vulvar lesions. Int J Gynecol Cancer 2022; 32:830-845. [PMID: 35728950 PMCID: PMC9279839 DOI: 10.1136/ijgc-2021-003262] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 11/16/2022] Open
Abstract
The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) developed consensus statements on pre-invasive vulvar lesions in order to improve the quality of care for patients with vulvar squamous intraepithelial neoplasia, vulvar Paget disease in situ, and melanoma in situ. For differentiated vulvar intraepithelial neoplasia (dVIN), an excisional procedure must always be adopted. For vulvar high-grade squamous intraepithelial lesion (VHSIL), both excisional procedures and ablative ones can be used. The latter can be considered for anatomy and function preservation and must be preceded by several representative biopsies to exclude malignancy. Medical treatment (imiquimod or cidofovir) can be considered for VHSIL. Recent studies favor an approach of using imiquimod in vulvar Paget's disease. Surgery must take into consideration that the extension of the disease is usually wider than what is evident in the skin. A 2 cm margin is usually considered necessary. A wide local excision with 1 cm free surgical margins is recommended for melanoma in situ. Following treatment of pre-invasive vulvar lesions, women should be seen on a regular basis for careful clinical assessment, including biopsy of any suspicious area. Follow-up should be modulated according to the risk of recurrence (type of lesion, patient age and immunological conditions, other associated lower genital tract lesions).
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Affiliation(s)
- Mario Preti
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Elmar Joura
- Department of Gynecology and Gynecologic Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Pedro Vieira-Baptista
- Hospital Lusiadas Porto, Porto, Portugal
- Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal
| | - Marc Van Beurden
- Centre for Gynecological Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | | | - Maaike C G Bleeker
- Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Jacob Bornstein
- Galilee Medical Center and Azrieli Faculty of Medicine, Bar-Ilan, Israel
| | - Xavier Carcopino
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397, Marseille, France
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Paris, France
| | | | - Bilal Emre Erzeneoglu
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecological Oncology, Hacettepe University, Ankara, Turkey
| | - Niccolò Gallio
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Debra Heller
- Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Vesna Kesic
- Department of Obstetrics and Gynecology, University of Belgrade, Belgrade, Serbia
| | - Olaf Reich
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Colleen K Stockdale
- Department of Obstetrics & Gynecology, University of Iowa, Iowa City, Iowa, USA
| | - Bilal Esat Temiz
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecological Oncology, Hacettepe University, Ankara, Turkey
| | - Linn Woelber
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
- Dysplasia Center Hamburg, Jerusalem Hospital, Hamburg, Germany
| | | | - Jana Zodzika
- Department of Obstetrics and Gynaecology Rīga Stradiņš university, Riga, Latvia
| | - Denis Querleu
- Department of Obstetrics and Gynecologic Oncology, University Hospital, Strasbourg, France
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Murat Gultekin
- Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Preti M, Joura E, Vieira-Baptista P, Van Beurden M, Bevilacqua F, Bleeker MCG, Bornstein J, Carcopino X, Chargari C, Cruickshank ME, Erzeneoglu BE, Gallio N, Heller D, Kesic V, Reich O, Stockdale CK, Temiz BE, Woelber L, Planchamp F, Zodzika J, Querleu D, Gultekin M. The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD) and the European Federation for Colposcopy (EFC) Consensus Statements on Pre-invasive Vulvar Lesions. J Low Genit Tract Dis 2022; 26:229-244. [PMID: 35763611 PMCID: PMC9232287 DOI: 10.1097/lgt.0000000000000683] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) developed consensus statements on pre-invasive vulvar lesions in order to improve the quality of care for patients with vulvar squamous intraepithelial neoplasia, vulvar Paget disease in situ, and melanoma in situ. For differentiated vulvar intraepithelial neoplasia (dVIN), an excisional procedure must always be adopted. For vulvar high-grade squamous intraepithelial lesion (VHSIL), both excisional procedures and ablative ones can be used. The latter can be considered for anatomy and function preservation and must be preceded by several representative biopsies to exclude malignancy. Medical treatment (imiquimod or cidofovir) can be considered for VHSIL. Recent studies favor an approach of using imiquimod in vulvar Paget's disease. Surgery must take into consideration that the extension of the disease is usually wider than what is evident in the skin. A 2 cm margin is usually considered necessary. A wide local excision with 1 cm free surgical margins is recommended for melanoma in situ. Following treatment of pre-invasive vulvar lesions, women should be seen on a regular basis for careful clinical assessment, including biopsy of any suspicious area. Follow-up should be modulated according to the risk of recurrence (type of lesion, patient age and immunological conditions, other associated lower genital tract lesions).
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Affiliation(s)
- Mario Preti
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Elmar Joura
- Department of Gynecology and Gynecologic Oncology, Comprehensive Cancer; Center, Medical University of Vienna, Vienna, Austria
| | - Pedro Vieira-Baptista
- Hospital Lusiadas Porto, Porto, Portugal; Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal
| | - Marc Van Beurden
- Centre for Gynecological Oncology Amsterdam, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | | | - Maaike C. G. Bleeker
- Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Jacob Bornstein
- Galilee Medical Center and Azrieli Faculty of Medicine, Bar-Ilan, Israel
| | - Xavier Carcopino
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397, Marseille, France
| | - Cyrus Chargari
- Radiation Therapy, Gustave Roussy Cancer Campus, Paris, France
| | - Margaret E. Cruickshank
- Aberdeen Centre for Women’s Health Research, University of Aberdeen, Aberdeen, United Kingdom
| | - Bilal Emre Erzeneoglu
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecological Oncology, Hacettepe University, Ankara, Turkey
| | - Niccolò Gallio
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | | | - Vesna Kesic
- Department of Obstetrics and Gynecology, University of Belgrade, Belgrade, Serbia
| | - Olaf Reich
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | | | - Bilal Esat Temiz
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecological Oncology, Hacettepe University, Ankara, Turkey
| | - Linn Woelber
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Dysplasia Center Hamburg, Jerusalem Hospital, Hamburg, Germany
| | | | - Jana Zodzika
- Department of Obstetrics and Gynaecology Rīga Stradiņš university, Riga, Latvia
| | - Denis Querleu
- Department of Obstetrics and Gynecologic Oncology, University Hospital, Strasbourg, France; Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Murat Gultekin
- Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Günthert AR, Limacher A, Beltraminelli H, Krause E, Mueller MD, Trelle S, Bobos P, Jüni P. Efficacy of topical progesterone versus topical clobetasol propionate in patients with vulvar Lichen sclerosus - A double-blind randomized phase II pilot study. Eur J Obstet Gynecol Reprod Biol 2022; 272:88-95. [PMID: 35290878 DOI: 10.1016/j.ejogrb.2022.03.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/11/2022] [Accepted: 03/08/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Lichen sclerosus (LS) is a chronic inflammatory skin disease that mostly affects the anogenital region of women and lowers patients' quality of life. Current standard treatment of LS is topical steroids. OBJECTIVE To evaluate the efficacy of topical progesterone 8% ointment and compare to standard therapy with topical clobetasol propionate 0.05% in premenopausal women presenting with previously untreated early onset LS. STUDY DESIGN Randomized, double-blind, 2-arm, single center superiority trial in premenopausal women with histologically confirmed vulvar LS who were randomized in a 1:1 ratio to receive clobetasol propionate 0.05% ointment or progesterone 8% ointment. The primary outcome was the clinical severity LS score after 12 weeks, which consists of six clinical features assessed by the physician. Secondary outcomes were the symptom severity LS score, which consists of three symptoms rated by the patient, the Short Form SF-12 physical and mental health scores, and adverse events. Response to medication was assessed by biopsy at the end of the treatment to evaluate inflammatory parameters. RESULTS Overall, 105 women were screened, 102 underwent vulvar biopsy and 37 received a histologically confirmed diagnosis of LS and were randomized: 17 to progesterone and 20 to clobetasol propionate. At 12 weeks, the mean clinical LS scores improved from 4.6 (SD 2.0) to 4.5 (SD 1.7) in the progesterone arm, and from 4.6 (SD 2.8) to 2.9 (SD 2.2) in the clobetasol propionate arm (difference in favor of clobetasol 1.61; 95% CI 0.44 to 2.77, p = 0.009), and the mean symptom severity LS scores improved from 4.5 (SD 3.8) to 3.1 (SD 3.0) in the progesterone arm, and from 4.7 (SD 2.8) to 1.9 (SD 1.8) in the clobetasol propionate arm (difference in favor of clobetasol 1.32; 95% CI -0.25 to 2.89, p = 0.095). LS was in complete remission in 6 out of 10 patients (60%) with available biopsy in the progesterone arm, and in 13 out of 16 patients (81.3%) in the clobetasol propionate arm (odds ratio in favor of clobetasol 0.35; 95% CI 0.06 to 2.06, p = 0.234). No drug-related serious adverse event occurred during the trial. CONCLUSIONS Topical progesterone 8% ointment is inferior to standard therapy with topical clobetasol propionate 0.05% in previously untreated premenopausal women with vulvar LS after 12 weeks treatment.
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Affiliation(s)
- Andreas R Günthert
- Department of Gynecology and Obstetrics, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland; gyn-zentrum ag, Lucerne, Switzerland
| | | | - Helmut Beltraminelli
- Department of Dermatology and Dermatopathology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Elke Krause
- Department of Gynecology and Obstetrics, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Michael D Mueller
- Department of Gynecology and Obstetrics, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Sven Trelle
- CTU Bern, University of Bern, Bern, Switzerland
| | - Pavlos Bobos
- University of Toronto, Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada
| | - Peter Jüni
- University of Toronto, Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada; Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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8
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Pors J, Tessier-Cloutier B, Thompson E, Almadani N, Ho J, Gilks B, Huntsman D, Hoang L. Targeted Molecular Sequencing of Recurrent and Multifocal Non-HPV-associated Squamous Cell Carcinoma of the Vulva. Int J Gynecol Pathol 2021; 40:391-399. [PMID: 33323855 DOI: 10.1097/pgp.0000000000000742] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Recurrent vulvar squamous cell carcinomas (SCCs) are a poorly understood and aggressive group of treatment-resistant neoplasms. Currently, it remains unclear whether these are in fact recurrences of the same primary tumor, or the development of entirely new tumors. Here, to address this question, we examined the mutational profile of a series of patients with recurrent or multifocal non-human papilloma virus (HPV)-associated vulvar SCC. We performed a targeted 33-gene next-generation sequencing panel on a series of 14 patients with recurrent or multifocal non-HPV-associated vulvar SCC and precursor neoplasms. This amounted to 54 cases (33 SCC, 1 verrucous carcinoma, 13 differentiated vulvar intraepithelial neoplasia, and 7 differentiated exophytic vulvar intraepithelial lesion), with 79 mutations detected altogether. TP53 [51/79 (65%)] was the most frequently mutated gene. Mutations in PIK3CA [16/79 (20%)), HRAS [6/79 (8%)], PTEN [4/79 (5%)], EGFR [1/79 (1%)], and GNAS [1/79 (1%)] were occasionally seen. Most patients with SCC [5/9 (56%)] recurrent, 4/5 (80%) multifocal] demonstrated a clonal relationship, and harbored the same mutations in the same genes in metachronous or synchronous tumors. A subset of the recurrent tumors [2/5 (40%)] recurred with additional mutations. These clonal relationships were shared between SCC and differentiated vulvar intraepithelial neoplasia in each case. By contrast, a small number of recurrent tumors [3/9 (33%)] demonstrated novel mutations, entirely different from the primary tumor. Thus, our findings suggest that recurrent non-HPV-associated vulvar SCC can arise from 2 mechanisms.
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9
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Wölber L, Jaeger A. Vulvadysplasie und Vulvakarzinom. COLOPROCTOLOGY 2021. [DOI: 10.1007/s00053-021-00543-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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Lichen Sclerosus et Atrophicus With Histopathologic Features Mimicking Mycosis Fungoides: A Large Series of Cases Comparing Genital With Extragenital Lichen Sclerosus. Am J Surg Pathol 2021; 46:83-88. [PMID: 34049317 DOI: 10.1097/pas.0000000000001738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory dermatosis of unknown etiology involving the genital and/or extragenital area, showing histopathologically a characteristic homogeneization and sclerosis of the superficial collagen with variably dense lymphoid infiltrates. Intraepidermal lymphocytes may be observed, and in some cases may pose differential diagnostic problems with mycosis fungoides (MF). We studied the histopathologic features of 121 cases of LSA with dense lymphoid infiltrates (genital: 94; male:female: 93:1; age range: 2 to 87 y; median age: 11 y; extragenital: 27; male:female: 0.1:1; age range: 11 to 79 y; median age: 59 y), to better characterize the intraepidermal lymphoid infiltrate and to compare genital with extragenital cases. Epidermotropic lymphocytes mimicking the histopathologic features of MF were present in 93.6% of the genital specimens but none of the extragenital cases. Interestingly, typical features of LSA were mssing in 39.4% of genital LSA, and in a further 25.5% were present only focally. Immunohistochemical analyses showed a predominance of CD8+ T-lymphocytes within the epidermis. Molecular studies of the T-cell receptor genes revealed a monoclonal population of T-lymphocytes in nearly half of the cases. Our study shows that MF-like histopathologic features are extremely common in genital LSA but are never encountered in extragenital cases. A diagnosis of MF in the genital area should be made only upon compelling features, keeping in mind the frequent pseudolymphomatous aspects of LSA.
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Watchorn RE, van den Munckhof EHA, Quint KD, Eliahoo J, de Koning MNC, Quint WGV, Bunker CB. Balanopreputial sac and urine microbiota in patients with male genital lichen sclerosus. Int J Dermatol 2020; 60:201-207. [PMID: 33084022 DOI: 10.1111/ijd.15252] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/22/2020] [Accepted: 09/16/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Male genital lichen sclerosus (MGLSc) is a chronic inflammatory scarring dermatosis associated with penile carcinoma. The prepuce is pivotal in its etiology. Other proposed etiological factors are the subject of dispute and include occluded urinary exposure, autoimmunity, immunodysregulation, and infectious agents. OBJECTIVE To determine whether the bacterial microbiota of the balanopreputial sac and urine are associated with MGLSc. SUBJECTS AND METHODS Twenty uncircumcised patients with MGLSc and 20 healthy uncircumcised males were enrolled in a prospective case-control study. Balanopreputial swabs and urine specimens were subjected to 16S rRNA gene amplicon sequencing. RESULTS Microbiota analysis indicated differences between the groups. In the balanopreputial sac, the median relative abundance of Finegoldia spp. was lower (9% [range 0-60%]) in MGLSc patients than in controls (28% [range 0-62%]). Conversely, the median relative abundance of Fusobacterium spp. was higher in MGLSc patients (4% [range 0-41%]) than in controls (0% [range 0-28%]). In the urine, the median relative abundance of Finegoldia spp. was comparable between groups, whereas that of Fusobacterium spp. was higher in MGLSc patients (0% [range 0-18%] vs. 0% [range 0-5%]). There was a strong association between the microbiota composition of the balanopreputial sac and urine in MGLSc. CONCLUSION Dysbiosis could be involved in the etiopathogenesis of MGLSc. Further studies are required to confirm the association suggested herein and to determine its nature.
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Affiliation(s)
| | | | - Koen D Quint
- Department of Dermatology, Leiden University Medical Center, Leiden, Netherlands
| | - Joseph Eliahoo
- Statistical Advisory Service, Imperial College London, London, UK
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Dasgupta S, Ewing-Graham PC, Swagemakers SMA, van der Spek PJ, van Doorn HC, Noordhoek Hegt V, Koljenović S, van Kemenade FJ. Precursor lesions of vulvar squamous cell carcinoma - histology and biomarkers: A systematic review. Crit Rev Oncol Hematol 2020; 147:102866. [PMID: 32058913 DOI: 10.1016/j.critrevonc.2020.102866] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/21/2019] [Accepted: 01/13/2020] [Indexed: 12/01/2022] Open
Abstract
The precursor lesion of vulvar squamous cell carcinoma (VSCC), namely vulvar intraepithelial neoplasia (VIN), is classified as: human papillomavirus (HPV)-related high grade squamous intraepithelial lesion (HSIL), and HPV-independent differentiated VIN (dVIN). Traditionally, histology and immunohistochemistry (IHC) have been the basis of diagnosis and classification of VIN. HSIL shows conspicuous histological atypia, and positivity on p16-IHC, whereas dVIN shows less obvious histological atypia, and overexpression or null-pattern on p53-IHC. For both types of VIN, other diagnostic immunohistochemical markers have also been evaluated. Molecular characterization of VIN has been attempted in few recent studies, and novel genotypic subtypes of HPV-independent VSCC and VIN have been identified. This systematic review appraises the VSCC precursors identified so far, focusing on histology and biomarkers (immunohistochemical and molecular). To gain further insights into the carcinogenesis and to identify additional potential biomarkers, gene expression omnibus (GEO) datasets on VSCC were analyzed; the results are presented.
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Affiliation(s)
- Shatavisha Dasgupta
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, the Netherlands.
| | | | - Sigrid M A Swagemakers
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, the Netherlands; Department of Bioinformatics, Erasmus MC, University Medical Centre Rotterdam, the Netherlands.
| | - Peter J van der Spek
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, the Netherlands; Department of Bioinformatics, Erasmus MC, University Medical Centre Rotterdam, the Netherlands.
| | - Helena C van Doorn
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| | - Vincent Noordhoek Hegt
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, the Netherlands.
| | - Senada Koljenović
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, the Netherlands.
| | - Folkert J van Kemenade
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, the Netherlands.
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Fergus KB, Lee AW, Baradaran N, Cohen AJ, Stohr BA, Erickson BA, Mmonu NA, Breyer BN. Pathophysiology, Clinical Manifestations, and Treatment of Lichen Sclerosus: A Systematic Review. Urology 2020; 135:11-19. [DOI: 10.1016/j.urology.2019.09.034] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 11/25/2022]
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Tetzlaff MT, Tang S, Duke T, Grabell DA, Cabanillas ME, Zuo Z, Yao JC, Nagarajan P, Aung PP, Torres‐Cabala CA, Duvic M, Prieto VG, Huen A, Curry JL. Lichenoid dermatitis from immune checkpoint inhibitor therapy: An immune‐related adverse event with mycosis‐fungoides‐like morphologic and molecular features. J Cutan Pathol 2019; 46:872-877. [DOI: 10.1111/cup.13536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Michael T. Tetzlaff
- Department of Pathology, Section of DermatopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
- Department of Translational Molecular PathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Sherry Tang
- Department of Pathology, Section of DermatopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Taylor Duke
- Department of DermatologyThe University of Texas Health Science Houston Texas
| | - Daniel A. Grabell
- Department of DermatologyThe University of Texas Health Science Houston Texas
| | - Maria E. Cabanillas
- Department of Endocrine Neoplasia and Hormonal DisordersThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Zhuang Zuo
- Department of HematopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - James C. Yao
- Department of GI Medical OncologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Priyadharsini Nagarajan
- Department of Pathology, Section of DermatopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Phyu P. Aung
- Department of Pathology, Section of DermatopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Carlos A. Torres‐Cabala
- Department of Pathology, Section of DermatopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
- Department of DermatologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Madeleine Duvic
- Department of DermatologyThe University of Texas MD Anderson Cancer Center Houston Texas
- Department of DermatologyThe University of Texas Health Science Houston Texas
| | - Victor G. Prieto
- Department of Pathology, Section of DermatopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
- Department of DermatologyThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Auris Huen
- Department of DermatologyThe University of Texas MD Anderson Cancer Center Houston Texas
- Department of DermatologyThe University of Texas Health Science Houston Texas
| | - Jonathan L. Curry
- Department of Pathology, Section of DermatopathologyThe University of Texas MD Anderson Cancer Center Houston Texas
- Department of Translational Molecular PathologyThe University of Texas MD Anderson Cancer Center Houston Texas
- Department of DermatologyThe University of Texas MD Anderson Cancer Center Houston Texas
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Time series analysis of TP53 gene mutations in recurrent HPV-negative vulvar squamous cell carcinoma. Mod Pathol 2019; 32:415-422. [PMID: 30291345 DOI: 10.1038/s41379-018-0141-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/10/2018] [Accepted: 08/14/2018] [Indexed: 01/16/2023]
Abstract
The impact of TP53 gene mutations in recurrent HPV-negative vulvar squamous cell carcinomas is unclear. TP53 gene mutations were analyzed in archival tissues of 24 primary squamous cell carcinoma and local vulvar recurrences arising in chronic inflammatory dermatoses by analyzing the full coding sequence of the TP53 gene and correlated with disease-free survival. After resection of the primary squamous cell carcinoma with clear margins 19/24 patients had one and 5/24 had multiple recurrences. The first recurrence occurred after median of 46 months (range 12-180 months). In all, 17/24 (71%) primary squamous cell carcinomas had TP53 gene mutations and recurred after median disease-free intervals of 33 months (range 12-180). 14/17 (88%) recurrent squamous cell carcinomas carried again TP53 gene mutations, five with identical and nine with different, more complex TP53 gene mutations. 7/24 (29%) patients with a p53 wild-type primary SCC had the first recurrence after median 65 months (range 14-144) featuring p53 wild-type in 3/7 (43%) and TP53 gene mutations in 4/7 (57%) recurrent squamous cell carcinomas. Disease-free intervals of > 5 years (60-180 months) were observed in 10/24 patients total (42%; equally divided among p53 wild-type (5/7; 71%) and TP53 gene mutated (5/17; 29%) squamous cell carcinomas). In summary, squamous cell carcinomas recurred in the residual vulvar dermatosis independent of TP53 gene mutational status of the primary squamous cell carcinoma. The majority of TP53 gene mutated cancers recurred with different TP53 gene mutations, some of them more complex, and patients with p53 wild type developed TP53 gene mutations in the recurrent squamous cell carcinomas, possibly indicating increased genetic instability in longstanding chronic inflammatory dermatoses. A change of TP53 gene mutational status after > 5 years suggests de novo oncogenic events/carcinogenesis. Longer disease-free intervals in patients with p53 wild-type primary squamous cell carcinoma suggest that TP53 gene mutational status may serve as a prognostic marker for disease-free intervals.
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Abdulrahman Z, Kortekaas KE, De Vos Van Steenwijk PJ, Van Der Burg SH, Van Poelgeest MIE. The immune microenvironment in vulvar (pre)cancer: review of literature and implications for immunotherapy. Expert Opin Biol Ther 2018; 18:1223-1233. [DOI: 10.1080/14712598.2018.1542426] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ziena Abdulrahman
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Kim E Kortekaas
- Department of Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Sjoerd H Van Der Burg
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
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Zhao Y, Zhao S, Li H, Qin X, Wu X. Expression of galectin-7 in vulvar lichen sclerosus and its effect on dermal fibroblasts. Oncol Lett 2018; 16:2559-2564. [PMID: 30013650 DOI: 10.3892/ol.2018.8897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 05/02/2018] [Indexed: 11/06/2022] Open
Abstract
Lichen sclerosus is a chronic and inflammatory disease. Extensive studies have focused on the epidermis, with the dermis or epidermis-dermis receiving less attention. To investigate the role of galectin-7, a keratinocyte protein, in vulvar lichen sclerosus (VLS) and its potential effects on dermal fibroblasts, immunohistochemical staining was performed with VLS tissue samples and normal control samples. The expression of galectin-7 was determined by evaluating the galectin-7 integrated density analysis, and further assessed by western blot analysis. Dermal fibroblasts were isolated from the normal tissue of the female anogenital region following sexual plastic surgery. A cell viability assay was performed on isolated dermal fibroblast cells in the presence or absence of galectin-7. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was performed to determine the transcriptional level of collagen I and collagen III in the response to different doses of galectin-7. In the immunohistochemical analysis, galectin-7 demonstrated a significantly elevated level in VLS, compared to control tissues, which was confirmed by western blot analysis. In the analysis of primary dermal fibroblast cells, galectin-7 significantly inhibited the viability rate of fibroblasts in a dose-dependent manner. RT-qPCR data revealed that the transcription level of collagen I and collagen III were positively associated with the galectin-7 treatment concentration. The overexpression of galectin-7 is associated with the progression of VLS in the epidermis, a high concentration of galectin-7 inhibits the viability of the primary vulvar dermal fibroblasts, and stimulates the accumulation of collagen I and collagen III in dermal fibroblast cultures, thus galectin-7 may serve as a drug target during VLS progression.
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Affiliation(s)
- Yi Zhao
- Department of Obstetrics and Gynecology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Shanshan Zhao
- Department of Neurology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Hui Li
- Department of Obstetrics and Gynecology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Xin Qin
- Department of Physiology, College of Basic Medical Science, China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Xin Wu
- Department of Obstetrics and Gynecology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
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Lewin MR, Hick RW, Selim MA. Lichenoid Dermatitis of the Vulva: Diagnosis and Differential Diagnosis for the Gynecologic Pathologist. Adv Anat Pathol 2017; 24:278-293. [PMID: 28654444 DOI: 10.1097/pap.0000000000000160] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Inflammatory processes affecting the vulva may present a unique challenge due to location specific changes. Different factors are behind the intricacy in the presentation of vulvar dermatoses. First, the vulva is lined by different epithelia (hair-bearing keratinized epithelium, modified mucosa, and mucosa). Furthermore, among other factors, this organ is exposed to friction, occlusion, and trauma. Lastly, as there is a tendency to look for health care advice at an advanced stage of the disease, the lesion may be modified by secondary changes due to self-treatment. This article describes the clinical presentation and pathologic features of vulvar dermatoses with a lichenoid pattern and highlights practical points for their diagnoses.
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Hald AK, Blaakaer J. The possible role of human papillomavirus infection in the development of lichen sclerosus. Int J Dermatol 2017; 57:139-146. [DOI: 10.1111/ijd.13697] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/02/2017] [Accepted: 06/09/2017] [Indexed: 12/26/2022]
Affiliation(s)
| | - Jan Blaakaer
- Department of Obstetrics and Gynaecology; Odense University Hospital; Odense Denmark
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20
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Christmann-Schmid C, Hediger M, Gröger S, Krebs J, Günthert AR. Vulvar lichen sclerosus in women is associated with lower urinary tract symptoms. Int Urogynecol J 2017; 29:217-221. [DOI: 10.1007/s00192-017-3358-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 04/12/2017] [Indexed: 11/25/2022]
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21
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Human Papillomavirus–Induced Squamous Intraepithelial Lesions in Vulvar Lichen Planus. J Low Genit Tract Dis 2016; 20:360-4. [DOI: 10.1097/lgt.0000000000000248] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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The Use of Human Adipose-Derived Stem Cells in the Treatment of Physiological and Pathological Vulvar Dystrophies. Stem Cells Int 2016; 2016:2561461. [PMID: 26880944 PMCID: PMC4736981 DOI: 10.1155/2016/2561461] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 12/10/2015] [Indexed: 11/18/2022] Open
Abstract
"Vulvar dystrophy" is characterized by chronic alterations of vulvar trophism, occurring in both physiological (menopause) and pathological (lichen sclerosus, vulvar graft-versus-host disease) conditions. Associated symptoms are itching, burning, dyspareunia and vaginal dryness. Current treatments often do not imply a complete remission of symptoms. Adipose-Derived Stem Cells (ADSCs) injection represents a valid alternative therapy to enhance trophism and tone of dystrophic tissues. We evaluated efficacy of ADSCs-based therapy in the dystrophic areas. From February to April 2013 we enrolled 8 patients with vulvar dystrophy. A biopsy specimen was performed before and after treatment. Digital photographs were taken at baseline and during the follow-up. Pain was detected with Visual Analogue Scale and sexual function was evaluated with Female Sexual Function Index. All patients received 2 treatments in 3 months. Follow-up was at 1 week , 1 and 3 months, and 1 and 2 years. We obtained a significant vulvar trophism enhancement in all patients, who reported pain reduction and sexual function improvement. Objective exam with speculum was easy to perform after treatment. We believe ADSCs-based therapy finds its application in the treatment of vulvar dystrophies, since ADSCs could induce increased vascularization due to their angiogenic properties and tissue trophism improvement thanks to their eutrophic effect.
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Kellogg Spadt S, Kusturiss E. Vulvar Dermatoses: A Primer for the Sexual Medicine Clinician. Sex Med Rev 2015; 3:126-136. [PMID: 27784605 DOI: 10.1002/smrj.55] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Vulvar dermatoses are common dermatological conditions that affect the vulva, and can cause considerable pain, irritation, pruritus, and burning, and have an adverse impact on a woman's sexual function. AIM To provide an overview of the clinical features, etiology, and management options for the common vulvar dermatoses, including lichen sclerosus, lichen planus, lichen simplex, contact dermatitis, and vulvar psoriasis, and briefly describe the impact of vulvar dermatoses on sexual function. METHODS The key words "vulvar dermatoses," "lichen sclerosus," "lichen planus," "lichen simplex chronicus," "vulvar dermatitis," and "vulvar psoriasis," were utilized to search Medline and PubMed for articles, with special attention given to those published within the past 5 years. MAIN OUTCOME MEASURE Five hundred thirty-six results were generated from the literature search. Publications that were judged current and relevant to the pathophysiology, evaluation, and treatment of vulvar dermatoses were included in the review. RESULTS Fifty-seven articles were selected for inclusion in this review. CONCLUSIONS Vulvar dermatoses can cause chronic pain, itching, and dyspareunia, and can have a profound effect on a woman's sexual expression and comfort. Delay in diagnosis is often due to hesitancy to seek treatment on the part of the patient or delay in biopsy on the part of the provider. This can result in failed prescriptive and self-treatment measures, worsening symptoms, and frustration and sexual dysfunction for the patient, and potentially the development of squamous cell carcinoma. It is imperative for sexual medicine providers, who commonly treat women with vulvar concerns, to be familiar with the presentation, diagnosis, and treatment of common vulvar dermatoses and their effect on sexual function. Kellogg Spadt S and Kusturiss E. Vulvar dermatoses: A primer for the sexual medicine clinician. Sex Med Rev 2015;3:126-136.
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Origoni M, Gelardi C, Salvatore S, Candiani M. Lichen sclerosus of the vulva. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.12.71] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Stewart CJR, Crook ML. Fascin and cyclin D1 immunoreactivity in non-neoplastic vulvar squamous epithelium, vulvar intraepithelial neoplasia and invasive squamous carcinoma: correlation with Ki67 and p16 protein expression. J Clin Pathol 2013; 67:319-25. [PMID: 24218024 DOI: 10.1136/jclinpath-2013-201920] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS To investigate cyclin D1 and fascin immunoreactivity in normal, reactive and neoplastic vulvar skin correlating the findings with p16 protein and Ki67 expression. METHODS 66 vulvar biopsy or resection specimens demonstrating normal appearances, reactive epidermal changes, usual-type vulvar intraepithelial neoplasia (uVIN), differentiated-type VIN (dVIN), p16-positive squamous cell carcinoma (SCC) and p16-negative SCC were examined immunohistochemically for cyclin D1, fascin, Ki67 and p16 protein. Where applicable, expression patterns were compared in microanatomically distinct areas, particularly at the invasive front (deep tumour margin) of SCC. RESULTS Normal epidermis showed parabasal Ki67 and cyclin D1 staining while fascin labelled cells in the lower one-third of the epithelium. Reactive and dVIN specimens demonstrated mildly increased Ki67 and cyclin D1 expression that maintained parabasal polarity, whereas uVIN and p16-positive SCC were characterised by loss of cyclin D1 staining. However, in 14 of 20 p16-positive SCC small infiltrative tumour groups and single infiltrating cells at the invasive front showed a cyclin D1-positive/ Ki67-negative phenotype. In contrast, p16-negative SCC generally showed diffuse and concordant cyclin D1 and Ki67 labelling, including at the invasive margin. Fascin expression was increased in all VIN and SCC lesions. CONCLUSIONS Variations in cyclin D1 and Ki67 expression between p16-positive and p16-negative vulvar SCCs suggest different mechanisms of invasion in these tumour subgroups. Fascin is upregulated in vulvar squamous neoplasia but immunostaining does not discriminate in situ from invasive lesions nor putative human papilloma virus (HPV)-associated and HPV-independent SCCs.
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Affiliation(s)
- C J R Stewart
- Department of Histopathology, King Edward Memorial Hospital, , Perth, Western Australia, Australia
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Brodrick B, Belkin ZR, Goldstein AT. Influence of treatments on prognosis for vulvar lichen sclerosus: Facts and controversies. Clin Dermatol 2013; 31:780-6. [DOI: 10.1016/j.clindermatol.2013.05.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Mannweiler S, Sygulla S, Tsybrovskyy O, Razmara Y, Pummer K, Regauer S. Clear-Cell differentiation and lymphatic invasion, but not the revised TNM classification, predict lymph node metastases in pT1 penile cancer: A clinicopathologic study of 76 patients from a low incidence area. Urol Oncol 2013; 31:1378-85. [DOI: 10.1016/j.urolonc.2012.01.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 01/13/2012] [Accepted: 01/31/2012] [Indexed: 10/28/2022]
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Günthert AR, Duclos K, Jahns BG, Krause E, Amann E, Limacher A, Mueller MD, Jüni P. Clinical scoring system for vulvar lichen sclerosus. J Sex Med 2012; 9:2342-50. [PMID: 22759453 DOI: 10.1111/j.1743-6109.2012.02814.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Vulvar lichen sclerosus (LS) is a chronic inflammatory and mutilating disease, which goes often undetected for years. Advanced disease severely affects quality of life like sexual disorders and is also associated with an increased risk of vulvar cancer. AIM To develop and validate a patient-administered symptom score and a physician-administered clinical score for the diagnosis and evaluation of vulvar LS. METHODS We included 24 patients with established LS diagnosis and 49 with other vulvar disease. The physician-administered score was based on six clinical features and the patient-administered score was a symptom-based four-item composite score. We determined inter-item correlations and internal consistency of both scores, and estimated sensitivities, specificities, likelihood ratios, and posttest probabilities for different cutoffs of the physician-administered score. MAIN OUTCOME MEASURES Characteristics of patients with and without LS were compared using χ(2) and unpaired t-test as required. We then determined Cronbach's alpha as a measure of the overall consistency of scores and calculated positive and negative likelihoods. RESULTS Lack of redundancy of items (correlation coefficients < 0.90) and internal consistency (Cronbach's α ≥ 0.70) suggested that final composite scores were valid and yielded excellent power to rule in LS. CONCLUSION Scores may be useful for assessing symptoms of vulvar disorders, to ease diagnosis of LS and to evaluate treatment response over time.
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Affiliation(s)
- Andreas R Günthert
- Department of Gynecology and Obstetrics, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
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Residual anogenital lichen sclerosus after cancer surgery has a high risk for recurrence: A clinicopathological study of 75 women. Gynecol Oncol 2011; 123:289-94. [DOI: 10.1016/j.ygyno.2011.07.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 07/04/2011] [Accepted: 07/07/2011] [Indexed: 11/23/2022]
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Abstract
Lichen sclerosus (LS) is an inflammatory skin disease predominantly affecting the anogenital region. If untreated, progressive sclerosis results in scarring with distortion of the normal architecture. LS occurs more commonly in women than men but may occur in all age groups, including adolescents and prepubertal children. Its exact prevalence is unknown, but estimates range from 1:60 to 1:1000. In this article, LS is discussed in detail with respect to disease management in adults and children, risk of malignancy, and association with other diseases.
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Affiliation(s)
- Ruth Murphy
- Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, UK.
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Regauer S. Histopathological work-up and interpretation of sentinel lymph nodes removed for vulvar squamous cell carcinoma. Histopathology 2009; 55:174-81. [DOI: 10.1111/j.1365-2559.2009.03350.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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35
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High prevalence of concomitant anogenital lichen sclerosus and extragenital psoriasis in adult women. Obstet Gynecol 2008; 111:1143-7. [PMID: 18448747 DOI: 10.1097/aog.0b013e31816fdcdf] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To analyze the prevalence of lichen sclerosus and psoriasis in gynecologic patients. METHODS The prevalence of lichen sclerosus and psoriasis individually, as well as the prevalence of both diseases in the same patient, was evaluated among 2,800 women attending a primary care gynecology practice for annual routine gynecologic examinations. The incidence of lichen sclerosus (new diagnosis of lichen sclerosus per year/population at risk) was calculated for the last 5 years. RESULTS Two hundred (7.1%) women had a biopsy-proven anogenital lichen sclerosus, and 57 women (2%) had an extragenital psoriasis vulgaris. Fifteen women had both diseases (0.5%). The prevalence of psoriasis in lichen sclerosus patients was 7.5% (15 of 200; 95% confidence interval 4.3-12.1%) compared with 1.6% (42 of 2,600) in the non-lichen sclerosus patient group. Lichen sclerosus was diagnosed in 13 of 15 psoriasis patients at an average of 19.5 years after the diagnosis of psoriasis at the age of 48 years (range 30-70 years). The incidence rates of lichen sclerosus for the last 5 years were 0.5% in 2002, 0.7% in 2003 and 2004, 1.9% in 2005, and 1.8% in 2006. CONCLUSION The prevalence of psoriasis in lichen sclerosus patients (7.5%) is higher than in the general population and among the non-lichen sclerosus patients in this practice (1.6%). This association may result from a similar immune dysregulation in these women. LEVEL OF EVIDENCE II.
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Günthert AR, Faber M, Knappe G, Hellriegel S, Emons G. Early onset vulvar Lichen Sclerosus in premenopausal women and oral contraceptives. Eur J Obstet Gynecol Reprod Biol 2008; 137:56-60. [DOI: 10.1016/j.ejogrb.2007.10.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Revised: 08/21/2007] [Accepted: 10/12/2007] [Indexed: 11/29/2022]
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Raspollini MR, Asirelli G, Taddei GL. Analysis of lymphocytic infiltrate does not help in prediction of vulvar squamous cell carcinoma arising in a background of lichen sclerosus. Int J Gynaecol Obstet 2007; 100:190-1. [PMID: 17900577 DOI: 10.1016/j.ijgo.2007.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Revised: 07/17/2007] [Accepted: 07/17/2007] [Indexed: 11/27/2022]
Affiliation(s)
- M R Raspollini
- Department of Human Pathology and Oncology, School of Medicine, University of Florence, Florence, Italy.
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Tapp RA, Feng J, Jones JW, Carlson JA, Wilson VL. Single base instability is promoted in vulvar lichen sclerosus. J Invest Dermatol 2007; 127:2563-76. [PMID: 17554370 DOI: 10.1038/sj.jid.5700889] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Single base substitution mutations in codons 248 and 273 of TP53 and codon 12 Kirsten-ras (KRAS) are commonly found in human carcinomas. To determine whether these mutations also occur in normal and inflamed tissues from which carcinomas arise, we utilized the ultra-sensitive polymerase chain reaction/restriction endonuclease/ligase chain reaction mutation assay. Ninety samples of genital skin, including lichen sclerosus (LS) affected skin, adjacent normal and non-adjacent normal, were assayed. Mutations were detected in 103 of 349 assays and consisted of KRAS G34A, G34T, G35A, and TP53 C742T, G818C, C817T, and G818A mutations. Mutant prevalence varied from 1 to 20 per 10(6) wild-type cells. Mutations occurred significantly more frequently in LS (78/224 (35%)) than adjacent normal (20/88 (23%)) and non-adjacent normal genital skin (5/38 (13%)). KRAS G34A mutation was relatively common to all classes of specimen, whereas TP53 gene C742T and G818C mutations were significantly more frequent in LS than normal genital skin. In matched samples, immunohistochemistry evaluation of p53 protein expression revealed the presence of epidermal p53 clones in LS whose presence and number significantly correlated with the presence of TP53 C742T and G818C mutations. Based on these results, it appears oncogenic point mutations occur in normal genital skin, and are selected for in LS.
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Affiliation(s)
- Ronald A Tapp
- Department of Veterinary Comparative Biomedical Sciences, Louisiana State University, Baton Rouge, Louisiana, USA
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Hengge UR, Krause W, Hofmann H, Stadler R, Gross G, Meurer M, Brinkmeier T, Frosch P, Moll I, Fritsch P, Müller K, Meykadeh N, Marini A, Ruzicka T, Gollnick H. Multicentre, phase II trial on the safety and efficacy of topical tacrolimus ointment for the treatment of lichen sclerosus. Br J Dermatol 2007; 155:1021-8. [PMID: 17034535 DOI: 10.1111/j.1365-2133.2006.07446.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lichen sclerosus is a chronic inflammatory autoimmune disease causing significant sclerosis, atrophy and pruritus. Treatment remains unsatisfactory, with potent corticosteroids being the most effective therapy. OBJECTIVES To conduct a multicentre, phase II trial to assess the safety and efficacy of tacrolimus ointment 0.1% for the treatment of lichen sclerosus with a follow-up period of 18 months at 10 university and teaching hospitals in Germany and Austria. METHODS Eighty-four patients (49 women, 32 men and three girls) aged between 5 and 85 years with long-standing, active lichen sclerosus (79 with anogenital and five with extragenital localization) were treated with topical tacrolimus ointment 0.1% twice daily for 16 weeks. Computerized analysis of the lesional area was performed. The primary endpoint was clearance of active lichen sclerosus. Secondary endpoints were time to optimal response, reduction of sclerosis and duration of remission. RESULTS The primary endpoint (clearance of active lichen sclerosus) was reached by 43% of patients at 24 weeks of treatment. Partial resolution was reached in 34% of patients. Maximal effects occurred between week 10 and 24 of therapy. Treatment led to a significant reduction of the total lesional area (P < 0.01) and to a significant decline in the total symptom score (P < 0.005). Symptoms (e.g. itching) and findings (erythema, erosions and induration) showed significant improvement. No serious adverse events were observed. There were three (9%) recurrences during the follow-up period. CONCLUSIONS Topical tacrolimus ointment 0.1% was safe and effective for the treatment of long-standing active lichen sclerosus.
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Affiliation(s)
- U R Hengge
- Department of Andrology and Venereology, Philipps-University Marburg, Marburg, Germany.
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Regauer S, Beham-Schmid C. Detailed analysis of the T-cell lymphocytic infiltrate in penile lichen sclerosus: an immunohistochemical and molecular investigation. Histopathology 2006; 48:730-5. [PMID: 16681690 DOI: 10.1111/j.1365-2559.2006.02406.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To determine the extent of clonal outgrowth in the lymphocytic tissue infiltrate of lichen sclerosus (LS). The presence of T cells with a monoclonally rearranged T-cell receptor gamma-gene (TCRgamma) has been described in up to 50% of biopsies of vulvar and penile LS. MATERIAL AND RESULTS We analysed 33 foreskin specimens with LS for the presence of clonal T cells by conventional polymerase chain reaction (PCR) analysis and with TCRgamma-PCR-based fluorescent fragment analysis. Eighteen of 33 patients revealed a band indicating a monoclonally rearranged TCRgamma on conventional PCR analysis. Subsequent TCRgamma-PCR-based fluorescent fragment analysis identified 8/18 patients with monoclonal T-cell DNA ranging from 1.4% to 23.1% of total T-cell DNA analysed and a size range from 56 to 72 base pairs. Four of 18 patients had an oligoclonal and 6/18 patients revealed a polyclonal banding pattern. The lymphocytic infiltrate contained low numbers of gammadelta T cells and cytotoxic T cells in comparable numbers to the low percentage of clonal TCRgamma DNA. CONCLUSIONS The low percentage of clonal TCRgamma DNA argues against a systemic neoplastic disease, but rather for a local immune disorder. The target antigen of the clonal outgrowth is unknown, but an exaggerated antigen-dependent proliferation of T cells due to chronic local antigen exposure, probably an infectious antigen, is the most likely explanation.
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Affiliation(s)
- S Regauer
- Institute of Pathology, Medical University of Graz, Graz, Austria.
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Liegl B, Regauer S. p53 immunostaining in lichen sclerosus is related to ischaemic stress and is not a marker of differentiated vulvar intraepithelial neoplasia (d-VIN). Histopathology 2006; 48:268-74. [PMID: 16430473 DOI: 10.1111/j.1365-2559.2005.02321.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To analyse p53 immunoreactivity in 207 biopsy specimens of lichen sclerosus (LS) and "differentiated vulvar intraepithelial neoplasia" (d-VIN), a postulated precursor lesion for LS-associated vulvar squamous cell carcinoma (SCC), which is characterized by atypical basal keratinocyte proliferations with p53+ basal/suprabasal keratinocyte nuclei. METHODS AND RESULTS Forty early, 78 classic, 30 hypertrophic vulvar LS, 26 paediatric vulvar and penile LS, 33 vulvar LS-associated SCC and 30 vulvar/penile control specimens were examined for p53 expression and the presence of d-VIN. Nuclear p53 staining was observed in 175/207 LS biopsy specimens. Eighty percent of early and 69% of paediatric LS showed discontinuous/continuous p53 staining in basal keratinocytes. Classic LS showed no p53 staining in 17%, discontinuous basal keratinocyte staining in 20%, continuous basal keratinocyte staining in 58%, basal/suprabasal staining in 5%. Hypertrophic LS revealed basal keratinocyte staining in 32% and basal/suprabasal staining in 61%. p53 staining was associated with sclerosis of blood vessels and dermis, lymphoid infiltrates, vasculitis and hypertrophic LS. d-VIN was seen in 2% of LS alone and in 24% of LS-associated SCC. CONCLUSION d-VIN in LS is rare, while p53 staining is common and best explained as an ischaemic stress response due to poor oxygenation, vasculitis and inflammation rather than as a marker of a precancerous lesion in LS.
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Affiliation(s)
- B Liegl
- Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, 8036 Graz, Austria
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Abstract
Genital lichen sclerosus in women is a clinically and histologically well defined disease. In addition to the classical atrophic form, there is a hypertrophic variant, which is characterised histologically by squamous cell hyperplasia. The aetiology is unknown but an autoimmune pathogenesis seems most likely. Infectious or hormonal influences do not play a major role. We describe a squamous cell carcinoma of the vulva with a co-existing lichen sclerosus. This case raises again the question of a precancerous potential of lichen sclerosus. In the dermatological literature, only a few cases with association of lichen sclerosus and squamous cell carcinoma are known. This is in contrast to gynaecological literature, where a high number of squamous cell carcinomas has been described. Gynaecologists search for the histological findings of lichen sclerosus adjacent to squamous cell carcinoma. Such an attempt is not valid without the clinical signs of lichen sclerosus, so that indeed classical lichen sclerosus does not seem to be a precancerous lesion. On the other hand, the hypertrophic form of lichen sclerosus seems to be associated with squamous cell carcinoma in about 3-5% of case.
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Földes-Papp Z, Reich O, Demel U, Tilz GP. Lack of specific immunological disease pattern in vulvar lichen sclerosus. Exp Mol Pathol 2005; 79:176-85. [PMID: 15950965 DOI: 10.1016/j.yexmp.2005.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Accepted: 04/26/2005] [Indexed: 10/25/2022]
Abstract
The literature suggests that autoantibody formations and disturbances in cellular or humoral immunities are relevant immunological events in lichen sclerosus (LS). We examined 39 patients (age range: 7-81 years) enrolled in this experimental immunopathology study and treated for vulvar LS. In the serum, we used 88 clinical immunology parameters to evaluate the immunological patterns, i.e., autoimmune phenomena, humoral immunity, cellular immunity, and inflammation. The analyses permitted direct comparison of the measured distributions of alternative data. We found that all pathological findings of single immunological events followed a random distribution without any positive or negative trend or a distribution with a negative trend. There was a lack of correlation between the majority of cases and the presence of pathological findings (confidence intervals 0.950 and 0.999). Combinations of two or more of the four patterns did not improve the outcomes (confidence intervals 0.950 and 0.999). However, abnormalities in systemic immune parameters implying system impairments might have occurred long before the patients with such a chronic disease presented to the clinic. This may be especially true of such diseases as vulvar LS, where local skin scarring might represent a local tissue response secondary to an initial insult by immune or other processes.
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Affiliation(s)
- Zeno Földes-Papp
- Clinical Immunology and Jean Dausset Laboratory, Medical University of Graz, Auenbruggerplatz 8, A-8036 Graz-LKH, Austria.
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Abstract
Vulvar lichen sclerosus (LS), a lymphocyte-mediated chronic skin disease, begins with uncharacteristic symptoms and progresses undiagnosed to atrophy and destructive scarring. Some patients with longstanding advanced LS have an increased risk of vulvar carcinoma. Early LS is treatable, although not curable, if diagnosed early. Therefore, patients with persistent vulvar symptoms should be biopsied to establish the diagnosis. In contrast to advanced LS, the histological features in early LS are quite subtle and often more prominent in adnexal structures than in interfollicular skin. Adnexal structures show acanthosis, luminal hyperkeratosis and hypergranulosis with/without dystrophic hair and basement membrane thickening. The epidermis/mucosa shows mild irregular, occasionally psoriasiform acanthosis and focal basement membrane thickening. Early dermal changes are homogenized collagen and wide ectatic capillaries in dermal papillae immediately beneath the basement membrane. The lymphocytic infiltrate can be sparse or dense, lichenoid or interstitial with epidermal lymphocyte exocytosis and lymphocytic/lymphohistiocytic vasculitis. Dermal melanophages indicate preceding keratinocyte/melanocyte destruction. Biopsy specimens of early LS rarely display all features. Therefore, serial sections and periodic acid-Schiff reactions are necessary for their identification. Recognition and treatment of these early stages of LS may result in longstanding remission. Progression to atrophic stages with their associated morbidity and even to squamous cell carcinoma may be prevented.
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Affiliation(s)
- S Regauer
- Institute of Pathology, Working Groups of Dermatopathology and Gynaecopathology and Department of Gynaecology and Obstetrics, Medical University Graz, Graz, Austria. sigrid.
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Abstract
Lichen sclerosus (LS) is a chronic localized lymphocyte-mediated dermatosis of genital skin with a presumed autoimmune origin. LS is characterized by localized dense lymphocytic tissue infiltrates, vasculitic processes and extensive tissue destruction. The lymphocytic infiltrate of LS biopsies contains between 1.4% and 21% of T-cells with monoclonally rearranged T-cell receptor gamma-chain gene, and the immunophenotype is dominated by B-cells, CD4-positive T-cells and antigen-presenting dendritic cells. Antigen-driven selection of T-cells and restricted T-cell receptor usage reflects prolonged exposure of the host immune system to a local (putative LS-associated) antigen. It is presently unclear at which time point in the evolution of LS the T-cell clones emerge. All investigators of LS agree on the non-neoplastic nature of the infiltrate. However, a small percentage of LS patients show serological (systemic) evidence of T-cell immune deficiencies. The lack of long-term follow up of patients with known monoclonally rearranged T-cell receptor gamma-chain gene in their LS biopsies, however, defers a final judgement on the clinical significance of our observations.
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Affiliation(s)
- Sigrid Regauer
- Institute of Pathology, Working group of Dermatopathology, Medical University of Graz, Auenbruggerplatz 25, A-8036 Graz, Austria.
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Regauer S, Liegl B, Reich O, Beham-Schmid C. Vasculitis in lichen sclerosus: an under recognized feature? Histopathology 2005; 45:237-44. [PMID: 15330801 DOI: 10.1111/j.1365-2559.2004.01929.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To analyse 90 vulvar and 72 penile cases of lichen sclerosus (LS) on haematoxylin and eosin sections for vascular changes and the vascular infiltrates immunohistochemically with antibodies to T cells, B cells and antigen-presenting dendritic cells. LS is a skin disease of presumed autoimmune origin. Autoimmune diseases are mediated by lymphocytes which occasionally produce a lymphocytic vasculitis. METHODS AND RESULTS Three types of lymphocytic infiltrates were identified: (i) perivascular lymphocytic infiltrates without damage to vessel walls; (ii) lymphocytic vasculitis in three forms: (a) concentric lymphohistiocytic infiltrates with lamination of the adventitia by basement membrane material which was typical for penile LS; (b) lymphocytic vasculitis with dense perivascular lymphocytic cuffing with occasional fibrin deposition in vessel walls and subendothelial lymphocyte infiltration, quite common in vulvar LS; and (c) intramural lymphocytic infiltrates in large muscular vessels; (iii) leukocytoclastic vasculitis in LS was exceptionally rare. In lymphocytic vasculitis, CD20+ B cells, CD4+ T cells and dendritic cells were the principal infiltrating cells. CONCLUSIONS Dendritic cells capture (foreign) antigens after entry into the affected tissues and initiate immune responses acting as a matrix on which antigen-specific T and B cells interact. The described vascular features are indicative of antigen-mediated vasculitic changes in LS.
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Affiliation(s)
- S Regauer
- Institute of Pathology, Medical University of Graz, Graz, Austria.
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Sander CS, Ali I, Dean D, Thiele JJ, Wojnarowska F. Oxidative stress is implicated in the pathogenesis of lichen sclerosus. Br J Dermatol 2004; 151:627-35. [PMID: 15377350 DOI: 10.1111/j.1365-2133.2004.06142.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Lichen sclerosus (LS) is a chronic inflammatory skin disease of unknown aetiology which can be associated with secondary malignancies. Recent evidence supports an autoimmune basis for this disorder, as demonstrated by autoantibodies to extracellular matrix protein 1 (ECM-1). The pathophysiological mechanisms leading to autoimmunity and carcinogenesis are poorly understood. OBJECTIVES We hypothesized that oxidative stress, which has been demonstrated to be involved in the pathogenesis of several autoimmune and malignant disorders, contributes to these processes in LS. METHODS Skin biopsies from 16 patients with untreated, histologically confirmed vulval LS were examined immunohistochemically using antibodies against the lipid peroxidation products malondialdehyde and 4-hydroxynonenale and against the oxidative DNA damage marker 8-hydroxy-2'-deoxyguanosine. Protein carbonyls as markers of protein oxidation were visualized using the dinitrophenylhydrazone method. Expression of antioxidant enzymes was investigated. Normal vulval tissue from 16 subjects served as control. RESULTS In vulval LS tissue a significant increase of lipid peroxidation products was found particularly within the basal cell layers of the epidermis, thus colocalizing with ECM-1. Oxidative DNA damage was detected throughout LS biopsies. Intriguingly, protein oxidation was significantly increased within the dermis of LS lesions, indicating oxidative protein damage in the areas of sclerosis and inflammation. The enzymatic antioxidant defence in LS was found to be significantly disturbed. CONCLUSIONS This is the first study to demonstrate oxidative damage to lipids, DNA and proteins in LS, revealing a novel pathophysiological mechanism which may contribute to sclerosis, autoimmunity and carcinogenesis. Therapeutic strategies using antioxidants might be a useful new approach in the treatment of LS and could also help to prevent secondary malignancies.
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Affiliation(s)
- C S Sander
- Dermatology Department, The Churchill Hospital, Old Road, Oxford OX3 7LJ, UK
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Regauer S, Beham-Schmid C. Monoclonally Rearranged γT-Cell Receptor in Lichen Sclerosus—A Finding of Clinical Significance? Am J Dermatopathol 2004; 26:349-50; author reply 350-1; discussion 351. [PMID: 15249866 DOI: 10.1097/00000372-200408000-00015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hassanein AM, Mrstik ME, Hardt NS, Morgan LA, Wilkinson EJ. Malignant melanoma associated with lichen sclerosus in the vulva of a 10-year-old. Pediatr Dermatol 2004; 21:473-6. [PMID: 15283794 DOI: 10.1111/j.0736-8046.2004.21412.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Malignant melanoma of the vulva in childhood is a rare neoplasm. Lichen sclerosus of the vulva in childhood is also a rare disease. The association of these two rare lesions in the vulva of young girls is extremely rare. We present a 10-year-old white girl with malignant melanoma associated with lichen sclerosus of the vulva. She had dark pigmentation of both the labia minora and posterior fourchette. The inner labia majora and fourchette showed whitish, glistening areas of skin. Histologic examination found mostly an in situ lentiginous/mucosal melanoma with focal invasion to a depth of 0.44 mm in the left upper labium majus. All specimens showed evidence of lichen sclerosus. Partial vulvectomy was performed, and no metastases were detected at the time of treatment. The patient has been disease free for the 12 months after treatment. It is critical for physicians to realize that melanoma can occur in children, and although rare, can occur in the vulva. We feel that lichen sclerosus in this instance may represent a pattern of host immune response to melanoma.
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Affiliation(s)
- Ashraf M Hassanein
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida 32610, USA.
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Citarella L, Massone C, Kerl H, Cerroni L. Lichen sclerosus with histopathologic features simulating early mycosis fungoides. Am J Dermatopathol 2004; 25:463-5. [PMID: 14631186 DOI: 10.1097/00000372-200312000-00002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mycosis fungoides (MF) is a cutaneous T-cell lymphoma characterized in its early stages by a superficial band-like infiltrate with epidermotropism of lymphocytes without particularly atypical cytologic features. Even though clinicopathologic presentation is diagnostic in typical cases, some inflammatory skin disorders can simulate the histopathologic features of early MF. In this study we present data on 9 patients affected by lichen sclerosus (LS) (M:F ratio 8:1; age range 7-75 years; mean age 31.3 years; median age 13 years), who presented with histopathologic features simulating early lesions of MF. The histopathologic picture was characterized in all cases by a dense, band-like infiltrate of lymphocytes within the superficial dermis, with exocytosis of lymphocytes within the lower part of the epidermis. The papillary dermis was expanded and showed focally coarse bundles of collagen simulating MF. The typical signs of LS were either absent or present only focally. Molecular analyses of the TCRgamma gene rearrangement performed with the polymerase chain reaction (PCR) technique revealed a polyclonal smear in eight cases, and a monoclonal band in one. Our study shows that LS can present with histopathologic features simulating early MF. Especially in cases revealing a monoclonal population of T lymphocytes by PCR, the correct diagnosis may be overlooked without proper clinical information and clinicopathologic correlation. Lichen sclerosus should be added to the list of cutaneous T-cell pseudolymphomas.
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