Affiliation:
1. Department of Pathology University Hospitals Cleveland Medical Center Cleveland OH USA
2. Department of Pathology Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic Cleveland OH USA
3. Harvard School of Dental Medicine Boston MA USA
4. Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontology, School of Dentistry The University of Jordan Amman Jordan
5. Oral Diagnostic Sciences Department King Abdulaziz University Faculty of Dentistry Jeddah Saudi Arabia
6. Department of Oncology and Diagnostic Sciences, School of Dentistry University of Maryland Baltimore MD USA
7. University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center Baltimore MD USA
8. Center for Oral Pathology StrataDx Lexington MA USA
Abstract
AimsOral epithelial dysplasia (OED) often exhibits a lymphocytic/lichenoid immune response (LIR), imparting histological resemblance to lichenoid mucositis and rendering diagnosis challenging. The clinical appearances of OED and lichenoid inflammatory processes are generally divergent, presenting as well‐demarcated hyperkeratotic plaques and diffuse white and/or red mucosal change with variably prominent Wickham striae, respectively. To date, clinicopathological characterisation of OED with LIR, including clinical/gross appearance, has not been depicted.Methods and resultsCases of solitary OED with LIR for which a clinical photograph was available were identified in the authors’ institutional files. Clinical and histological features were documented. In 44 identified cases, dysplasia was mild (19 of 44, 43.2%), moderate (19 of 44, 43.2%) and severe (six of 44, 13.6%). Clinically/grossly, all 44 cases (100.0%), presented as well‐demarcated hyperkeratotic plaques lacking diffuse white‐and‐red mucosal change or Wickham striae. Histologically, OED with LIR exhibited numerous ‘lichenoid’ features beyond the lymphocytic band in the superficial lamina propria, including: leucocyte transmigration (38 of 44, 86.4%), spongiosis (37 of 44, 84.1%), Civatte/colloid bodies (36 of 44, 81.8%), basal cell degeneration (29 of 45, 65.9%), sawtooth rete ridges (11 of 44, 25.0%) and subepithelial clefting (7 of 44, 15.9%).ConclusionsVirtually any lichenoid histological feature may be seen in OED with LIR, representing a significant diagnostic pitfall. The typical clinical appearance of OED with LIR is of a well‐demarcated hyperkeratotic plaque, characteristic of keratinising dysplasia and devoid of lichenoid features. This suggests that pathologist access to clinical photographs during diagnostic interpretation of biopsied white lesions, which represents opportunity to perform gross examination of the disease process, may reduce interobserver variability and improve diagnostic accuracy in this challenging differential diagnosis.