6. MICROSCOPIC EXAMINATION
Sections studied shows
• epidermis with orthokeratotic hyperkeratosis,
hypergranulosis, irregular acanthosis and civatte bodies.
• a band–like inflammatory infiltrate seen at the dermo –
epidermal junction along with melanin incontinence and
focal basal cell vacuolation.
14. Differential Diagnosis
Lichen sclerosus et atrophicus
• The epidermis shows hyperkeratosis,
atrophy and significant thinning with loss
of the normal rete ridge pattern.
• A lichenoid inflammatory pattern is seen
in early stage lesions.
• A superficial sclerosing process, vacuolar
degeneration of the basal layer, clefts and
dermal hyalinization are seen in late stage
lesions.
• There is broad condensation of
the dermal collagen in the upper dermis.
• Scattered plasma cells, histiocytes and
mast cells can be seen.
15. Differential Diagnosis
Diagnosis in favor of Lichen planus over Lichen sclerosus et atrophicus
• The presence of well formed granular layer.
• Presence of civatte bodies.
• Lack of basement membrance thickening or epidermal atrophy.
16. Differential Diagnosis
Bowen’s disease
• There is full thickness dysplasia of the
squamous epithelium.
• Pilosebaceous epithelium may be
involved by atypical keratinocytes.
• Disorderly maturation of the
epidermis.
• Overlying parakeratosis and loss of
granular layer.
• Mitotic figures, multinucleated cells
and dyskeratotic cells are present.
• Stromal inflammation may be
present in the dermis and
occasionally features of regression is
seen.
17. Differential Diagnosis
Diagnosis in favor of Lichen planus over Bowen’s disease.
• The presence of well formed granular layer.
• Presence of civatte bodies.
• No atypical cells/dysplasia seen.
Histological patterns include- Psoriasiform pattern, atrophic form, verrucous hyperkeratotic type, irregular variant, pigmented type and pagetoid variant.
Rarely mucinous and sebaceous metaplasia may be noted.
