Oral Surg Oral Med Oral Pathol. Sep;60(3) Lichenoid dysplasia: a distinct histopathologic entity. Krutchkoff DJ, Eisenberg E. We have observed. Citation. M Virdi, A Sachdev, A Gupta, K Aggarwal. Lichen Planus Or Lichenoid Dysplasia: Is It Premalignant!. The Internet Journal of Head and Neck Surgery. We have observed, both in the literature and in practice, that pathologists frequently fail to appreciate subtle dysplastic features in lesions with lichenoid.
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Oral lichen planus versus epithelial dysplasia: difficulties in diagnosis
Although the World Health Organization WHO currently considers oral lichen planus to be a disease that may evolve to cancer 20its actual potential to evolve malignantly is the target of much controversy. Furthermore, the role of Histochemical markers, Quantitative cytology and Morphometry as prognostic tools in evaluation of OLP has been proved beyond doubt. Clinically these two appear similar, but LD is usually unilateral as seen in our case report and is more frequently seen on cancer prone sites like floor of the mouth, tongue, mandibular lingual alveolar ridge, soft palate, tonsillar pillar and uvula.
The implication of this premise is that patients with lichenoid dysplasia represent a risk group, which can be identified by the appropriate use of available diagnostic methods and, as such, can be distinguished from patients with OLP with no dysplasia-related increased risk of development of oral cancer 3.
Eisenberg and Krutchkoff 11 reported that oral lichen planus is unlikely to evolve malignantly. Statistically significant differences were noted and the results obtained may have a value in predicting their behavior.
Oral lichenoid dysplasia: a clinicopathologic analysis.
Br Dent J ; Drug related LL is considered as a different form of delayed hypersensitivity reaction, wherein drug or its metabolite acts as haptens.
Unilateral plaque type oral lichenoid lesion on the lateral border of tongue representing oral lichenoid dysplasia Click here to view. Segregation of these lichenoid lesions is mandatory as each may embody a distinct disease entity in terms of cause, diagnosis and prognosis. Nuclear volume is almost three times llichenoid of normal mucosa in OLP and six times that of normal mucosa in oral sq cell carcinoma. Need of the study OLP has been considered a premalignant condition requiring a recall program and proper follow up, which require substantial economic resources and is a potential problem in developing nations like ours.
Van der Meij et al.
Internet Scientific Publications
Conclusion It can be concluded from this study that the accuracy and objectivity of morphometric methods may be applied usefully to discriminate between purely benign, potentially premalignant and malignant lesions of the oral cavity. Clinical management and malignant transformation. Van der Meij and Van der Waal 17 wrote well about such difficulty.
Clinico-pathological mimicry and its diagnostic implications. Some cell dyspladia which suggest malignancy present in the oral lichen planus may also be found in epithelial dysplasia, impairing its diagnosis and, consequently, stressing the importance of following these patients in the long run.
Cells that were clumped together or not clear were not taken into consideration. All three had persistent burning pain associated with large mucosal lesions.
The pathogenesis of these two lesions is entirely different – in lichen planus the lichenoid infiltrate represents cell mediated immune response incited by different antigens whereas in LD, it represents immune surveillance mechanism against atypical epithelial cells [ 2 ]. In addition, hyperkeratosis with plugging, perivascular infiltration and more deeply spread inflammatory infiltrate into the stroma are other significant differences [ 28 ].
Open in a separate window. Inversely, in none of the cases any changes were found in the normal maturation pattern of epithelial cells.
Evidence-Based Care Module March 9, Erythema multiforme, graft versus host disease, lichenoid drug reactions, oral lichenoid dysplasia, oral lichenoid lesion, oral lichen planus, stomatitis venenata. Drugs reported in the literature as being related to oral lichenoid reactions  Click here to view.
Lichenoid dysplasia: a distinct histopathologic entity.
Proliferative verrucous leukoplakia and precancerous conditions In: Some authors believe that lichenoid dysplasia should be considered as an injury with high likelihood of evolving to malignancy 13,15,18reinforcing even further the theory that most cases of lichen planus with possible evolution to malignancy stem from failed initial diagnosis. The most frequently observed disorders on oral lichen planus cases were increased nuclear-cytoplasmic ratio Classification of Oral Lichenoid Lesions.
They proposed that epithelial dysplasia with lichenoid features that is, LD is a distinct histopathologic entity with a true malignant predisposition. Nuclear and cellular volumes may serve as potential discriminators between benign lesions and premalignant lichen planus.
Furthermore, this condition needs to be diagnosed with a strict Clinico-pathologic criterion, which might reduce or possibly eliminate confusion about possible premalignant character of OLP and OLL oral lichenoid lesions 4. Lee and Fabiger;