The strip of mucosa contains parakeratosis and although the lamina propria is not present, a suggestion of a lichenoid infiltrate as evidenced by the presence of lymphocytes at the base of the epithelium.
Again, note the heavy infiltrate of lymphocytes at the base of the epithelium.
The presence of necrotic keratinocytes, so-called Civatte or colloid bodies, (lower right corner) are scattered throughout the epithelium. Note that the base of the epithelium is at the top of the image, whereas the luminal surface is at the bottom.
Lichen planus (LP), although commonly diagnosed on the skin, is an underrecognized condition in the esophagus. Unlike cutaneous LP, eosphageal LP occurs almost exclusively in older women who also have oral involvement. There is a poor association with cutaneous LP in these patients. On endoscopy, lacy white papules, desquamation, pinpoint erosions, pseudomembranes and stenosis can be seen.
Microscopically, esophageal LP is characterized by a lichenoid lymphocytic infiltrate involving superficial laminia propria and basal epithelium. Necrotic kertinocytes (Civatte bodies) may be present. In contrast to cutaneous LP, esophageal LP exhibits parakeratosis (rather than orthohyperkeratosis), epithelial atrophy (rather than acanthosis) and lack of hypergranulosis.
Manifests as progressive dysphagia and odynophagia.
Intralesional triamcinolone and balloon dilatation produce symptomatic relief in many patients.
- The most characteristic finding in esophageal lichen planus is a bandlike lymphocytic infiltrate in the superficial lamina propria and basal epithelium
Case is contributed by Kate Sciandra MD, Dept of Pathology, VAMC, ALbuquerque New Mexico.