Hypertrophic lichen planus mimicking squamous cell carcinoma

An 87-year-old female presented with a 3 month history of hyperkeratotic nodules on her left shin. An initial clinical and histological diagnosis of multiple squamous cell carcinomas on the left shin was made. Review of the biopsy, however, showed hypertrophic lichen planus with pseudoepitheliomatous hyperplasia. Typical lichen planus was seen affecting the oral mucosa, nails and skin elsewhere.     

Metastatic cutaneous squamous cell carcinoma arising from a previous area of chronic hypertrophic lichen planus

Malignant transformation of cutaneous lichen planus is a rare event. We report a 34 year old Caucasian male who presented with an exophytic tumor on the right foreleg. The tumor gradually developed within previous areas of histologically proven hypertrophic lichen planus that had existed for about 10 years. However, the current histological examination of the excised tumor revealed highly differentiated squamous cell carcinoma with a depth of tumor invasion of 10 mm. At that time, neither sentinel lymph node biopsy nor further imaging diagnostics revealed evidence for metastatic spreading. Nevertheless, five months after surgery inguinal lymph node metastases were detected. Initial chemotherapy and inguinal lymph node dissection were unable to stop the spread of the tumor. One year later, parailiacal lymph node metastases were detected by computed tomography. Further cycles of chemotherapy resulted in significant reduction of the parailiacal tumor masses. This report indicates that the long-standing hypertrophic form of lichen planus seems to have a considerable propensity for malignant transformation, even in young patients.     

Squamous cell carcinoma arising in vulval lichen planus

We report two cases of squamous cell carcinoma arising in vulval lichen planus. Patients with lichen planus should be examined for evidence of genital involvement. If this is present, such patients should be closely monitored, and any atypical lesions biopsied.     

泛发性扁平苔藓继发面部巨大鳞状细胞癌1例

报告1例泛发性扁平苔藓并发巨大鳞状细胞癌。患者男，20岁。因全身暗红色斑块10年，面部肿块5个月就诊。腹部皮损组织病理活检显示，符合扁平苔藓病理改变，面部肿块经病理诊断为中分化鳞状细胞癌。     

皮肤鳞状细胞癌中人乳头瘤病毒的检测

目的:检测皮肤鳞状细胞癌(SCC)皮损中的人乳头瘤病毒(HPV)并探讨其在SCC发病中的作用.方法:用原位杂交(ISH)、聚合酶链反应技术(PCR)检测SCC患者43例,健康者28例标本组织切片中的HPV6、11、16、18、31、33.结果:43例SCC中有2例肢端部位皮损呈HPV DNA阳性,检出类型为HPV16和HPV33.其中1例标本中HPV16和HPV33同时阳性.对照组全部为阴性.结论:HPV16等6种黏膜型HPV可能与肢端以外SCC的发生无相关性,而与肢端部位SCC可能有关联性.     

Vulvar squamous cell carcinoma and lichen sclerosus

There are two clinicopathological types of vulvar squamous cell carcinoma, human papillomavirus (HPV)-positive and HPV-negative, which can be distinguished to some degree on routine histology. Human papillomavirus-positive carcinomas account for one-quarter to one-third of cases, occur in women on average 20 years younger than in HPV-negative, and are associated with multiple lower genital tract neoplasia. Human papillomavirus negative carcinoma is linked to lichen sclerosus. Of all carcinomas, 7-96% show lichen sclerosus in skin adjacent to the carcinoma, the majority being the first presentation of lichen sclerosus, and up to 5% of patients with lichen sclerosus develop carcinoma after long-term follow up. Where lichen sclerosus is associated with malignancy, it is often hyperplastic, may show a subtle form of intraepithelial neoplasia termed 'differentiated vulvar intraepithelial neoplasia', and may lose its pathognomonic oedematous-hyaline layer. The local additional factors causing lichen sclerosus to develop malignancy on the vulva are not known.     

Immunohistochemical study of toll-like receptors 1 and 2 expression in cutaneous lichen planus lesions

Lichen planus (LP) is a chronic inflammatory, T cell-mediated autoimmune skin disease. Innate immunity could explain the interplay between environmental triggers and the autoimmune cascade leading to disease development. Toll-like receptors (TLRs) are important components of the innate immune system, with no previous evaluation of TLRs 1 and 2 in cutaneous LP. This work aims to investigate TLRs 1 and 2 expression in cutaneous LP. This case–control study included 30 patients with LP and 15 healthy controls. Biopsies from the patients’ lesional skin and from the controls’ normal skin were examined immunohistochemically for TLR 1 and 2 expression. A significant re-localization was found in TLR1 expression with a higher percentage of basal and a significantly lower percentage of homogenous epidermal expression in patients (73.3 and 0 %, respectively) compared with controls (13.3 and 73.3 %, respectively) (P < 0.001). TLR2 showed a significantly higher percentage of epidermal expression (more in the upper spinous layer) and significantly lower percentage of epidermal but more basal expression in patients (66.6 and 10 %, respectively) compared with controls (0 and 73.3 %, respectively) (P < 0.001). The median (IQR) of TLR1 [1 (0.75–1)] and TLR2 [1 (1–1)] staining score in patients was significantly lower than that of the controls [2 (1–2) and 1 (1–2), respectively] (P < 0.05). This work thus shows a re-localization of TLR 1 and 2 expression sites with decreased grade of expression in LP lesions. Targeting TLR signaling is expected to be a novel treatment strategy for cutaneous LP.