CLINICAL AND PATHOLOGICAL STUDY OF ORAL LICHEN PLANUS

Abstract

The clinical and pathological observation has been carried out in 59 cases of oral lichen planus examined by our department and results are as follows.1) Patients were 16 males and 43 females, and predilection was observed in females in their fifties.2) Within 6 months sized with subjunctive symptom, many of them visited our hospital as their chief complaint was pain.3) Focus appeared at buccal mucous membrane bilaterally in most cases, then at tongue and then at mucobuccal fold. At buccal mucous membrane a great many reticular patterns appeared but incidence of the pattern except reticular pattern was observed a little and also the difference in disease pattern by site was observed a little. These disease patterns accompanied with erosion were observed in 35 cases. With or without erosion can be considered to be an important index on degree of lesion and presence of secondary lesion, and in this report the cases were classified into erosive pattern and nonerosive pattern regardless of the disease pattern described above.4) In the investigation on past history and life history 2 cases of oral lichen planus seemed to be drug eruption were experienced. And 1 case grown at buccal mucous membrane developed into squamous cell carcinoma. These cases were all erosive patterns.5) Investigating the relationship between oral lichen planus and metal prosthesis with referring to patch test, positive percentage was markedly lower compaired with the past reports. In 4 cases progress was observed after metal prosthesis was removed, but since improvement of symptom was recognized only in 1 case, the influence by metal prosthesis is considered to be comparatively small.6) In the results of glucose tolerance test the incidence of diabetes mellitus pattern or junction pattern showed high (93%), especially in erosive pattern many diabetes mellitus patterns were observed. The possibility that oral lichen planus indicates the early stage of diabetes mellitus is clear.7) Amount of serum immunoglobulin (IgG, IgA, IgM) ranged within the normal values.8) In histological studies appearance of granular cell layer at mucoepithelium and acceleration of keratinization were seen in a few cases. Squamous cell layer thickened, prolongation and acumination or rete ridges and enlargement of inter-cellular space were shown. And in basal cell degeneration necrosis of cell, liquefaction degeneration and appearance of hyaline body were observed. At subepithelial tissue zonal inflammatory cellular infiltration was present and infiltrate cell was mainly lymphocyte.In electron microscopic findings inter-cellular space at epithelial layer enlarged, intrusion of amorphous flocculent material was often seen, and numbers of finger-like process and desmosome decreased. Basement membrane was not uniform in thickness and disposition, and duplication, winding and discontinuities were present. The cell infiltrated to sub-epithelial tissue was considered to be lymphocyte but cell-organell was scanty and cluster dense body was not present.9) With direct immunofluorescence method comparing with cutaneous lichen planus, less cases of immunoglobulin and deposition of complement were observed, but deposition of fibrinogen was observed at high percentage mainly at basement membrane, and in erosive pattern this tendency was shown evidently. With indirect immunofluorescence method serum antibody exhibited negative.10) Although the author may not conclude on etiology, it was assumed that degeneration of mucoepithelial basal cell and submucosal lymphocyte infiltration were the basis for lesion morphologically, and involvement of mechanism of cellular immunity in epithelial connective layer junction played an important role in pathological process of this disease.