Abstract
IntroductionLichen planus is an immune mediated inflammatory lesion involving skin and mucosal sites including oral mucosa, vulva and rarely vagina. Lichen planus occurring at mucosal sites has been shown to be associated with squamous cell carcinoma in a proportion of cases. To the best of our knowledge, no case of lichen planus of uterine cervix has been reported in the available literature.Case PresentationA 45-year-old female underwent vaginal hysterectomy for uterine prolapse. The resected specimen showed a bluish-colored area in the non-dependent part of the ectocervix. Microscopic sections from this area showed dense lymphocytic infiltrate at the junction of mucosa and submucosa causing disruption of the basal cell layer. On immunohistochemical examination there was predominance of CD8+ T lymphocytes at the junction with scattered CD4+ T lymphocytes, characteristic of lichen planus. Based on the history and negative serum antibody titers, other differential diagnoses including lupus erythematosus and drug reaction were excluded. The patient did not have any cutaneous or oral lesions of lichen planus.ConclusionLichen planus of uterine cervix is a hitherto unreported entity, and is worth studying considering the premalignant potential of lichen planus at other mucosal sites.
Highlights
Lichen planus is an immune mediated inflammatory lesion involving skin and mucosal sites including oral mucosa, vulva and rarely vagina
The same is true in a proportion of oral lesions which occur without cutaneous involvement
Cervix is another mucosal site, where we report the first case of lichen planus, its pre-malignant potential remains to be seen
Summary
Lichen planus is chronic inflammatory mucocutaneous disease with an immunologic etiopathogenesis [1,2]. Though uterine cervix is a mucosal site, no case of lichen planus has been reported in the English literature. A bluish discolored area without ulceration measuring 2.5 × 3 × 3 cm in size was seen in the uterine cervix (Figure 1). The discolored area was processed in entirety and the sections showed mild focal hyperplasia of the epithelium, basal layer destruction and a dense band-like lymphocytic infiltrate at the junction of epithelium and the subepithelium with exocytosis of lymphocytes in the epithelium (Figure 2). Inset shows immunostaining for CD8 subset of T-cells with aggregation at the junction and intraepithelial location along with basal layer destruction and exocytosis of lymphocytes into the epithelium (×400). A final pathologic diagnosis of isolated lichen planus of the uterine cervix was rendered
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