Is Vulvovaginal Lichen Planus Associated With Squamous Cell Carcinoma?

Abstract

Objective: The aim of the study was to assess for the presence of vulvar lichen planus (LP) in association with human papillomavirus (HPV)-independent squamous cell carcinoma (SCC).

Materials and methods: We performed a clinicohistopathologic review of consecutive vulvectomies and wide local excisions for HPV-independent vulvar or vaginal SCC from 2007 to 2017. Data collected included site of SCC, adjacent precursor lesions and dermatoses, dermatologic treatment, and outcome.

Results: There were 43 cases of primary HPV-independent vulvar SCC treated by excision, but no vaginal cancers. Eighteen women (42%) had a preoperative diagnosis of lichen sclerosus (LS); none had a diagnosis of LP. Topical corticosteroids were prescribed in 19 (44%) of 43, with 4 women placed on maintenance therapy. Tumors arose from the labia minora, labia majora, and periclitoris, but not from vestibule or perianus. On histopathological review, LS was present in 41 (95%) of 43 specimens, 1 had a nonspecific lichenoid reaction, and 1 had lichen simplex; both of the latter had subsequent biopsies showing LS. Lichen planus was not seen in association with SCC. Differentiated vulvar intraepithelial neoplasia (dVIN) was present in 38 (88%) of 43 specimens, whereas 1 had acanthosis with altered differentiation and 4 (9%) had no precursor lesion. Differentiated vulvar intraepithelial neoplasia had standard, basaloid, and hypertrophic morphology, superficially resembling erosive LP in 9 (24%) of 38 and hypertrophic LP in 6 (16%) of 38.

Conclusions: Lichen planus was not seen in association with HPV-independent vulvar SCC, whereas LS was underrecognized and inadequately treated in this group. Pathologists should be aware that dVIN may superficially resemble erosive or hypertrophic LP.

FIGURE 1

A, A 50-year-old with a 20-year history of LS and 2 opposing tumors of keratinizing SCC and dVIN in a field of LS. B, Standard dVIN morphology is accompanied by dermal sclerosis (H&E ×200).

FIGURE 2

A, This example of hypertrophic dVIN displays basal layer degeneration at the tips of rete ridges (arrows) and dense lymphocytic infiltrate (H&E ×100). B, Basilar atypia away from the tips of rete ridges (arrows) differentiates dVIN from hypertrophic LP (H&E ×200).

FIGURE 3

Basaloid dVIN seen as thinned epithelium, full-thickness atypia, stromal fibrosis, and a dense lymphoplasmacytic infiltrate; p16 was negative (H&E ×200).

FIGURE 4

A, A 74-year-old with verrucous SCC, dVIN, and VAAD on background of pallor, lichenification, and architectural change characteristic of LS. B, VAAD adjacent to dVIN is demonstrated by thickened epithelium, parakeratosis, and an underlying pale band, with a sharp transition to the spiky rete ridges and basilar atypia (inset) of standard dVIN. Throughout there is a dense lymphocytic infiltrate and stromal sclerosis (H&E ×40, inset H&E ×400).

FIGURE 5

An area of acanthotic morphology without basal layer atypia showed a variable appearance of the stratum corneum and granular cell layer (H&E ×100).