A Clinicohistopathological Characterization of Oral Lichen Planus: A Cross-Sectional Study

Abstract

Objective: Based on the modified diagnostic criteria for oral lichen planus (OLP) proposed by Van der Meij and Van der Waal, the objective of the current investigation was to demonstrate a clinicohistopathological association in the diagnosis of OLP.

Materials and methods: Data were retrieved from 250 individuals who visited the Department of Oral Medicine and Radiology and were diagnosed with OLP between September 2018 and December 2021. Upon completion of the histopathological analysis, the precise diagnosis of OLP was made. Repeat biopsies were performed in the cases suspecting malignant transformation during the follow-up phase. The data were analyzed using SPSS software. The Fisher's exact test and chi-square test of association were used to establish the significant differences between the variables at a 5% significance level.

Results: Of the 250 patients, 48% and 52% were males and females, respectively. The two clinical manifestations observed were reticular (n=145, 58%) and erosive types (n=105, 42%). The most frequently impacted locations were the buccal mucosa (n=150, 60%) and labial mucosa (n=100, 40%). Fourteen individuals (two with reticular form and 12 with erosive form) later during follow-up showed dysplasia, with moderate (n=2) to mild (n=12) dysplastic alterations. Koilocytes were reported in 84 cases (34%), which included 35 (24%) reticular cases and 49 (47%) erosive lesions. The histopathological features such as acanthosis, epithelial atrophy, hyperkeratosis, presence of neutrophils, koilocytes, and epithelial dysplasia were shown to be statistically significant between the clinical forms (p<0.001).

Conclusion: The results of the current study highlight the concordance of histopathological and clinical diagnoses, especially for early definitive diagnosis of OLP. More research studies are warranted to validate the trend of epithelial dysplasia in OLP associated with human papillomavirus (HPV) and to explore the course of the lesions that might be affected by this trait.

Keywords: epithelial dysplasia; hydropic degeneration; koilocytosis; oral lichen planus; plasma cells.

Figure 1. 10× magnification of epithelial hyperkeratosis, acanthosis, saw-tooth rete pegs, and subepithelial lymphocytic infiltration

Figure 2. 40× magnification of epithelial atrophy, hydropic degeneration of the basal layer saw-tooth rete pegs, subepithelial lymphocytic infiltration, and plasma cells in the connective tissue

Figure 3. 40× magnification of koilocytes showing vacuolated cells