Division of Research, ProPath, Dallas, TX 75247, USA.
World J Gastroenterol. 2013;19(14):2278-81. doi: 10.3748/wjg.v19.i14.2278.
Esophageal involvement by lichen planus (ELP), previously thought to be quite rare, is a disease much more common in women and frequently the initial manifestation of mucocutaneous lichen planus (LP). Considering that the symptoms of ELP do not present in a predictable manner, ELP is perhaps more under-recognized than rare. To date, four cases of squamous cell carcinoma in association with ELP have been reported, suggesting that timely and accurate diagnosis of ELP is of importance for appropriate follow-up. In this case report, a 69-year-old female presented with dysphagia and odynophagia. She reported a history of oral LP but had no active oral or skin lesions. Endoscopic examination revealed severe strictures and web-like areas in the esophagus. Histologic examination demonstrated extensive denudation of the squamous epithelium, scattered intraepithelial lymphocytes, rare eosinophils and dyskeratotic cells. Direct immunofluorescence showed rare cytoid bodies and was used to exclude other primary immunobullous disorders. By using clinical, endoscopic, and histologic data, a broad list of differential diagnoses can be narrowed, and the accurate diagnosis of ELP can be made, which is essential for proper treatment and subsequent follow-up.
食管扁平苔藓（ELP）受累，以前认为较为罕见，实际上在女性中更为常见，且常为黏膜皮肤扁平苔藓（LP）的初始表现。由于 ELP 的症状无规律可循，因此其可能比罕见更易被漏诊。迄今为止，已有 4 例与 ELP 相关的鳞状细胞癌的报告，这提示及时准确地诊断 ELP 对于适当的随访非常重要。在本病例报告中，一名 69 岁女性因吞咽困难和咽痛就诊。她自述有口腔 LP 病史，但无活动性口腔或皮肤病变。内镜检查显示食管严重狭窄和网状区域。组织学检查显示鳞状上皮广泛脱落，散在的上皮内淋巴细胞，罕见的嗜酸性粒细胞和角化不良细胞。直接免疫荧光显示罕见的细胞样小体，用于排除其他原发性免疫性大疱性疾病。通过使用临床、内镜和组织学数据，可以缩小广泛的鉴别诊断列表，并做出 ELP 的准确诊断，这对于正确的治疗和后续随访至关重要。
