Yamanaka Yasmin, Yamashita Maurício, Innocentini Lara M A, Macedo Leandro D, Chahud Fernando, Ribeiro-Silva Alfredo, Roselino Ana Maria, Rocha Maria José A, Motta Ana Carolina
Department of Stomatology, Public Oral Health and Forensic Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
Department of Pathology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
Am J Dermatopathol. 2018 Jul;40(7):491-497. doi: 10.1097/DAD.0000000000001071.
A great number of lichenoid lesions have overlapping clinicopathological features, so the use of adjunct tests to establish definitive diagnosis is recommended for correct management and prognosis of the lesions. In this context, direct immunofluorescence (DIF) can be a useful tool. Thus, this study aimed to characterize the clinical, histopathological, and DIF pattern in patients with oral lichen planus (OLP) and patients with oral lichenoid lesions (OLLs). Patients with OLP and patients with OLL were characterized and compared with patients with mucous membrane pemphigoid, pemphigus vulgaris, and fibrous hyperplasia through a cross-sectional study. Patients with OLP (n = 30) and patients with OLL (n = 26) were mostly white women in the fifth decade of age, with reticular lesions mainly on the buccal mucosa. All patients with OLP and half of the patients with OLL showed liquefaction degeneration at the basal cell layer and a band-like lymphocytic infiltrate in the subepithelial tissue. Twenty-two patients with OLP (73.3%), 10 with OLL (38.4%), 25 with mucous membrane pemphigoid (96.1%), and all with pemphigus vulgaris (100%) had positive DIF. There was no positive DIF in patients with fibrous hyperplasia. The most frequent DIF pattern in patients with OLP and patients with OLL was linear fibrinogen at the basement membrane zone, and a logistic regression model for positive DIF found statistically significant difference in OLP versus OLL (odds ratio, 3.73; confidence interval, 1.23-11.38). Although clinical and histopathological features are sufficient for diagnosing most of the patients with OLP and OLL, DIF is a key tool in differentiating some lichenoid lesions and could improve the diagnosis of OLP and OLL, especially in lesions showing typical clinical and histological features of OLP.
大量苔藓样病变具有重叠的临床病理特征，因此建议使用辅助检查来明确诊断，以便对病变进行正确的管理和判断预后。在这种情况下，直接免疫荧光（DIF）可能是一种有用的工具。因此，本研究旨在描述口腔扁平苔藓（OLP）患者和口腔苔藓样病变（OLL）患者的临床、组织病理学和DIF特征。通过横断面研究，对OLP患者、OLL患者以及黏膜类天疱疮、寻常型天疱疮和纤维增生患者进行了特征描述和比较。OLP患者（n = 30）和OLL患者（n = 26）大多为50岁左右的白人女性，网状病变主要位于颊黏膜。所有OLP患者和一半的OLL患者在基底细胞层出现液化变性，上皮下组织有带状淋巴细胞浸润。22例OLP患者（73.3%）、10例OLL患者（38.4%）、25例黏膜类天疱疮患者（96.1%）和所有寻常型天疱疮患者（100%）DIF呈阳性。纤维增生患者未出现DIF阳性。OLP患者和OLL患者最常见的DIF模式是基底膜区线性纤维蛋白原，阳性DIF的逻辑回归模型发现OLP与OLL之间存在统计学显著差异（比值比，3.73；置信区间，1.23 - 11.38）。虽然临床和组织病理学特征足以诊断大多数OLP和OLL患者，但DIF是区分某些苔藓样病变的关键工具，可改善OLP和OLL的诊断，特别是在表现出OLP典型临床和组织学特征的病变中。
