S3C17P6-Lichen Striatus

S3C17P6-1: A follicular lymphoepithelial lesion of lichen striatus is, in this example, a cell-rich lichenoid reaction and a cytolytic T cell process. In this field, the changes are not sufficiently mucinous to be characterized as follicular mucinosis.

S3C17P6-2: Several of the sweat glands and ducts of this lobule are identified by their proximity to blue arrows. Centrally, epithelial islands are closely associated with the lymphoid infiltrates; the boundary between epithelial islands and lymphoid infiltrates is poorly defined. Lymphoid cells intermingle among the altered epithelial cells. Lumens are obliterated in the central area. The lesion qualifies as a lymphoepithelial island in the setting of lichen striatus.

S3C17P6-3: This higher magnification of the central area of figure S3C17P6-2 shows the lymphoepithelial islands with lymphocytes among the epithelial cells of the sweat gland. The epithelial cells have enlarged, irregular nuclei, and acidophilic cytoplasm. The patterns are comparable to those encountered in the lymphoepithelial islands of salivary glands in Sjogren’s syndrome. A small granuloma is present to the right near the margin of the field. This pattern of a lymphoepithelial lesion is peculiarly expressive of lichen striatus in most cases.

S3C17P6-4: The lichenoid reaction at the dermal-epidermal interface in this field is in a senescent phase. The widened papillary dermis is fibrotic and cell-poor. There are small collections of colloid bodies. Melanophages are also a marker for the lytic qualities of the earlier established reaction. The epidermis over the area of senescence is thin; it shows compact hyperkeratosis. The epidermis in the area of thinning is almost purely a superficial unit composed of cells committed to terminal differentiation. The follicle in the dermis shows a cell-rich, established reaction with erosion of the extremity of the follicle (lichen striatus).

S3C17P6-5: Some biopsy specimens from lesions of lichen striatus show minimal inflammatory infiltrates and little in the way of a significant lichenoid reaction.

S3C17P6-6 (see also S3C17P6-4): In this field, the patterns to the left of the center of the field are those of a focal senescent lichenoid reaction with a thin epidermis. This thin epidermis is essentially a surviving superficial unit; it is composed of keratinocytes that are committed to terminal differentiation. Clusters of colloid bodies are present in the papillary dermis. Just to the right of the center of the field, the patterns are again senescent, but the superficial unit is hyperplastic. In it, the keratinocytes have more abundant, acidophilic cytoplasm. The pattern is one of a superficial unit showing exaggerated markers for terminal differentiation. Nuclei are widely spaced. The granular layer is prominent. Blue arrows point to clusters of colloid bodies ( lichen striatus).

 

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