S5C12aP6aLSA



S5C12aP6a-1: This is a vulvar lesion of LS&A. The epidermis shows hyperkeratosis, a prominent granular layer, and elongation of rete ridges. There are lichenoid patterns at the dermal-epidermal interface; a well-developed lichenoid reaction is seen centrally and to the left. In the latter area, the papillary dermis contains a band-like infiltrate of lymphoid cells. The infiltrate hugs the epidermis; it has migrated into it to produce a lichenoid reaction. In the area of the lichenoid reaction, the pattern is that of a cell-rich variant.

S5C12aP6a-2: At a higher magnification, the patterns in this lesion of LS&A are lichen planus-like. The basement membrane zone at the dermal-epidermal interface is thickened and hyalinized; in areas, it is reduplicated.

S5C12aP6a-3: This pattern of clearly defined basement membrane hyalinosis is uncommon in lesions of LS&A; a more accurate characterization would be that this cell-rich lichenoid pattern is rarely encountered (or documented) in well-developed lesions.

S5C12aP6a-4: Basement membrane hyalinosis is a prominent feature. In addition, the basement membrane material is reduplicated. I would interpret this pattern as representative of an early stage which, with progression, will eventuate in the more extensive hyalinosis that is emphasized in the textbook descriptions of LS&A. The hyalin is first deposited at the dermal-epidermal interface in membranous patterns.

S5C12aP6a-5: In this portion of the lesion, the patterns are cell-poor in the fibrotic dermis and at the dermal-epidermal interface. Green arrows define the boundary between the zone of hyalinosis and a zone of less distinctive fibrosis in the underlying reticular dermis. In the zone of hyalinosis, vessels are ectatic. There are spotty, mild perivascular infiltrates of lymphoid cells (LS&A).

S5C12aP6a-6: The hyalin is coarsely laminated; it extends to the dermal-epidermal interface. Vessels are ectatic. There are mild perivascular infiltrates of lymphoid cells; the lymphoid infiltrates do not extend to the dermal-epidermal interface. Once the hyalinosis is this well-developed, it seems to function as an immunologic barrier; lymphoid infiltrates tend to be confined outside the area of hyalinosis at the interface between the zone of hyalinosis and the underlying fibrotic reticular dermis (LS&A).

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