S9C19aP11a-LSA



S9C19aP11a-1: This is an example of LS&A of the genital area. The patterns of LS&A, affecting this anatomic site, often seem a little different from those of extra-genital sites. The superficial unit shows epidermal hyperplasia and hypergranulosis. Some of the rete ridges have pointed extremities (a marker for a senescent lichenoid reaction). There are spotty areas of mild liquefaction degeneration at the dermal-epidermal interface. There is a band of sclerotic stroma at the dermal-epidermal interface.Vessels are ectatic. There are perivascular and band-like infiltrates of lymphoid cells at the interface between the altered fibrous tissue and the underlying reticular dermis. The reticular dermis is somewhat atrophic; it shows areas of elastosis.

S9C19aP11a-2: The epidermal patterns have a lichen planus-like quality with compact hyperkeratosis, a prominent granular layer, hyperplasia of the superficial unit, and irregular rete patterns. The rete ridges are broad based and tend to be pointed at the deep extremities. There are mild vacuolar changes at the dermal-epidermal interface. The papillary dermis is widened and fibrotic; vessels are ectatic. There are perivascular and spotty, band-like infiltrates of lymphoid cells at the interface between the area of fibrosis and the underlying reticular dermis.

S9C19aP11a-3: The band-like area of sclerosis, at the dermal-epidermal interface, is relatively free of lymphoid cells. The lymphoid cells in the dermis are beneath the zone of sclerosis. Vessels are ectatic. The dermis beneath the zone of sclerosis is atrophic. To the right, the dermis shows elastosis. Lymphoid infiltrates are confined outside the area of sclerosis.

S9C19aP11a-4: The fibrous tissue has hyaline qualities. Lymphocytes are confined outside the zone of sclerosis; they are denied access to the dermal-epidermal interface (the “antigenic” zone). The wisps of blue in the sclerotic tissue are delicate elastic fibers. There are mild vacuolar changes at the dermal-epidermal interface. The basal unit is preserved in the altered rete ridges. The one rete ridge that is well represented in this field has a pointed extremity. The superficial unit is hyperplastic in patterns of terminal differentiation.

S9C19aP11a-5: In areas, the sclerotic fibrous tissue is laminated and hyalinized. Lymphocytes have collected among the lamellae, but few have gained access to the dermal-epidermal interface. The epidermis consists of a basal layer and a hyperplastic superficial unit (lichen planus-like attributes). Vessels show hyaline cuffs. Focally at the dermal-epidermal interface, hyaline membranes are duplicated in basement membrane-like patterns. In this field, the patterns are more characteristics of a classic pattern of LS&A.

S9C19aP11a-6: In this field, a few lymphocytes and histiocytes have collected near the dermal-epidermal interface. “Basement membrane” in this area is brightly acidophilic (a fibrinoid quality). It is reduplicated (a lichen planus-like quality). There are occasional plasma cells in the dermal infiltrates near the lower margin of the field.

S9C19aP11a-7: This field is representative of changes in another biopsy specimen from the same patient and the same anatomic site as the material from S9C19aP11a-6. The pattern might be characterized as a senescent lichenoid reaction in the setting of LS&A. In the absence of the material seen in S9C19aP11a-6, the patterns would not be diagnostic. Rete ridges are effaced. The band of altered fibrous tissue abutting upon the epidermis shows features of atrophy. Collagen bundles are delicate and widely spaced in a clear matrix. Lymphoid infiltrates are mild. Vessels are cuffed by hyalin.

S9C19aP11a-8: The fibrous matrix is loosely laminated. The collagen bundles are thin; they are delicate and widely spaced. The epidermis retains lichen planus-like qualities. There are mild vacuolar changes at the dermal-epidermal interface. Hyalinization of dermal connective tissue is not uniformly well-developed feature in all lesions of LS&A. Like other lichenoid processes, the patterns are variable depending on the stage of the lesion at the time of biopsy and on the site selected for biopsy.

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