Case Number : Case 71 Posted By: Guest

Phillip Mckee - Overseas consultations (Arizona, USA) Wrote:

Some great comments from you all. I think that the massive hyperkeratosis with marked hypergranulosis in the absence of any parakeratosis puts one into the lichen planus spectrum. Clinically, the lesion was not hypertrophic although I take the point made in several comments. Early chronic GVHD and a lichenoid drug reaction (which is sometimes indistinguishable from lichen planus) are good differential diagnoses. In any event, clinicopathological correlation is essential. Thank you all for your contributions.

Submitted on 16/09/2010 20:33
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Wayne Grayson - (Johannesburg, South Africa) Wrote:

Hypertrophic lichen planus.

Submitted on 16/09/2010 17:16
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Marcela Saeb Lima - MSLDermatopato (Mexico City) Wrote:

Hypertrophis LE is a very good differential diagnosis, which I consider after looking to Dr. Carr´s description.

Submitted on 16/09/2010 16:44
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

Still my first possibility is LP.But I like very much the possibility of hypertrophic LE mentioned by Dr R.Carr as a DD.

Submitted on 16/09/2010 16:14
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Richard Carr - Warwick (UK) Wrote:

Just took a momments break from the reporting to check out the pearls of the day. Now this is a lichenified/"hypertrophic" lichenoid reaction telling that the condition is itichy. I would go for lichen planus first. Lichenoid MF can occasionally be itchy. you don't necessarily need the eosinophils in lichenoid drug eruptions. In lichen planus-like keratosis often have quite a mixed infiltrate of eosinophils and histiocytes and plasma cells and agree often parakeratosis. I would favour LP here but of course it is a differential diagnosis case with clinical correlation. Lichen sclerosus and hypertropic lumpus would come in as well the former probably more likely than the latter (no BM thickening). Best wishes to all. R.

Submitted on 16/09/2010 15:59
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Carlos B - Trainee (Spain) Wrote:

Lichen planus or LP-like chronic GVHD!! Bet none of you thought of that last one - what do you think Professor

Submitted on 16/09/2010 15:23
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Juan Carlos Garcés - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil Ecuador) Wrote:

Good morning..Wedge shape hypergranulosis, saw teeth appereance of the rete ridges, interface dermatitis...The infiltrate is not typically band like, but I would think in first place in Lichen planus

Submitted on 16/09/2010 14:31
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Hi all, I do agree that the infiltrate is not the classic band like, but I think in lichenoid drug reaction, one must c focal parakeratosis and the infiltrate usually shows esinophils. Also, I think in benign lichenoid keratosis, there are usually numerous apoptotic bodies and the hypergranulosis is not much pronounced as in this section. Waiting to know the correct diagnosis.

Submitted on 16/09/2010 14:22
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Marcela Saeb Lima - MSLDermatopato (Mexico City) Wrote:

I will go for lichenoid keratosis vs lichenoid drug reaction

Submitted on 16/09/2010 13:31
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Lushen Pillay - Wits Dermatology, South Africa (South Africa) Wrote:

Not a typical Lichen Planus "band like infiltrate". Will go for Lichenoid Drug eruption or Lichen Planus-like Keratosis.

Submitted on 16/09/2010 13:24
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Galal Elenany - cairo university (faculty of medicine) Wrote:

Hyperkeratosis, Wedge shaped hypergranulosis, Acanthosis, Saw teeth appearance of the rete ridges. attempt to form a lichenoid band of lymphocytes, focal interface dermatitis. Lichen planus

Submitted on 16/09/2010 12:15
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ANDREW DANCKWERTS - WITS UNIVERSITY (JOHANNESBURG, RSA) Wrote:

LICHENOID REACTION PATTERN WITH PREDOMINANT LYMPHOCYTES FORMING LYMPHOID AGGRAGATES, NOT IN A DEFINITIVE BAND-LIKE DISTRIBUTION: DDx: LICHENOID DRUG ERUPTION, LICHEN PLANUS-LIKE KERATOSIS OR SECONDARY SYPHILIS

Submitted on 16/09/2010 10:23
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V Mehta - UK (Trainee) Wrote:

Lichen planus.

Submitted on 16/09/2010 09:57
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

I can see hyperkeratosis, wedge shaped hypergranulosis, vacuolar changes at DEJ, esinophilic epidermis and some saw tooth rete ridges. The infiltrate is lymphocytic and few melanophages are also seen. I think I can see one colloid body at the extreme left of the field. The infiltrate is not the classic band infiltrate that touches the undersurface of the epidermis, however I can't think except in Lichen Planus!

Submitted on 16/09/2010 04:17
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

Lichen planus.

Submitted on 15/09/2010 21:06
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