Case Number : Case 1489- 09 March Posted By: Guest

Lichenoid Keratosis

Keratosis, NOS.  No evidence of lichen planus or dysplasia. 

Yes...I didn't read the mucosa site of the lesion. So I change my diagnosis to Oral Lichenoid Reaction (NOS)

I was thinking of lichen planus, there is not enough basal hyperplasia and cytologic alterations for me but when is mild dysplasia there is usually not a good interobserver agreement...   

Hmm. I do see oral biopsies regularly in my routine practice and I agree does look rather lichenoid but something is holding me back from typical lichen planus (would have to consider lichenoid reaction to amalgam). Reactive atypical only, certainly no dysplasia. Although frictional keratosis with chronic hyperplastic mucosal candidiasis would be a further consideration. Clinical correlation essential. (edited - needs PAS thought there might be fungi in image 1 but changed my mind just nuclei).

Oral lichenoid reaction, ddx: lichen planus, lichenoid hypersensitivity, chronic irritation.  Would do PAS.  I don't see any significant atypia or dysplasia.

agree that CPC is essential, lichenoid pattern in oral mucosae has broad differential diagnoses

In the first img left bottom there is something like fungal spores...not sure about it! 

PAS was negative.  Clinically, they were considering lichen planus; so consistent with lichen planus.