Published online Apr 14, 2013. doi: 10.3748/wjg.v19.i14.2278
Revised: January 10, 2013
Accepted: January 29, 2013
Published online: April 14, 2013
Esophageal involvement by lichen planus (ELP), previously thought to be quite rare, is a disease much more common in women and frequently the initial manifestation of mucocutaneous lichen planus (LP). Considering that the symptoms of ELP do not present in a predictable manner, ELP is perhaps more under-recognized than rare. To date, four cases of squamous cell carcinoma in association with ELP have been reported, suggesting that timely and accurate diagnosis of ELP is of importance for appropriate follow-up. In this case report, a 69-year-old female presented with dysphagia and odynophagia. She reported a history of oral LP but had no active oral or skin lesions. Endoscopic examination revealed severe strictures and web-like areas in the esophagus. Histologic examination demonstrated extensive denudation of the squamous epithelium, scattered intraepithelial lymphocytes, rare eosinophils and dyskeratotic cells. Direct immunofluorescence showed rare cytoid bodies and was used to exclude other primary immunobullous disorders. By using clinical, endoscopic, and histologic data, a broad list of differential diagnoses can be narrowed, and the accurate diagnosis of ELP can be made, which is essential for proper treatment and subsequent follow-up.
Core tip: Lichen planus is an idiopathic disorder that generally affects middle-aged patients with clinical manifestations in the skin, mucous membranes, genitalia, hair, and nails. It is fairly common as a skin disease, affecting 0.5% to 2% of the population, the mouth being the most common site of involvement. We present one such case, diagnosed using clinical, endoscopic, and histologic data, and distinguished from primary immunobullous disorders by immunofluorescence.