Which one of the following histologic changes is most consistent with the diagnosis of lichen sclerosis? (LQ)
|A||Atrophy of the epidermis with dermal fibrosis|
|B||Atypia of the epidermis with dysplasia|
|C||Hyperplasia of the epidermis with hyperkeratosis|
|D||Invasion of the epidermis by individual malignant cells|
a. Several pathologic conditions are associated with the formation of white plaques on the vulva, which are clinically referred to as leukoplakia. Lichen sclerosis is seen histologically as atrophy of the epidermis with underlying dermal fibrosis.
b. This abnormality is seen in postmenopausal women, who develop pruritic white plaques of the vulva.
c. It is not thought to be premalignant. Loss of pigment in the epidermis (vitiligo) can also produce leukoplakia.
d. Inflammatory skin diseases, such as chronic dermal inflammation, squamous hyperplasia (characterized by epithelial hyperplasia and hyper keratosis), and vulvar intraepithelial neoplasia (characterized by epithelial atypia or dysplasia), can also present with leukoplakia.
e. The male counterpart of lichen sclerosis, called balanitis xerotica obliterans, is found on the penis.
f. Paget’s disease is a malignant tumor that can be found in the breast or the vulva.
g. The latter is seen clinically as pruritic, red, crusted, sharply demarcated maplike areas.
h. Histologically, these malignant lesions reveal single anaplastic tumor cells surrounded by clear spaces (“halos”) infiltrating the epidermis. These malignant cells stain positively with PAS and mucicarmine stains.