[729] Lichenoid Esophagitis; Clinical Overlap with Established Esophageal Lichen Planus

Safia N Salaria, Michael W Cruise, Laura D Wood, Elizabeth A Montgomery. Johns Hopkins School of Medicine, Baltimore, MD

Background: Lichen planus (LP) affects mucocutaneous surfaces, and is characterized by intra-epithelial and lamina propria lymphocytosis and squamous cell apoptosis (Civatte bodies). LP esophagitis (LPE) is under recognized; concurrent cutaneous disease is present in some patients, but LPE alone and/or with oral lesions is more common.
Design: We diagnose patients with characteristic pathologic findings of LP esophagitis and known correlation with skin disease or immunofluorescence (IF) results as LPE but use descriptive terminology (“lichenoid esophagitis pattern”/LEP) when confirmation is unavailable. We reviewed clinicopathologic features of cases diagnosed at our institution with LPE or LEP (1/2000 - 8/2012). Immunostains (CD3, CD20, FOXP3) were performed on biopsies from patients with 1) proven LPE, 2) proven LPE and oral LP 3) LPE plus known cutaneous LP, 4) LPE and nonspecific skin changes, and 5) patients with LEP on biopsy, with negative LPE IF studies.
Results: There were 88 specimens with LPE or LEP from 65 patients. Most (79%) patients were female. Seventeen (26%) patients had LPE confirmed by IF. Five (8%) patients had both esophageal (1 with IF) and skin LP.

Clinicopathologic Features of Lichen Planus Esophagitis (LPE) Versus Lichenoid Esophagitis Pattern (LEP)
 Established LPE % (N)LEP % (N)p
Number of patients32% (21)68% (44) 
Female95% (20)71% (31)0.000001
Median Age63580.083
Dysphagia43% (9)23% (10)NS
Structures38% (8)9% (4)0.000001
Distribution - Med Esophagus14% (3)27% (12)NS
Distribution - Upper and Lower Esophagus33% (7)18% (8)NS
Associated Rheumatologic Disorders24% (5)11% (5)0.00236
HIV0% (0)14% (6)0.00007
Viral Hepatitis0% (0)9% (4)<0.05
Takin >3 Medications67% (14)59% (26)0.00001
Progression to Dysplasia/Carcinoma5% (1)7% (3)NS

Immunolabeling with CD20, CD3, and FOXP3 did not allow distinction between LEP and LPE.
Conclusions: Both LPE and LEP present with dysphagia, with superimposable histologic features and immunolabeling with CD20, CD3, and FOXP3. About 5% of LPE patients have tandem skin manifestations. LPE is more likely than LEP to arise in women, result in stricture formation, and be associated with rheumatologic disorders, whereas LEP is associated with viral hepatitis, HIV, and use of multiple medications. Either process can be associated with progression to neoplasia in a minority of case. Since the risk of stricture formation is high in patients with LPE, it is worth performing pertinent IF studies to confirm LPE, although knowledge of the clinical association of LEP with viral hepatitis, HIV, and use of multiple medications is of value in daily practice.
Category: Gastrointestinal

Monday, March 4, 2013 9:30 AM

Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 113, Monday Morning


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