Oral epithelial dysplasia with lymphocytic immune response: clinicopathological characterisation of 44 cases

Ivan J Stojanov; Joud Omari; Ibrahim Akeel; Ahmed S Sultan; Sook-Bin Woo

doi:10.1111/his.15171

Oral epithelial dysplasia with lymphocytic immune response: clinicopathological characterisation of 44 cases

Histopathology. 2024 Mar 18. doi: 10.1111/his.15171. Online ahead of print.

Authors

Ivan J Stojanov^{1

2}, Joud Omari^{3

4}, Ibrahim Akeel⁵, Ahmed S Sultan^{6

7}, Sook-Bin Woo^{3

8}

Affiliations

¹ Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
² Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
³ Harvard School of Dental Medicine, Boston, MA, USA.
⁴ Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontology, School of Dentistry, The University of Jordan, Amman, Jordan.
⁵ Oral Diagnostic Sciences Department, King Abdulaziz University Faculty of Dentistry, Jeddah, Saudi Arabia.
⁶ Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland, Baltimore, MD, USA.
⁷ University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA.
⁸ Center for Oral Pathology, StrataDx, Lexington, MA, USA.

PMID: 38497348
DOI: 10.1111/his.15171

Abstract

Aims: Oral epithelial dysplasia (OED) often exhibits a lymphocytic/lichenoid immune response (LIR), imparting histological resemblance to lichenoid mucositis and rendering diagnosis challenging. The clinical appearances of OED and lichenoid inflammatory processes are generally divergent, presenting as well-demarcated hyperkeratotic plaques and diffuse white and/or red mucosal change with variably prominent Wickham striae, respectively. To date, clinicopathological characterisation of OED with LIR, including clinical/gross appearance, has not been depicted.

Methods and results: Cases of solitary OED with LIR for which a clinical photograph was available were identified in the authors' institutional files. Clinical and histological features were documented. In 44 identified cases, dysplasia was mild (19 of 44, 43.2%), moderate (19 of 44, 43.2%) and severe (six of 44, 13.6%). Clinically/grossly, all 44 cases (100.0%), presented as well-demarcated hyperkeratotic plaques lacking diffuse white-and-red mucosal change or Wickham striae. Histologically, OED with LIR exhibited numerous 'lichenoid' features beyond the lymphocytic band in the superficial lamina propria, including: leucocyte transmigration (38 of 44, 86.4%), spongiosis (37 of 44, 84.1%), Civatte/colloid bodies (36 of 44, 81.8%), basal cell degeneration (29 of 45, 65.9%), sawtooth rete ridges (11 of 44, 25.0%) and subepithelial clefting (7 of 44, 15.9%).

Conclusions: Virtually any lichenoid histological feature may be seen in OED with LIR, representing a significant diagnostic pitfall. The typical clinical appearance of OED with LIR is of a well-demarcated hyperkeratotic plaque, characteristic of keratinising dysplasia and devoid of lichenoid features. This suggests that pathologist access to clinical photographs during diagnostic interpretation of biopsied white lesions, which represents opportunity to perform gross examination of the disease process, may reduce interobserver variability and improve diagnostic accuracy in this challenging differential diagnosis.

Keywords: leukoplakia; lichen planus; oral cancer; oral epithelial dysplasia; oral lichenoid lesion; oral potentially malignant disorder.

Grants and funding

University Hospitals Cleveland Medical Center