p53 immunostaining in lichen sclerosus is related to ischaemic stress and is not a marker of differentiated vulvar intraepithelial neoplasia (d-VIN).
OBJECTIVE
To analyse p53 immunoreactivity in 207 biopsy specimens of lichen sclerosus (LS) and "differentiated vulvar intraepithelial neoplasia" (d-VIN), a postulated precursor lesion for LS-associated vulvar squamous cell carcinoma (SCC), which is characterized by atypical basal keratinocyte proliferations with p53+ basal/suprabasal keratinocyte nuclei.


RESULTS
Forty early, 78 classic, 30 hypertrophic vulvar LS, 26 paediatric vulvar and penile LS, 33 vulvar LS-associated SCC and 30 vulvar/penile control specimens were examined for p53 expression and the presence of d-VIN. Nuclear p53 staining was observed in 175/207 LS biopsy specimens. Eighty percent of early and 69% of paediatric LS showed discontinuous/continuous p53 staining in basal keratinocytes. Classic LS showed no p53 staining in 17%, discontinuous basal keratinocyte staining in 20%, continuous basal keratinocyte staining in 58%, basal/suprabasal staining in 5%. Hypertrophic LS revealed basal keratinocyte staining in 32% and basal/suprabasal staining in 61%. p53 staining was associated with sclerosis of blood vessels and dermis, lymphoid infiltrates, vasculitis and hypertrophic LS. d-VIN was seen in 2% of LS alone and in 24% of LS-associated SCC.


CONCLUSIONS
d-VIN in LS is rare, while p53 staining is common and best explained as an ischaemic stress response due to poor oxygenation, vasculitis and inflammation rather than as a marker of a precancerous lesion in LS.
Liegl
B
B
Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, 8036 Graz, Austria.
Regauer
S
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017209:Apoptosis; D014408:Biomarkers, Tumor / Q000032:analysis; D002278:Carcinoma in Situ / Q000737:chemistry / Q000175:diagnosis / Q000473:pathology*; D002294:Carcinoma, Squamous Cell / Q000737:chemistry / Q000175:diagnosis / Q000473:pathology; D049109:Cell Proliferation; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007511:Ischemia / Q000175:diagnosis / Q000473:pathology*; D015603:Keratinocytes / Q000737:chemistry* / Q000473:pathology; D008875:Middle Aged; D011230:Precancerous Conditions / Q000737:chemistry / Q000175:diagnosis / Q000473:pathology; D016159:Tumor Suppressor Protein p53 / Q000032:analysis*; D014844:Vulva / Q000098:blood supply* / Q000473:pathology; D007724:Vulvar Lichen Sclerosus / Q000175:diagnosis / Q000473:pathology*; D014846:Vulvar Neoplasms / Q000737:chemistry / Q000175:diagnosis / Q000473:pathology*
D014408:Biomarkers, Tumor; D016159:Tumor Suppressor Protein p53