High prevalence of esophageal involvement in lichen planus: a study using magnification chromoendoscopy.
OBJECTIVE
The first cases of squamous cell carcinoma in esophageal lichen planus were recently described. We performed a study to establish the prevalence of endoscopic and histopathologic abnormalities consistent with lichen planus and (pre-) malignancy in a cohort of patients with lichen planus.


METHODS
A total of 24 patients with lichen planus were prospectively studied using high-magnification chromoendoscopy. Focal esophageal abnormalities were mapped, classified, and biopsied. Biopsies were also taken from normal-appearing esophageal mucosa at three levels (proximal, middle, and distal). The presence of a lymphohistiocytic interface inflammatory infiltrate and Civatte bodies (i. e. apoptotic basal keratinocytes) at histopathologic examination was considered diagnostic for esophageal lichen planus. Symptoms were assessed using validated questionnaires.


RESULTS
A total of 38 focal abnormalities were biopsied. These consisted of: layers of mucosa peeling off, hyperemic lesions, papular lesions, submucosal plaques/papules, a flat polypoid lesion, and segments of cylindrical epithelium. No endoscopic signs of dysplasia were present. Esophagitis consistent with gastroesophageal reflux disease was noted in 12 / 24 patients. Histopathology showed chronic inflammation of the esophageal mucosa in the majority (18 / 24) of patients. In 50 % (12 / 24), the diagnosis of esophageal lichen planus was made. Dysplasia was not present. There were no differences in symptoms between patients with and without esophageal lichen planus.


CONCLUSIONS
At screening endoscopy a high prevalence (50 %) of esophageal lichen planus was found in patients with orocutaneous lichen planus. No dysplasia was found.
Quispel
R
R
Department of Gastroenterology, University Medical Center Utrecht, Utrecht, The Netherlands. rquispel@rdgg.nl
van Boxel
O S
OS
Schipper
M E
ME
Sigurdsson
V
V
Canninga-van Dijk
M R
MR
Kerckhoffs
A
A
Smout
A J
AJ
Samsom
M
M
Schwartz
M P
MP
D016145:Endoscopy, Digestive System / Q000379:methods*; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000473:pathology; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D008010:Lichen Planus / Q000150:complications / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology; D015995:Prevalence; D011446:Prospective Studies