Unusual Histological Evidence of Dysplasia in a Case of Oral Pemphigus Vulgaris: A Potential Diagnostic Challenge.
This report describes the management of an unusual case of oral pemphigus vulgaris (PV). The patient was referred for a painful single bullous lesion together with a small proliferative area localized in the soft palate. Histology and direct immunofluorescence data were consistent for PV but disclosed unusual signs of high-grade dysplasia in the proliferative area. At surgical removal of the dysplastic area 1 week after the start of cortisone therapy there was no evidence of dysplasia. Histological signs of high-grade dysplasia in oral mucosa are often associated with concurrent or subsequent carcinoma. However, severe inflammation may induce reactive epithelial cell changes and hence mimic histologic dysplasia. Pathologic evaluation of dysplasia in an inflammatory disease like PV may be a diagnostic challenge and a careful pathological evaluation is advisable before choosing between surgical and medical approach.
University of Bologna, Bologna, Italy davide.gissi@unibo.it.
Davide Bartolomeo
DB
Gissi
University of Bologna, Bologna, Italy.
Achille
A
Tarsitano
University of Bologna, Bologna, Italy.
Chiara
C
Baldovini
University of Bologna, Bologna, Italy.
Andrea
A
Gabusi
D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001379:Azathioprine / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D009059:Mouth Diseases / Q000188:drug therapy / Q000473:pathology*; D010160:Palate, Soft / Q000473:pathology*; D010392:Pemphigus / Q000188:drug therapy / Q000473:pathology*; D011241:Prednisone / Q000008:administration & dosage
D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D001379:Azathioprine; D011241:Prednisone
dysplasia; inflammation; malignant transformation; oral pemphigus