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p53 immunostaining in lichen sclerosus is related to ischaemic stress and is not a marker of differentiated vulvar intraepithelial neoplasia (d‐VIN)
Author(s) -
Liegl B,
Regauer S
Publication year - 2006
Publication title -
histopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.626
H-Index - 124
eISSN - 1365-2559
pISSN - 0309-0167
DOI - 10.1111/j.1365-2559.2005.02321.x
Subject(s) - lichen sclerosus , pathology , staining , vulvar intraepithelial neoplasia , keratinocyte , biopsy , basal cell carcinoma , basal (medicine) , biology , medicine , vulva , basal cell , biochemistry , insulin , in vitro , endocrinology
Aim : 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. Methods and 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 specimems. Eighty percent of early and 69% of paediatric LS showed discontinuous/continous 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. Conclusion : 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.