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A DIAGNOSTICDELIMA
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INTRODUCTION
Lack of clinico pathologic correlation in thediagnosis of OLP based on the presentlyavailable diagnostic criteria herein certainsuggestions & modifications have beenmade.
OLP is regarded as a clinicopathologic
diagnosis based on a combination of clinical& histopathologic criteria
Studies are done to correlate between clinical& histo atholo ic features of OLP.
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LICHEN PLANUSChronic mucocutaneous disease of
unknown etiologyEtiopathogenesisImmunologically mediated processthat microscopically resembleshypersensitivity reaction.
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C/F : Female predilection (>40yrs)
Bilateral symmetrical white keratotic striae.
TYPES :
Keratotic Vesiculobullous A tropic E rosive
Reticular
Annular
Papular
Linear
Floral
Plaque like
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H ISTOPAT H OLOGYHyperkeratosis
Basal cell degeneration
T-Lymphocytic infiltration
Rete ridges (saw tooth)
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K ERATOTIC OLP
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DIFFERENTIAL DIAGNOSIS
Lichenoid drug reaction
Lichenoid Dysplasia
Lupus erythematosis
White Sponge Nevus
Hairy Leukoplakia
Cheek Chewing
Graft Versus Host Disease
Candidiasis
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PLAQUE LI K E LIC H EN PLANUS
Idiopathic Leukoplakia
Squamous cell carcinoma
EROSIVE OR ATROP H IC LIC H EN PLANUS
Cicatricial Pemphigoid
Pemphigus Vulgaris
Chronic Lupus Erythematosis
Contact Hypersensitivity
Chronic Candidiasis
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LIC H ENOID REACTION
Presence of lesion resembling Lichen Planus mainlyon the buccal mucosa associated with ingestion of some category of medications & presence of exogenous materials in the oral cavity.
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LIC H ENOID DYSPLASIA
K rutchoff & Eisenberg
A lesion that histopathologically revealedcharacteristics of Oral Lichen Planus and additional
presence of dysplastic features within the overlyingepithelium .
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WHO Diagnostic criteria for OLP & OLL
Clinical CriteriaPresence of bilateral more or less symmetrical
lesions.Presence of a lace like network of slightly raisedgray white linesErosive,Atrophic,Bulbous & Plaque type lesions
are only accepted as a subtype in the presence of reticular lesions elsewhere in the oral mucosa.In all other lesions that resemble OLP but do notcomplete the aforementioned criteria the term
clinically compatible w ith should be used.
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HISTOPATHOLOGICALCRITERIA
Presence of well defined band like zone of cellular infiltration that is confined to the superficial part
of the connective tissue consisting mainly of lymphocytesSigns of liquefaction degeneration of the basal celllayer
Absence of epithelial dysplasiaWhen histopathological features are less obviousthe term histopathologically compatible w ithshould be used
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FINAL DIAGNOSIS OF OLP &OLL
C linical as histopathological criteria has to be included
OLLC linically typical of OLP but H istopathologically only compatible w ith OLPH istopathologically typical of OLP but
clinically only compatible w ith OLPC linically compatible w ith OLP &H istopathologically compatible w ith OLP
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CONCLUSIONThere is a lack of Clinicopathologiccorrelation in the diagnostic assessment of OLP.Modified WHO definition of OLP &OLL includes both clinical as well ashistopathological criteria thus may
eliminate confusion for diagnosis
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