Esophageal lichen planus
Macroscopic Criteria and Grading
- Negative Endoscopy (N)
- Criteria: None of the criteria below were fulfilled.
- Possible signs: None.
- Stenosis/Strictures (S)
- S1: Passable with an endoscope.
- S2: Below 1 cm diameter; non-passable with an endoscope.
- Hyperkeratosis (H)
- Criteria: White, rough mucosal surface.
- Trachealization (T)
- Criteria: Tracheal-like appearance of the esophagus.
- Denudation of the Mucosa (D)
- D0: No denudation.
- D1: Iatrogenic denudation (sloughing and/or tearing of the mucosa after taking biopsies).
- D2: Spontaneous, localized denudation (sloughing and/or tearing of the mucosa < 1 cm²).
- D3: Spontaneous, extensive denudation (sloughing and/or tearing of the mucosa > 1 cm²).
Microscopic Criteria and Grading
- Histopathologic Criteria (HP)
- Criteria:
- Detachment of the epithelium (subepithelial/intraepithelial).
- Lymphocytic (T-cell) infiltrate (subepithelial, junctional, intraepithelial).
- Intraepithelial apoptosis (Civatte bodies).
- Dyskeratosis.
- Grading:
- HP0: Negative.
- HP1: Weak positive.
- HP2: Positive.
- HP3: Strong positive.
- Immunofluorescence Criteria (F)
- Criteria:
- Fibrinogen depositions along the basement membrane in direct immunofluorescence (DIF).
- Grading:
- F0: No visible reaction.
- F1: Weak positive (some fibrinogen deposits visible).
- F2: Positive (fibrinogen deposits clearly present along the basement membrane).
- Other Depositions: IgG, IgA, or C3 were described but not included in the grading system.
Grading of Esophageal Lichen Planus (ELP)
- Severe ELP
- Criteria:
- Endoscopy: D2 (Spontaneous, localized denudation) and positive histopathology (≥ HP1).
- Positive DIF may substitute for HP if HP grading is ambiguous.
- Mild ELP
- Criteria:
- Endoscopy D1 (Iatrogenic denudation) and positive histopathology (≥ HP1) and/or DIF (≥ F1).
- Endoscopy N (Negative) or U (Unspecified) and positive histopathology (≥ HP1) and DIF (≥ F1).
- No ELP
- Criteria: None of the above criteria were fulfilled.
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