Histopathological specialized staining of oral lichen planus-induced fibrotic changes and surgical treatment of associated restricted mouth opening: a case report

Background Oral lichen planus is a chronic inflammatory and immune-mediated disease that affects the oral mucosa. Recent findings have suggested that oral lichen planus is often associated with submucosal fibrotic changes. Fibrotic changes in the buccal submucosa may cause restricted mouth opening. This report discusses the histopathological examination (including specialized staining) and surgical treatment for oral lichen planus-induced fibrotic changes. Case presentation Here, we describe a 63-year-old woman who had oral lichen planus with fibrotic changes. Her maximum mouth opening distance was approximately 30 mm due to submucosal fibrotic changes, and she exhibited gradual fibrosis progression. Histological examinations were performed to assess the oral lichen planus-induced fibrotic changes. Then, double Z-plasty were performed as treatment for restricted mouth opening. The immunohistochemical staining results were negative for cytokeratin 13 and positive in some layers for cytokeratin 17 and Ki-67/MIB-1. Masson's trichrome staining showed enhanced collagen formation. Postoperative mouth opening training enabled the patient to achieve a mouth opening distance of > 50 mm. Conclusion Our findings suggest that histopathological examination with specialized staining can aid in the evaluation of oral lichen planus-induced fibrotic changes, and that Z-plasty is effective for the treatment of restricted mouth opening due to oral lichen planus.

Diagnostic utility of Cytokeratin 13 and Cytokeratin 17 in Oral Epithelial Dysplasia and Oral Squamous Cell Carcinoma

Objective: To determine the immunohistochemical expression of CK 13 and CK 17 in Oral Epithelial Dysplasia and Oral Squamous Cell Carcinoma. Methods: A total of 170 cases were retrieved from record files of Histopathology Department, to conduct a cross sectional study at Armed Forces Institute of Pathology, Rawalpindi, over a period of one year from June 2018 to June 2019 along with their formalin-fixed, paraffin embedded blocks comprising 85 cases of each oral squamous cell carcinoma and oral epithelial dysplasia. Blocks were trimmed and cut into very thin sections of 5 microns using microtome and mounted on slides. Tissue mounted slides were stained with routine haematoxylin and eosin followed by immunohistochemical staining of cytokeratin 13 and cytokeratin 17. New histological diagnosis of each case was made. Mean and standard deviation were calculated for quantitative variables. Frequency and percentages were calculated for qualitative variables. Chi-square test was employed to assess the significance of difference. The P-value <0.05 was considered significant. Results: In this study, 101 (59.4%) male and 69 (40.6%) female patients with the mean age of 60.63 ± 13.814 (mean ± SD) were collected and buccal mucosa was the most common site of presentation. In a total of 170 cases, 34 (20%) cases showed positive expression of cytokeratin 13 whereas 136 (80%) cases showed negative expression of cytokeratin 13. In comparison, out of 170 cases, 133 (78.2%) cases showed positive expression of cytokeratin 17 whereas 37 (21.8%) cases showed negative expression of cytokeratin 17. The P-value was found to be < 0.001 and 0.001 for expression of cytokeratin 13 and cytokeratin 17 respectively. Conclusion: Opposite expression of cytokeratin 13 and cytokeratin 17 was seen in this study, in the form of loss of cytokeratin 13 and over expression of cytokeratin 17 with increase in the degree of dysplasia and invasive carcinoma. Correct assessment, diagnosis and management with the help of these markers can lead to early diagnosis and favorable treatment outcome.