Esophageal lichen planus: Current knowledge, challenges and future perspectives

Figure 1 Endoscopic findings in esophageal lichen planus. A: Trachealization; B: Trachealization and fragile mucosa; C: Hyperkeratosis; D: Hyperkeratosis and stenosis; E and F: Tearing and localized denudation of the mucosa; G-I: Tearing and spacious denudation of the mucosa. Endoscopic images were taken from our cohort of patients.

Figure 2 Histologic findings in esophageal lichen planus. A and B: Lichenoid lymphocytic infiltrate of the lamina propria spilling over to the partially detached squamous epithelium; B and C: Intraepithelial lymphocytosis associated with apoptotic squamous cells (Civatte bodies, arrows); D: Dense CD3+ T-cell rich inflammation of the lamina propria involving 2/3 of surface epithelium and muscularis; E: Presence of a CD4+T-cell subset in the infiltrate; F: Civatte body rimmed by CD3+ T-cells.

Figure 3 Esophageal epidermoid metaplasia in esophageal lichen planus. A-C: Atrophic squamous epithelium showing extensive detachment from the lamina propria, subtle hyperkeratosis (A, C) and mild intraepithelial CD3+ T-lymphocytosis (B) associated with scattered Civatte bodies (C, arrow); D, and E: Low-grade squamous orthokeratotic dysplasia in detached epithelium of ELP. Presence of basal-type cells in the lower half of the flat epithelium, note presence of scattered mitosis (E, star); F: An increased Ki67+ proliferation index.

Figure 4 Direct immunofluorescence. Fibrinogen deposits in the basal membrane as a characteristic feature of Lichen planus. Direct immunofluorescence image was taken from one of our patients.

Figure 5 Proposal for management of esophageal lichen planus. * As topical steroids (e.g. budesonide or fluticasone), swallowed spray, viscous solution, or orodispersable tablets might be adminstered. LP: Lichen planus; DIF: Direct immunofluorescence; ELP: Esophageal lichen planus.