Morphological features of various variants of the course of scleroatrophic lichen of the vulva

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Scale for assessing objective and subjective clinical signs of lichen sclerosus of the vulva

signs	Variants of the course of lichen sclerosus (SL)
	atrophic	mark (+ or V)	Sclerosing	mark (+ or V)	Sclero-­atrophic	mark (+ or V)	Comments
objective
Pigmentation	missing		pronounced		moderately pronounced		* associated with atrophy of the vulva
	mild				pronounced*
Atrophy of the external genitalia	intermediate stage		missing		intermediate stage*		* necessarily combined with depigmentation
	final stage		initial stage		final stage*
Sclerosis and thickening of the skin	missing		pronounced		moderately pronounced *		* associated with atrophy of the vulva
					pronounced*
Stenosis of the vestibule*	missing		missing		missing		* The symptom depends on the duration of the disease ** develops rapidly, within 2-5 years *** develops for a long time, only after 10 years from the onset of the disease
	1 degree **		1 degree **		1 degree **
	2 degree **		2 degree **		2 degree **
	3 degree **		3 degree **		3 degree **
Skin condition	Dry, smooth, shiny like «parchment»		Wrinkled and sharply thickened like «shagreen»		The combination of skin areas according to the type of «parchment» and «shagreen»
subjective
Itching of the vulva	missing		light *		heavy**		* with a process duration of less than 3 years
	light		moderate
			heavy
Dyspareunia/Vulvodynia	superficial		deep		mixed

Note: the variant of the clinical course of SLV with the largest number of marks (+ or V) is selected.

Fig. 1. Atrophic variant of the course of the vulva SL. A site of fibrinoid necrosis with leukocyte infiltration of multilayer squamous epithelium with the development of parakeratosis, dyskeratosis Development of dense fibrous connective tissue in the superficial layers of the dermis with moderate

Fig. 2. Atrophic variant of the course of the vulva SL. Uneven atrophy and chronic inflammation of the skin with the development of fibrous tissue ((hematoxylin-eosin staining, x 100)

Fig. 3. Atrophic variant of the course of the vulva SL. Sharp atrophy of the epidermis with the development of pronounced fibrosis of the superficial and deep layers of the dermis. Moderate lymphoplasmocytic and histiocytic infiltration of the stroma, pronounced angiomatosis of the dermis, infiltration by protein eosinophilic masses (CHIC-Hotchkiss reaction, x 100)

Fig. 4. Atrophic variant of the course of the vulva SL. In the areas of parakeratosis, there is a decrease in the amount of glycogen in the cells of the multilayer squamous epithelium, moderate lympho-histiocytic infiltration of the dermis with angiomatosis (CHIC-Hotchkiss reaction, x 100)

Fig. 5. Atrophic variant of the course of the vulva SL. Parakeratosis, hyperkeratosis of the multilayer squamous epithelium. Pronounced fibrosis of the superficial and deep layers of the dermis with compression of the lumen of blood vessels, moderate lymph-histiocytic infiltration of the stroma (picro-Mallory coloration, x 100)

Fig. 6. Atrophic variant of the course of the vulva SL. Sharp atrophy of the epidermis. Development of dense fibrous tissue in the superficial and deep layers of the dermis with moderate lymphohistiocytic infiltration and angiomatosis of the dermis (picro-Mallory coloration, x 100)

Fig. 7. Atrophic variant of the course of the vulva SL. Hypoelastosis. Against the background of moderate chronic inflammation of the dermis, there is a sharp shortage of elastic fibers (orsein staining, x 100)

Fig. 8. The sclerosing variant of the vulva SL. Against the background of uneven atrophy and acanthosis of the multilayer squamous epithelium in the superficial and deep layers of the dermis, pronounced lymph-histiocytic cell infiltration, the development of dense connective tissue in the dermis((hematoxylin-eosin staining, x 100)

Fig. 9. The sclerosing variant of the vulva SL. Sharp atrophy of epidermal cells, uneven hyperkeratosis, development of dense connective tissue in the dermis (hematoxylin-eosin staining.x 100)

Fig.10. The sclerosing variant of the vulva SL.  Under the atrophic multilayered squamous epithelium there is fibrous tissue with single reduced thin-walled vessels in the surface layers of the dermis with deposition of hyaline masses, moderate lymph-histiocytic infiltration of the deep layers of the dermis (CHIC-Hotchkiss reaction, x 100)

Fig.11. The sclerosing variant of the vulva SL. Sharp atrophy of epidermal cells with areas of hyperkeratosis with pronounced fibrosis of the superficial and deep layers of the dermis with sclerosis and hyalinosis of a few vessels of the microcirculatory bed (picro-Mallory coloring, x 200)

Fig.12 The sclerosing variant of the vulva SL. Under the atrophic multilayered squamous epithelium with signs of keratinization and hyperkeratosis, there is a moderately pronounced chronic inflammation of the superficial and deep layers of the dermis with angiomatosis, plasma impregnation of the walls of the vessels of the microcirculatory bed (CHIC-Hotchkiss reaction, x 100)

Fig.13. The sclerosing variant of the vulva SL.  Under the atrophic multilayered squamous epithelium with signs of keratinization, there is pronounced fibrosis of the dermis with moderate lymph-histiocytic infiltration and uneven angiomatosis (Picro-Mallory coloring, x 100)

Fig.14. Scleroatrophic variant of SL.  Sharp atrophy of epidermal cells with areas of increased keratinization with the development of fibrous connective tissue with lympho-histiocytic infiltration of the dermis (hematoxylin-eosin staining, x 100)

Fig.15. Scleroatrophic variant of SL.  Sharp atrophy and dystrophy of epidermal cells, pronounced fibrosis and hyalinosis of the superficial layers of the dermis with reduction of microcirculatory vessels, development of fibrous tissue in the deep layers of the dermis (CHIC-Hotchkiss reaction, x 100)

Fig.16. Scleroatrophic variant of the course of SL. Uneven atrophy and hyperkeratosis of the multilayer squamous epithelium, moderate chronic inflammation of the dermis with the development of fibrous tissue ((hematoxylin-eosin staining, x 100)

Fig.17. Scleroatrophic variant of the course of SL. Sharp atrophy of epidermal cells, weakly expressed lymphohistiocytic infiltration of the surface layers of the dermis, fibrous tissue in the dermis (hematoxylin-eosin staining, x 100)

Fig.18. Scleroatrophic variant of the course of SL. Sharp ectasia of the lumen of the blood vessels of the dermis with the development of fibrous tissue in the dermis with lymphohistiocytic infiltration of the stroma (Picro-Mallory coloration, x 100)

Fig.19. Scleroatrophic variant of the course of SL. Sharp atrophy of epidermal cells, fibrosis and hyalinosis of the superficial layers of the dermis, sclerosis and recalibration of small-caliber vessels of the deep layers of the dermis (Picro-Mallory staining, x 100)

Fig. 20. Scleroatrophic variant of the course of SL. Under the atrophic multilayer squamous epithelium with signs of hyperkeratosis, fibrous edematous tissue with compression of blood vessels and moderate lymph-histiocytic infiltration of the dermis (Picro-Mallory coloration, x 100)

 

About the authors

Ekaterina V. Kolesnikova

Kuban State Medical University

Author for correspondence.
Email: jokagyno@rambler.ru
ORCID iD: 0000-0002-6537-2572
Krasnodar, Russian Federation

Alexander V. Zharov

Kuban State Medical University; Regional Clinical Hospital No. 2

Email: jokagyno@rambler.ru
ORCID iD: 0000-0002-5460-5959
Krasnodar, Russian Federation

Sergey S. Todorov

Rostov State Medical University

Email: jokagyno@rambler.ru
ORCID iD: 0000-0001-8476-5606
Rostov-on- Don, Russian Federation

Gregoriy A. Penzhoyan

Kuban State Medical University

Email: jokagyno@rambler.ru
ORCID iD: 0000-0002-8600-0532
Krasnodar, Russian Federation

Natalya V. Mingaleva

Kuban State Medical University

Email: jokagyno@rambler.ru
ORCID iD: 0000-0001-5440-3145
Krasnodar, Russian Federation

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