Main clinical characteristics | Standard pathological examination (HE) Direct immunofluorescence (DIF) | |
---|---|---|
Erosive GLP | ||
Typical | Erosive gingivitis usually bilateral affecting oral mucosa and/or tongue (reticular patches with or without erosions), no blisters No indirect Nikolsky’s sign | HE: basal cell degeneration, necrosis of basal and parabasal keratinocytes, predominant band-like lymphocytic infiltrate adjacent to basal cells, inflammation may include plasma cells DIF−: absence of linear deposits of IgG, IA and C3 along the epithelial basement membrane, but sometimes nonspecific marking of colloid bodies HE: similar to GLP, but the inflammatory infiltrate, may extend within the deep lamina propria DIF−: similar to GLP HE: similar to GLP with epithelial cleavage DIF−: similar to GLP |
Related (oral lichenoid lesions) | Either similar to typical GLP or more or less erosive | |
Bullous | Particularly erosive GLP, presence of blisters but no oral indirect Nikolsky’s sign | |
AIBD | ||
MMP (CP) | Erosive gingivitis: well limited erosions, greyish yellow fibrinous background, and surrounded by a more or less extensive inflammatory halo, with no reticular component; rare intact blisters, ± other oral mucosa sites affected (oral mucosa and palate) Possible erosive zones covered with pseudomembranous, suggestive sign if associated with oral indirect Nikolsky’s’ sign | HE: subepithelial cleavage with no acantholysis, inflammatory infiltrate of neutrophils and eosinophils DIF+: Linear deposit of IgG, and C3 along the epithelial basement membrane, often associated with IgA |
PLP | Erosive gingivitis: combined characteristics of lichen planus and mucous membrane pemphigoid (possible oral indirect Nikolsky’s sign) | HE: characteristics of GLP or MMP or both DIF+: similar to MMP |
PV | Erosions with jagged edges and a dull-red background, circled with white areas of leukemia, no oral indirect Nikolsky’s sign | HE: acantholysis with supra-basal intraepithelial cleavage DIF+: IgG and C3 deposits on the surface of the keratinocytes (« fishnet» or « honeycomb» feature) |
PG | Erosive gingivitis similar to GLP | HE: Spongiosis within the epithelium, dense bunched inflammatory infiltrate areas, mainly composed of plasma cells associated with a few polymorphs DIF− |