Oral pemphigus vulgaris: Liquid‐based cytological findings and pitfalls

Abstract

Pemphigus vulgaris (PV) is a chronic autoimmune bullous disease characterized by the formation of suprabasal cleavage and acantholysis. As this disease almost always affects the oral mucosa, conventional cytological smears of oral lesions can be used for the initial diagnosis of PV. We report two cases of PV that were initially diagnosed based on cytological smears of an oral sample. As atypical squamous cells were present even in the liquid‐based cytological (LBC) smears of the oral lesion in these two cases, this ultimately led to the misinterpretation of squamous cell carcinoma. These findings demonstrate that cytological mimicry of oral PV can occur in malignant cases when there is an absence of appropriate clinical information.

Liquid‐based cytology for differentiating two cases of pemphigus vulgaris from oral squamous cell carcinoma

“…Another advantage of LBC smears is that they have a cleaner background than conventional smears. On the other hand, however, it has been reported that the LBC method does not confirm the strong perinuclear acid affinity staining characteristic of Tzanck cells 3,5 . We discovered that small, round‐shaped, and deeply stained atypical, orangeophilic, keratinized cells can be found not only in SCC but also in pemphigus (Figure 2A,C and Table 1).…”

“…On the other hand, however, it has been reported that the LBC method does not confirm the strong perinuclear acid affinity staining characteristic of Tzanck cells. 3,5 We discovered that small, round-shaped, and deeply stained atypical, orangeophilic, keratinized cells can be found not only in SCC but also in pemphigus (Figure 2A,C and Table 1). Although in Hara's paper, these cell characteristics are shown as one of the five practical items specific to oral squamous cell carcinoma, caution is required in the diagnosis of PV, since it has been reported that the diagnosis is difficult to make when small, round-shaped, and deeply stained atypical, orangeophilic keratinized cells are found in comparison of LBC cytology of cells from PV and SCC.…”

“…6,7 In fact, two cases of PV have been reported in which LBC smears of oral lesions showed atypical squamous cells, which were ultimately misdiagnosed as SCC. 5 Another report compared the characteristics of SCC cells with those of intravaginal PV, and noticed that it is difficult distinguish PV from SCC of the vagina. 3 Tzanck cells have a high nuclear-to-cytoplasmic (N/C) ratio and are seen as atypical parabasal/basal cells.…”

“…Although in Hara's paper, these cell characteristics are shown as one of the five practical items specific to oral squamous cell carcinoma, caution is required in the diagnosis of PV, since it has been reported that the diagnosis is difficult to make when small, round‐shaped, and deeply stained atypical, orangeophilic keratinized cells are found in comparison of LBC cytology of cells from PV and SCC 6,7 . In fact, two cases of PV have been reported in which LBC smears of oral lesions showed atypical squamous cells, which were ultimately misdiagnosed as SCC 5 . Another report compared the characteristics of SCC cells with those of intravaginal PV, and noticed that it is difficult to distinguish PV from SCC of the vagina 3 …”

Periodontal and Systemic Treatment Approach on Pemphigus Vulgaris: A Case Report

“…In this case report, successfully periodontal treatment of a PV patient was presented. Certain diagnosis of the PV was based on the histopathological and immunofluorescence evaluation in accordance with the literature (1,7).…”