Triad of Lichen Planus, Thymoma and Liver Cirrhosis-Hepatoma Reported
Journal name: The Malaysian Journal of Medical Sciences
Original article title: The Triad of Lichen Planus, Thymoma and Liver Cirrhosis-Hepatoma. First Reported Case
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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J. A. Hassan, S Saadiah, A M Roslina, M Atan, Noraidah Masir, S Hussein, T Ganesapillai
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The Malaysian Journal of Medical Sciences:
(A peer-reviewed, open-access journal)
Full text available for: The Triad of Lichen Planus, Thymoma and Liver Cirrhosis-Hepatoma. First Reported Case
Year: 2000
Copyright (license): CC BY 4.0
Summary of article contents:
Introduction
This case report presents a unique patient exhibiting erosive oral and cutaneous lichen planus (LP) alongside significant comorbidities, including liver cirrhosis, hepatoma, and thymoma. Previous literature has hinted at a possible association between LP and chronic liver disease, as well as between LP and thymoma, albeit with a controversial understanding of the cause-and-effect relationship. The case intends to challenge the view that these associations are merely coincidental and highlights the interplay between autoimmune mechanisms, liver pathology, and thymic disorders.
Association of Lichen Planus, Thymoma, and Hepatoma
The patient's profile illustrates numerous autoimmune phenomena, notably with the presence of erosive LP, which has previously been correlated with systems involving hepatobiliary disorders and conditions of the thymus. With an elevated serum alpha-fetoprotein level and a positive hepatitis B surface antigen, the patient was diagnosed with hepatoma superimposed on liver cirrhosis. The exploration of LP's prevalence in individuals displaying other autoimmune disorders has led to insights suggesting that the thymus plays a critical role in immunologic status — thus linking thymoma with various autoimmune conditions. The report emphasizes the need to explore the possibility of these three conditions occurring concomitantly, highlighting their significance and the potential shared underlying immunological mechanisms.
Conclusion
This case serves as a pioneering report of the coexistence of erosive lichen planus, thymoma, and hepatoma in the context of liver cirrhosis, further underscoring the prospective association and interplay between these conditions. As erosive LP is relatively rare, this finding warrants a deeper investigation into the association between lichen planus and both thymoma and chronic liver diseases. Future clinical evaluations for patients presenting with erosive lichen planus should include thorough assessments for thymic and liver disorders, integrating immunological perspectives into clinical practice.
FAQ section (important questions/answers):
What was the primary condition presented by the patient?
The patient primarily presented with erosive oral and cutaneous lichen planus (LP), alongside liver cirrhosis, thymoma, and hepatoma.
What were the key findings in the patient's examination?
Examination revealed erosive LP lesions in the mouth and skin, hepatomegaly, splenomegaly, and lymphadenopathy, indicating significant underlying disease.
How did the medical team confirm the diagnosis of thymoma?
The diagnosis of thymoma was confirmed through CT imaging and histological examination of a fine needle aspiration biopsy from the mediastinal mass.
What unusual association was reported in this case study?
This case uniquely reported the coexistence of lichen planus, thymoma, and hepatoma in a patient with liver cirrhosis, suggesting a probable association between these conditions.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Triad of Lichen Planus, Thymoma and Liver Cirrhosis-Hepatoma Reported”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Disease:
The text discusses multiple diseases such as lichen planus (LP), thymoma, liver cirrhosis, and hepatoma, emphasizing their interconnections and associations. The case report implies that these conditions are not mere coincidences but may have underlying immunological and pathological links that merit further investigation in clinical contexts.
2) Surface:
The term 'surface' relates to the examination of the oral mucosa and skin lesions. The findings indicate that the lichen planus presented by the patient involves the surface cells of the mucosa and skin, highlighting the condition's impact on the body's outer layers and its clinical manifestations.
3) Blood:
Blood tests revealed critical information regarding the patient's health, including anemia and elevated serum alpha-fetoprotein levels. Additionally, the presence of the hepatitis B surface antigen indicates underlying liver disease. The blood analysis plays a vital role in diagnosing and monitoring chronic conditions associated with lichen planus.
4) Observation:
The observation noted in the text illustrates the clinical relationship between LP, thymoma, and liver diseases. It emphasizes that these associations deserve consideration beyond mere coincidence, suggesting an underlying immune-mediated mechanism. Subsequent clinical outcomes rely heavily on diligent observation by healthcare providers.
5) Doubt:
Doubt was expressed regarding the elevation of serum alpha-fetoprotein levels and whether they indicate malignant processes like hepatoma or other liver conditions. The text discusses the uncertainty surrounding the interpretation of these biomarkers in the context of chronic liver disease due to hepatitis B infection.
6) Similarity:
The similarity is drawn between the histopathological features of lichen planus and chronic liver disease. The authors suggest that the immune response in LP shares characteristics with liver conditions, indicating a potential overlap in pathophysiology that could lead to further understanding of both diseases.
7) Knowledge:
Knowledge gained from the case presentation and literature review emphasizes the necessity for healthcare professionals to be aware of the associations among lichen planus, thymoma, and liver cirrhosis. It advocates for comprehensive evaluation protocols in patients with erosive LP to identify such coexisting conditions.
8) Cancer:
Cancer is referenced in relation to hepatoma, indicating a serious concern in patients with chronic liver disease. The presence of elevated alpha-fetoprotein and the patient's clinical indicators lead to the suspicion of cancer, making it essential for timely intervention and management strategies to be employed.
9) Nature:
The nature of the patient's conditions is explored in the context of their possible immune-mediated associations. The immune nature of lichen planus, as supported by histological findings, suggests that a deeper understanding of autoimmune responses may clarify their relationships with thymoma and liver disease.
10) Chang:
Chang refers to Dr. Chang Kian Meng, acknowledged for technical assistance in the study. The mention emphasizes the collaborative efforts of medical professionals in the investigation and diagnosis of complex cases like this, highlighting the interdisciplinary approach often required in challenging clinical situations.
11) Ulcer:
Ulcers noted in the patient’s oral cavity are a critical aspect of erosive lichen planus. The presence of painful oral ulcers significantly impacts the patient's quality of life, leading to difficulties in eating and nutrition, and underscores the importance of managing these symptomatic manifestations effectively.
12) Study (Studying):
The term 'study' relates to the various investigations and analyses conducted to understand the associations between LP, thymoma, and liver diseases. It indicates the importance of rigorous clinical research to better elucidate the relationships and guide therapeutic approaches for affected individuals.
13) Bile:
Bile is indirectly implicated in the discussion of liver function tests, as abnormal bile duct proliferation suggests liver cirrhosis. The text points to the impact of liver disease on its essential functions, including bile production, linking it to the overall pathophysiology affecting the patient's health.
14) Paik (Pāik):
Paik refers to Dr. Paik K-I, who contributed to the understanding of the triad of lichen planus, myasthenia gravis, and thymoma. This reference enhances the discussion by acknowledging previous individual cases that provide context and support for the possible connections among these conditions and their immune roles.
15) Ras (Rās, Rash):
The rash described in the patient's examination consists of pruritic papules typical of lichen planus. Its presence highlights the dermatological manifestations of autoimmune conditions and serves as a primary indicator for diagnosis, reflecting the skin's role as a visible marker for underlying systemic diseases.
16) Food:
Food is discussed in relation to the patient's difficulties in consuming solid meals due to the painful oral lesions caused by lichen planus. This impacts the patient’s nutritional status and quality of life, emphasizing the need for effective management of oral manifestations to facilitate adequate dietary intake.
17) Sign:
The term 'sign' refers to clinical signs observed during physical examination, such as hepatomegaly and lymphadenopathy, which are important in diagnosing the underlying conditions. These signs provide crucial evidence to guide subsequent investigations and inform the clinical management of the patient.
18) Hand:
Hand is not explicitly detailed in the text; however, it can refer metaphorically to the healthcare provider's role in diagnosing and treating the patient. The hands symbolize the careful examination and intervention required in managing complex cases of concurrent autoimmune and hepatic conditions.
Other Health Sciences Concepts:
Discover the significance of concepts within the article: ‘Triad of Lichen Planus, Thymoma and Liver Cirrhosis-Hepatoma Reported’. Further sources in the context of Health Sciences might help you critically compare this page with similair documents:
Autoimmune disease, Hepatitis B surface antigen, Chronic liver disease, Alopecia areata, Liver Cirrhosis, Histological examination, Lichen Planus, Ulcerative colitis, Oral lichen planus, Liver function test, Liver disease, Serum iron and TIBC, Vitiligo, Skin lesion, Immune mediated, Computed tomography, Myasthenia Gravis, Oral Ulcer, Hepatocellular Carcinoma, Psychiatric disturbances, Fine needle aspiration, Direct Immunofluorescence, Connective tissue disease, Helper T cells, Chronic Active Hepatitis, Fine-needle aspiration biopsy, Hepatic cirrhosis, Idiopathic Thrombocytopenic Purpura, Serum alpha-fetoprotein, Erosive lichen planus, Oral lesion, Thymoma, Hepatoma, Pruritic rash, Hepatic parenchyma, Antinuclear factor, Cutaneous Lichen Planus, Retrospective survey, Hepatitis B surface.