Dysplastic features relevant to malignant transformation in atrophic epithelium of oral submucous fibrosis: a preliminary study

Abstract

Background

The grading of oral epithelial dysplasia (OED) is not applicable to oral submucous fibrosis (OSMF) cases due to the presence of atrophic epithelium. The mucosal margins associated with resected OSCC specimens are often closely related to transformed cells. In this study, we compared the histomorphological alterations (dysplastic features) in the atrophic epithelium of OSMF patients with the mucosal margins of OSCC associated with OSMF (OSCC-OSMF).

Methods

We evaluated 17 dysplastic features in 37 patients with OSMF (biopsy site: buccal mucosa) and 37 patients with OSCC-OSMF (mucosal margins involving buccal mucosa) using histopathological staining.

Results

Dysplastic features, such as keratin pearls within rete ridges, nuclear pleomorphism, and atypical mitotic figures, were not observed in the epithelium of the OSMF or OSCC-OSMF groups. Basal cell hyperplasia (p=0.016), abnormal superficial mitosis (p=0.010), increased nuclear-cytoplasmic ratio (p=0.034), and hyperchromasia (p=0.031) were predominantly seen in the OSCC-OSMF group. We found no statistically significant differences in the following parameters: irregular epithelial stratification (p=1.00), loss of basal cell polarity (p=0.237), presence of drop-shaped rete ridges (p=0.077), increased number of mitotic figures (p=0.154), premature keratinization in single cells (p=0.499), anisonucleosis (p=0.289), anisocytosis (p=0.079), cellular pleomorphism (p=0.317), and increased number and size of nucleoli (p=0.129).

Conclusion

Increased basal cell layer hyperplasia, abnormal superficial mitosis, increased nuclear-cytoplasmic ratio, and hyperchromasia are high-risk features for OSMF, and affected patients should be followed on a priority basis for the early detection of OSCC.

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