Microinvasive oral squamous cell carcinoma- A clinicopathological study
Main Article Content
Abstract
Abstract:
Background and objectives: Microinvasive oral squamous cell carcinoma is an early stage malignancy characterized by invasion of superficial lamina propria without invasion of deeper structures. These lesions have a varied clinical presentation, minimal lymphatic involvement and a better prognosis. However, there is no clear consensus on its diagnosis and subsequent management. The aim of this study is to assess the depth of invasion of confirmed cases of microinvasive oral squamous cell carcinoma using special stains and immunohistochemistry with clinical correlation of these lesions.
Method: Tissue specimen of clinically diagnosed cases of oral leukoplakia (n=90), oral submucous fibrosis (n=60) and oral carcinoma (n=50) were microscopically evaluated for the presence of microinvasion by two independent examiners. The next step involved confirming the basement membrane breach by using Periodic acid Schiff (PAS) stain for evaluating the integrity of basement membrane. The confirmed cases were assessed using special stain and immunohistochemistry to measure the depth of invasion and were further correlated with the clinical features.
Results: A total of 29 cases were confirmed as microinvasive OSCC. These included clinically diagnosed 11 cases of leukoplakia, 7 cases of OSMF and 11 cases of carcinoma. Median age at diagnosis was 46 yrs; males (69%) were more affected than females (31%). The predominant risk factor was tobacco chewing alone (31.03%) which was in the form of gutkha and arecanut; common site was buccal mucosa (76%); predominant clinical presentation was a patch; and histopathology revealed varying grades of epithelial dysplasia. The mean depth of invasion was 31.29 µm (0.03 mm) with the range being 16.91 – 66.6 µm (0.02 – 0.07 mm).
Conclusion: The study suggest that depth of invasion could be a reliable marker to assess microinvasion and that severity of epithelial dysplasia is not a pre-requisite for microinvasive carcinoma.
Keywords: Microinvasion; Oral squamous cell carcinoma; Epithelial dysplasia; Depth of invasion; Oral leukoplakia; Potentially malignant disorders
Article Details
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Rao SVK, Mejia G, Thomson KR, Logan R. Epidemiology of oral cancer in Asia in the past decade- An update (2000-2012). Asian Pac J Cancer Prev 2013; 14:5567-77
2. Mehrotra R, Yadav S. Oral squamous cell carcinoma: etiology, pathogenesis and prognostic value of genomic alterations. Ind J Cancer 2006; 43: 60-6
3. Larsen SR, Johansen J, Sorensen JA. The prognostic significance of histological features in oral squamous cell carcinoma. J Oral Pathol Med 2009; 38:657-62
4. Sugimoto M, Wong DT, Hirayama A, Soga T, Tomita M. Capillary electrophoresis mass spectrometry-based saliva metabolomics identified oral, breast and pancreatic cancer specific profiles. Metabolomics 2010; 6:78-95.
5. Brennan M, Migliorati CA, Lockhart PB, Wray D, Al-Hashimi I, Axell T, Bruce AJ, Carpenter W, Eisenberg E, Epstein JB. Management of oral epithelial dysplasia: a review. Oral Surg Oral Med Oral Pathol Oral radiol Endod 2007; 103:S19.e1-S19.e12.
6. Dionne KR, Warnakulasuriya S, Zain RB, Cheong SC. Potentially malignant disorders of the oral cavity: Current practice and future directions in the clinic and laboratory. Int J Cancer 2015; 136:503-15.
7. Van der Waal I. Oral potentially malignant disorders: Is malignant transformation predictable and preventable? Med Oral Patol Oral Cir Bucal 2014; 19:e386-e390.
8. Broders AC. Squamous cell epithelioma of skin: A study of 256 cases. Annals of surgery 1921; 2:141-60
9. Shankar AA, Gokul. S. The dilemma of microinvasion. Head neck oncol 2014; 6:30
10. Pentenero M, Narone R, Motta F, Marino R, Gassino L, Broccoletti R, et al. Clinical features of microinvasive stage I oral carcinoma. Oral Dis 2011; 17:298-303.
11. Heffner DK. Lets make grading of squamous cell carcinomas more meaningful to clinicians (via “Ed’s Insight”). Ann Diagn Pathol 2002; 6:399-403.
12. Woolgar JA, Triantafyllon A. Pitfalls and procedures in the histopathological diagnosis of oral and oropharyngeal SCC: A review of the role of pathology in prognosis. Oral Oncol 2009; 45:361-85.
13. Cardesa A. Slootweg PJ. Benign and potentially malignant lesions of squamous epithelium. In: Pathology of head and neck, Berlin: Springer 2006; 13
14. Batsakis JG. Clinical pathology of oral cancer. In Shah JP, Johnson NW, Batsakis JG. Oral Cancer. 1st ed. Martin Dunitz, 2003: 75-129.
15. Wenig BM. Squamous cell carcinoma of the upper aerodigestive tract: Precursors and problematic variants. Mod Pathol 2002; 15:229-54.
16. Bagan. J, Sarrion. G and Jimmenez Y. Oral Cancer: Clinical features. Oral Oncol 2010; 46: 414-417.
17. Johnson NW, Jayasekara P, Amarasinghe AA. Squamous cell carcinoma and precursor lesions of the oral cavity: epidemiology and etiology. Periodontology 2000. 2011; 57: 19-37.
18. O- Charoeurat P, Pillai G, Patel S, Fishcer C, Archer D, Eccles S, et al. Tumor thickness predicts cervical node metastases and survival in early oral tongue cancer. Oral Oncol 2003; 39: 386-390.
19. Gandolfo S, Scully C, Carrozzo M. Oral Medicine. Churchill Livingstone- Elsevier: Philadelphia 2006.
20. Pires FR, Ramos AB, de Oliveira JBC, Tavares AS, da Luz PSR, dos Santos TCRB. Oral squamous cell carcinoma: clinicopathological features from 346 cases from a single oral pathology service during an 8-year period. J Appl Oral Sci 2013; 21: 460-7.
21. Haberland C, Sasaki C, Judson B, Virk R, Prasad M. Superficially invasive squamous cell carcinoma of the oral cavity; Oral Surg Oral Med Oral Radiol Oral Pathol 2012; e56.
22. Wenig BM. Squamous cell carcinoma of the upper aerodigestive tract: Precursors and problematic variants. Mod Pathol 2002; 15: 229-254.
23. Barnes L. Diseases of the larynx, hypopharynx and esophagus. In: Barnes L, editor. Surgical pathology of the head and neck. New York: Dekker; 2001; 127–237.
24. Ziraljevic M, Vujkor T, Nincic D, Mandic A, Zikic D, Masrilovic K. Arch Oncol 2004; 12: 142-144.
25. Padmore RF, Fowble B, Hoffman J, Rosser C, Hanlon A, Parchofsky AS. Microinvasive breast carcinoma: Clinicopathologic analysis of a single institution experience. Cancer 2000; 88: 1403-1409.
26. Speight P. Update on oral epithelial dysplasia and progression to cancer. Head and Neck Pathol 2007; 1:61-66.
27. Yuen AP, Ho CM, Chow TL, Tang LC, Cheung WY, Ng RW, et al. Prospective randomized study of selective neck dissection versus observation for N0 neck of early tongue carcinoma. Head Neck 2009; 31: 765-72.
28. Mashberg A, Samit A. Early diagnosis of asymptomatic oral and oropharyngeal squamous cancers. CA cancer J Clin 1995; 45: 328-51.