Nodal involvement in Oral Squamous Cell Carcinoma (SCC) patients with and without Oral Sub Mucous Fibrosis (OSMF): A Comparative Study

Clinicopathological characteristics of oral squamous cell carcinoma arising from oral submucous fibrosis: A systematic review

Introduction

Oral submucous fibrosis (OSMF) is considered to be a potentially malignant oral disorder with high risk of malignant transformation. Oral squamous cell carcinoma (OSCC) arising from OSMF has peculiar clinical and histopathological features.

Aim

To assess the clinicopathological features of OSCC arising in the background of OSMF in an attempt to identify the patients with OSMF who are at increased risk of developing OSCC.

Methodology

A systematic review was performed based on PRISMA guidelines to include articles published until May 2021 in English, relating the clinicohistopathological characteristics of OSCC arising from OSMF (OSMF-OSCC) or OSMF associated with OSCC (OSCC-OSMF). All the eligible articles were analyzed and relevant data were extracted.

Results

Seventeen articles were included for systematic review after following strict inclusion and exclusion criteria. The malignant transformation rate of OSMF-OSCC ranged from 1.9 to 9.13 and the prevalence of OSCC-OSMF ranged from 2.8 to 66. The mean age of the patients ranged from 36.6 years to 47.2 years and buccal mucosa was the common site to be affected. Majority of the OSCC-OSMF was well-to-moderately differentiated and majority of them did not metastasize to the lymph nodes.

Conclusion

OSCC associated with OSMF presents at a younger age with early tumor stage, better differentiation, and better prognosis when compared to OSCC not associated with OSMF. However, more multicentric prospective studies with large sample size are required to determine the true biologic behavior of OSCC arising in the background of OSMF to establish less aggressive treatment strategies considering them as a separate entity.

Unexpected additional pathologies at the surgical margins of oral squamous cell carcinoma

Background

There is a scarcity of literature on the presence of additional unexpected pathologies at the surgical margins of oral squamous cell carcinoma (OSCC). It is quite possible that such pathologies might get overlooked because of primary focus on the malignancy at the surgical margins. With this view in mind, a retrospective observational study has been designed to re-visit the surgical margins of OSCC for the possible presence of unexpected pathologies.

Methods

Haematoxylin and eosin-stained sections of 96 cases (four surgical margins in each case) of OSCC were carefully examined under a compound microscope by two oral pathologists for the presence of any additional pathology.

Results

Out of 96 specimens of OSCC, 76 (79.2%) cases showed the presence of accidental pathologies. The surgical margins of 20 (20.8%) cases showed no evidence of any pathology, whereas the margins of 23 (23.95%) cases were associated with more than one pathology. The most commonly observed accidental pathology was oral submucous fibrosis (40.625%), followed by leukoedema (16.675%), retention cysts (10.42%), and calcifications (7.3%). The mucous extravasation phenomenon (6.25%), minor salivary gland (MSG) inflammation (6.25%), and lichen planus (5.21%) were also observed in the surgical margins of OSCC.

Conclusion

A significant number of accidental pathologies exist at the surgical margins of OSCC. This effect could be because of over-emphasis on the tumour status at the surgical margins, which leads to over-looking of minor pathologies.

An Evaluation of Clinical and Histopathological Aspects of Patients with Oral Submucous Fibrosis in the Background of Oral Squamous Cell Carcinoma

Background

The behavior and prognosis of oral squamous cell carcinoma (OSCC) is presumably different in patients with oral submucous fibrosis (OSF). The objective of this study was to assess the effects of demographic features, habits, and histopathological features in the transformation of OSF to OSCC.

Methods

Data were extracted from the archives and histopathological evaluation and presence of nodal metastasis were recorded.

Results

OSF was detected in 130 (48%) out of 273 OSCC patients. The mean age of presentation among OSF-positive patients was 57.7 years, while patients diagnosed only with OSCC had a comparatively higher age, 59.5 years. In the below 50 years of age group, presence of OSF with OSCC was less (40%). In the OSF-positive group, male to female ratio was 3.2:1. The common primary sites were buccal mucosa and tongue in both groups. Betel quid chewing was present in more than 95% of the sample. Betel chewing, smoking, and alcohol consumption were present in 26.15% of OSF-positive patients. Degree of fibrosis was neither associated with the level of histological differentiation of the tumor (p= 0.195) nor associated with the malignant transformation (p =0.373). Lymph node metastasis was not seen in 76.63% and 68.54% of the patients with and without OSF, respectively.

Conclusions

High degree of prevalence of OSF was observed among the OSCC patients. There were also a male predilection and younger age at presentation in these patients. However, a significant association was not observed in the degree of fibrosis with malignant transformation or the level of histopathological differentiation of the tumor. Lymph node metastasis also failed to express a significant relationship with the presence of OSF.