Pattern of invasion in squamous cell carcinomas of the lower lip and oral cavity

Histopathological prognosticators and their clinicopathological correlation in oral squamous cell carcinomas of the tongue

Background

Tongue carcinomas account for 25%-40% of intraoral squamous cell carcinomas (OSCCs). Although TNM staging systems is an international standard for cancer reporting, prognosis evaluation, and treatment planning, multiple histopathological risk assessment predictors such as tumor thickness (TT), tumor shape, tumor growth pattern, and invasive malignancy grading scoring systems have been studied and should form a basis for prediction and prognostication of such aggressive carcinomas.

Aim

To evaluate and characterize the histomorphological prognostic indicators in OSCCs of tongue and compare it with OSCCs of other anatomic sites within the oral cavity. Furthermore, to elucidate the significance of histopathological indicators in predicting prognosis of tongue squamous cell carcinomas (SCCs).

Materials and Methods

Forty SCC cases with 20 each of tongue and 20 from other intraoral sites were retrieved from department archives. Clinical data and staging were obtained for each case. Histomorphological parameters including pattern of invasion (POI), tumor budding (TB), depth of invasion (DOI), TT, lymphocytic host response, tumor-associated tissue eosinophilia (TATE), vascular invasion, perineural invasion (PNI), and muscular invasion were assessed. The results were statistically evaluated.

Results

TB, DOI, and sarcolemmal spread were significant histologic predictors in tongue SCC. Upon correlation of histomorphological parameters with clinical staging, TT, POI, and TATE were observed to be significantly correlated (P ≤ 0.05).

Conclusion

The histomorphological risk assessment model may serve as important addition to the existing prognosticators and may be used as a prognostic index to help plan and individualize treatment protocol in cases with aggressive high-risk disease for whom the use of multimodality treatment seems beneficial.

Evaluation of Expression Of ADAM 10 as a Predictor of Lymph Node Metastasis in Oral Squamous Cell Carcinoma-An Immunohistochemical Study

BACKGROUND

Lymph node metastasis (LNM) is a well-known prognostic factor in Oral Squamous Cell Carcinoma(OSCC). A biological marker that predicts the Lymph Node Metastasis (LNM) in OSCC cases is the need of the hour. A Disintegrin And Metalloproteinases (ADAMs), a family of proteins that exhibit a metalloproteinase domain play a pivotal role in the pathogenesis of tumor growth and metastasis. This study aims to evaluate whether ADAM 10 can be used as a predictor of lymph node metastasis in OSCC using immunohistochemistry.

METHOD

A total of 90 samples that were categorized into 3 groups were included in the present study. Group I consisted of 30 samples of the normal oral mucosa, and Group II consisted of 30 samples of OSCC without lymph node metastasis. Group III consisted of 30 samples of OSCC with lymph node metastasis. Esophageal Squamous Cell Carcinoma was used as external positive control. Immunohistochemical expression of ADAM10 in their corresponding stained sections was assessed and staining intensity was calculated.

RESULTS

ADAM10 immunoreactivity was considered positive when located in cytoplasm or membrane or both. This method is similar to that used by Bamane et al. for OSCC cases. The mean value of the Staining Index score "AxB" was highest in Group III (7.90), followed by Group II (3.13) and least in Group I (0.27). These values were statistically significant.

CONCLUSION

Considering the findings of a higher percentage of ADAM10 positive cells, higher staining intensity, and higher staining index, the overexpression of ADAM10 can be used as an independent marker for OSCC patients to predict the lymph node metastasis.

CD103+ T Lymphocyte Count Linked to the Thickness of Invasion on Acral Melanoma without E-Cadherin Involvement

Background

Acral melanoma (AM) is a malignancy that originates from melanocytes, located in an anatomical area without sun exposure, aggressive, resistant to chemotherapy, and quickly metastasize. The invasion capability of tumor cells is the main factor for metastasis in malignancy. E-cadherin is a marker of tumor progressivity that has an important role in the process of invasion. The responsibility of E-cadherin in the invasion process of AM is not well known. CD103 is an immune component found in the tumor microenvironment that contributes to melanoma progression control, whereas E-cadherin is the ligand for CD103.

Purpose

The objective of this research was to see if there was an association between E-cadherin and CD103 immunoexpression and the thickness of invasion in AM.

Materials and Methods

This is observational cross-sectional research. Formalin-fixed paraffin-embedded (FFPE) acral melanoma tissue samples were collected during 2014–2020 at the Department of Anatomic Pathology, Dr. Hasan Sadikin Hospital, Bandung. A total of 40 samples were collected, including 20 cases of invasive melanoma less than 4 mm thickness and 20 cases of invasive melanoma greater than 4 mm thickness. All samples were immunostained with E-cadherin and CD103. Chi-Square test was used to examine the association concerning E-cadherin and CD103 with the thickness of invasion, respectively. The p-value of 0.05 was chosen as the significance level.

Results

This study showed an insignificant association between E-cadherin immunoexpression and the thickness of invasion on AM (p = 0.4272). CD103 immunoexpression had a significant association with the thickness of invasion on AM (p = 0.0001).

Conclusion

The findings revealed that CD103 in AM is associated with the thickness of invasion, and it may play important functions throughout the invasion process despite the uninvolvement of E-cadherin.

Association of E-cadherin & vimentin expression with clinicopathological parameters in lingual squamous cell carcinomas & their role in incomplete epithelial mesenchymal transition

Background & objectives:

Lingual squamous cell carcinomas (SCC) pose a major public health burden in India. Epithelial-mesenchymal transition (EMT) is the conversion of an epithelial cell to a mesenchymal phenotype at the invasive front (IF) enhancing invasiveness of these cells which may be studied using immunohistochemistry. The objective of this study was to assess the expression of E-cadherin and vimentin at the IF, and their correlation with the histological risk assessment score, clinicopathological parameters and lymph node metastasis.

Methods:

Thirty consecutive untreated patients diagnosed as lingual SCC who underwent hemiglossectomy over one year formed the study group. The immunohistochemical expression of E-cadherin and vimentin in the periphery as well as the centre of tumour islands was correlated with clinicopathological parameters, Brandwein-Gensler risk assessment score and lymph node metastasis, along with a correlation between the coexpression of two markers at the IF.

Results:

Loss of E-cadherin expression was seen at IF in 83.3 per cent (25/30) cases. Out of these, 20 per cent (5/25) showed a corresponding gain in vimentin expression (complete epithelial-mesenchymal transition) and 80 per cent (20/25) did not. Overall, 16.6 per cent (5/30) cases showed complete EMT. However, no correlation between E- cadherin and vimentin expression at the IF was found. No statistical significance was found between E-cadherin loss and vimentin gain at the IF, with the various parameters or the risk score.

Interpretation & conclusions:

The present study suggests that the cells at IF may metastasize even without a gain in vimentin expression (without classical EMT), as cohesive clusters showing incomplete EMT (E-cadh-/Vim-).

Role of Twist and Podoplanin in Partial Epithelial-Mesenchymal Transition in Oral Squamous Cell Carcinoma

The aim of this study was to perform a comparative analysis of podoplanin (PDPN) and Twist immunoexpressions in lower lip and oral tongue squamous cell carcinomas (LLSCC and OTSCC, respectively). PDPN and Twist immunoexpressions were semi-quantitatively evaluated by analyzing the invasion front, the compressive areas, the large islands and nests and dissociated cells of the chosen carcinomas. Their statistical associations and correlations with clinical-pathological characteristics were verified by the Mann-Whitney and Spearman's test. Twist expression was low in both carcinomas, with <25% labeling on the invasive front. Significant differences were observed for LLSCC (p=0.032) and OTSCC (p=0.025) regarding PDPN immunoexpression in relation to the worst invasion patterns determined by a histological malignancy gradation system. Statistically significant negative correlations between PDPN membrane expression and general (r=-0.356, p=0.024) and cytoplasmic Twist expressions (r=-0.336; p=0.034) in LLSCC were also observed. Twist and PDPN are suggested to be associated to a more aggressive invasion pattern in both LLSCC and OTSCC cases but not related to the different biological behaviors on these anatomical sites. Also, it was seen that PDPN membrane expression is inversely related to general and cytoplasmic Twist expression in LLSCC cases.

Twist and E-cadherin deregulation might predict poor prognosis in lower lip squamous cell carcinoma

OBJECTIVE

The aim of this study was to evaluate the expression of Twist and E-cadherin in lower lip squamous cell carcinoma (LLSCC) and their association with clinicopathologic parameters.

STUDY DESIGN

Fifty-nine cases of LLSCC were analyzed by applying immunohistochemistry techniques in a semiquantitative manner. The systems proposed by Bryne etal., Brandwein-Gensler etal., and Almangush etal. were applied for analysis of the histopathologic malignancy grading system.

RESULTS

Higher E-cadherin expression (general and membrane) was observed in cases presenting with disease-free survival after 5years of follow-up (P < .05). Higher Twist expression was observed in lesions classified as being in advanced stages, displaying recurrence, and having a high degree of malignancy. A significant negative correlation was detected between cytoplasmic Twist expression and membrane E-cadherin expression (P = .028). A statistically significant relationship was detected between high total Twist expression in tumors classified as high risk by Brandwein-Gensler etal., and no significant difference was observed among total, membrane, and cytoplasmic E-cadherin expressions in LLSCC cases and the 3 applied grading systems (P > .05).

CONCLUSIONS

The results of the present study suggest the potential involvement of Twist and E-cadherin in the modulation of events related to worse prognoses in LLSCC cases.

Comparison of the histologic risk assessment model between lower lip and oral squamous cell carcinoma

INTRODUCTION

The histologic risk assessment (HRA) grading system was proposed as a practical measure to predict clinical outcome and its effectiveness has been shown in several studies. It has been suggested that the HRA model might exhibit differences among various oral subsites. The aim of the present study was to compare this system between squamous cell carcinomas (SCCs) of the lower lip (LL) and oral cavity.

MATERIALS AND METHODS

All primary SCCs located in the LL and oral cavity were retrieved and graded using the HRA model. Data regarding risk score (RS), perineural invasion (PNI), lymphocytic infiltration (LI) and worst pattern of invasion (WPOI) were compared between LL and oral SCCs using χ² analysis (P<0.05).

RESULTS

There were a total of 33 LLSCCs, of which 15, 8 and 10 were categorized as low-risk (RS=0), intermediate-risk (RS=1-2) and high-risk (RS≥3) tumors, respectively. Corresponding values in the 48 oral SCCs were 7, 15 and 26 cases. Significant differences in RS (P=0.00), LI (P=0.01) and WPOI (P=0.01) were observed between LL and oral tumors.

CONCLUSIONS

The HRA model could be included among the various factors suggested to be different between lip and oral SCCs. Low-risk tumors were more prevalent in the lip which corroborates the less aggressive nature of these cancers. Considering the significantly higher LI in LL SCCs, inflammation may be regarded as an important factor in regulating the invasive behavior of these tumors.