Electron microscopic observations on structures related to the epithelial basement membrane in squamous cell carcinoma

Role of Hemidesmosomes in Oral Carcinogenesis: A Systematic Review

BACKGROUND

Oral cancers have limited diagnostic tools to aid clinical management. Current evidence indicates that alterations in hemidesmosomes, the adhesion complexes primarily involved in epithelial attachment to the basement membrane, are correlated to cancer phenotype for multiple cancers. This systematic review aimed to assess the experimental evidence for hemidesmosomal alterations, specifically in relation to oral potentially malignant disorders and oral squamous cell carcinomas.

METHODS

We conducted a systemic review to summarise the available literature on hemidesmosomal components and their role in oral pre-cancer and cancer. Relevant studies were retrieved from a comprehensive search of Scopus, Ovid MEDLINE, Ovid Embase and Web of Science.

RESULTS

26 articles met the inclusion criteria, of which 19 were in vitro studies, 4 in vivo studies, 1 in vitro and in vivo study, and 2 in vitro and cohort studies. Among them, 15 studies discussed individual alpha-6 and/or beta-4 subunits, 12 studies discussed the alpha-6 beta-4 heterodimers, 6 studies discussed the entire hemidesmosome complex, 5 studies discussed bullous pemphigoid-180, 3 studies discussed plectin, 3 studies discussed bullous pemphigoid antigen-1 and 1 study discussed tetraspanin.

CONCLUSION

Heterogeneity in cell type, experimental models, and methods were observed. Alterations in hemidesmosomal components were shown to contribute to oral pre-cancer and cancer. We conclude that there is sufficient evidence for hemidesmosomes and their components to be potential biomarkers for evaluating oral carcinogenesis.

Diagnostic and prognostic role of protein and ultrastructural alterations at cell-extracellular matrix junctions in neoplastic progression of human oral malignancy

Despite advancements in technology and increase in favorable outcomes associated with oral cancer, early detection remains the most significant factor in limiting mortality. The current study aimed to develop early diagnostic and prognostic markers for oral tumorigenesis. Protein and ultrastructural alterations at cell-extracellular matrix (ECM) adhesion junctions were examined concurrently using immunohistochemistry (IHC) and transmission electron microscopy (TEM) on progressive grade of oral carcinomas (n = 285). The expression of hemidesmosome (HD) proteins-integrin β4, BP180, and laminin-5 increased in hyperplasia as compared to normal, and significantly increased further, as the disease progressed. TEM analysis in parallel tissues revealed a significant decrease in HD number and increase in the length of basal lamina (BL) in hyperplasia. With cancer progression, the severity of ultrastructural alterations increased gradually and significantly. Overexpression of HD proteins, decrease in HD number and increase in BL length significantly correlated with nodal metastasis, local recurrence, and recurrence-free survival of patients. Concurrent use of IHC and TEM can add value to early recognition of neoplastic changes in primary carcinomas of oral cavity. In this regard, altered expression of integrin β4 and laminin-5, loss of HDs, and increased BL length could offer criteria for early diagnosis and prognosis of oral malignancy.

Ultrastructural changes in malignant transformation of oral mucosa

Transmission electron microscopy (EM) has been used to identify the ultrastructural details of normal and cancerous human oral mucosa. However, inconsistent reports of structural descriptions have rendered transmission EM valueless in the diagnosis of oral squamous cell carcinoma (SCC) or as a prognostic indicator. To identify features of dysplasia for diagnostic purposes, normal mucosa, severe dysplasia, oral SCC and normal margin adjacent to oral SCC were used to compare the ultrastructural features of normal and premalignant oral mucosa and oral SCC. The preparatory stages of dehydration, embedding, cutting and positive staining for transmission EM were modified and tested to improve ultrastructural definition. Thin and discontinuous basal laminas were found in mucosa with severe dysplasia and normal margin adjacent to oral SCC. No basal lamina was identified in oral SCC. This study has shown that there are some ultrastructural changes during malignant transformation of oral mucosa. Together with other laboratory investigative techniques, transmission EM may be helpful in detecting malignant changes in oral mucosa.

Ultrastructural analysis of the adjacent epithelium of oral squamous cell carcinoma

Fifteen biopsies of the immediate adjacent epithelium of oral squamous cell carcinoma were examined under light and electron microscopy. Light microscopic examination of one micron thick sections revealed that the majority of lesions (67%) had hyperplastic or mildly dysplastic epithelium while the remaining (33%) had moderate to severe dysplasia. Ultrastructural observations showed that all these lesions had subcellular alterations similar to those seen in frank malignant oral tissue, particularly in the lower half of the epithelium. Important ultrastructural changes observed included bizarre nuclei of basal and lower spinal cells, enlarged and multiple nucleoli, presence of interchromatin and perichromatin granules, loss of desmosomes and marked spongiosis as well as disturbed cellular maturation sequences in the keratinocytes evidenced by abnormal and irregular distribution of maturation markers such as keratohyalin granules and tonofilaments. The present study thus shows the value of electron microscopy in the detection of malignant changes in the adjacent epithelium of oral squamous cell carcinoma.

Ultrastructure of oral squamous cell carcinoma: a comparative analysis of different histological types

Twenty-five oral carcinomas and five normal oral epithelial specimens were studied using light and electron microscopy. All histological types (well differentiated squamous cell carcinoma, moderately differentiated squamous cell carcinoma, poorly differentiated squamous cell carcinoma, verrucous carcinoma and spindle cell carcinoma) were seen in the study sample. In addition, 1 case of carcinoma in situ was also present. The normal oral epithelium consisted of three keratinising types (gingiva) and two non-keratinising types (buccal mucosa). The ultrastructural features of oral carcinomas showed good correlation with the features seen in light microscopy. The differentiation status of the lesions showed a relationship with cell and nuclear size, tonofilament and keratin content as well as few other cellular abnormalities. It was also observed that the fine details revealed by electron microscopy were often a means of explaining the characteristic histopathological features of oral carcinoma.

Ultrastructural variations and assessment of malignant transformation risk in oral leukoplakia

Oral cancer is the most common malignancy in India, having a well defined precancerous state, leukoplakia. Various follow-up studies have shown that only 4 to 18% of oral leukoplakia lesions subsequently progress into invasive malignancy over a period of time. This study evaluates the potential of electron microscopy in the early detection of malignant changes in leukoplakia. The study revealed that of the 25 leukoplakia lesions examined, 7 showed changes akin to malignancy. Predominant ultrastructural alterations observed were reduplication and discontinuity of the basal lamina, basal cells with pleomorphic and bizarre nuclei containing perichromatin and interchromatin granules, prominent intercellular spaces and poorly formed desmosomes. Since none of these changes were evident under light microscopy the study demonstrates the value of electron microscopy in evaluating oral carcinogenesis. A long term follow-up of such patients is needed to understand the prognostic implications of these ultrastructural variation and how they can be used as a base line for better light microscopic evaluation.

Genesis of hadacidin-induced cleft palate in hamster: morphogenesis, electron microscopy, and determination of DNA synthesis, cAMP, and enzyme acid phosphatase

A morphological, electron microscopic, and biochemical study was undertaken to analyze the genesis of hadacidin-induced cleft palate in hamster fetuses. Gross and light microscopic observations indicated that hadacidin affected the growth of vertical palatal shelves to induce cleft palate. Electron microscopic observations showed that initial hadacidin-induced changes were seen in the mesenchymal cells. Within 12 hr of drug administration, the perinuclear space was swollen and a lysosomal response injury was evident in the mesenchymal cells. Subsequently, 24 hr after hadacidin treatment, lysosomes appeared in the epithelial cells; changes were also seen in the basal lamina which included separation of the lamina densa from the basal cells, duplication of lamina densa, and complete loss of basal lamina. Between 36 and 42 hr post-treatment, the cellular and basal lamina changes subsided, and the epithelium of vertical shelves underwent stratification. Biochemical determination of enzyme acid phosphatase indicated that the levels of enzyme activity in both the control and treated palatal tissues corresponded to the appearance of lysosomes. Measurement of cAMP levels suggested that the peak activity of cAMP corresponded to that of enzyme acid phosphatase and cell injury. The cAMP activity in hadacidin-injured cells, however, was significantly lower in comparison to that of the dying cells of control palates. Hadacidin treatment also affected DNA synthesis in the developing primordia of the palate. It was suggested that hadacidin injures the precursor cells of the palate prior to the appearance of the primordia, and subsequently affects their proliferative behavior, stunting the vertical growth of the palatal shelves and inducing a cleft palate.

Oral cancer

In the U.S. oral cancer accounts for 2.1% of all cancers and 1% of cancer deaths. Two to three times as many males as females are affected. Blacks have more intra-oral cancer than whites, and their incidence and mortality rates have increased in recent years. The etiologic process very likely involves several factors. The major etiologic agents are tobacco (all types) and alcoholic beverages. Herpes simplex virus, human papilloma virus, and Candida have been implicated. Host factors include poor state of dentition, nutritional aberrations, cirrhosis of liver, lichen planus, and immunologic impairmant. Cellular changes include amplification of some oncogenes, alterations in antigen expression, production of gamma-glutamyl transpeptidase, and disturbance of keratin and involucrin production. Experimentally, cancer is readily produced on the hamster cheek pouch and rat oral mucosa. Unlike oral cancer in humans, most experimental lesions are exophytic, and they rarely metastasize.

Ultrastructure of oral leukoplakia and lichen planus. I. Basal region and inflammatory cells

Nine cases of homogenous leukoplakia and 21 cases of lichen planus (11 reticular and 10 erosive) were studied under the electron microscope. The changes found in leukoplakia were limited to occasional breaks in the basal lamina and modest changes in the cytoplasm of the basal cells. The basal lamina in lichen planus was found to exhibit 3 distinctly different pictures reflecting the clinical types of lichen planus. The structural abnormalities in the basal cells increased with increasing severity of the lesions. The inflammatory infiltrate in lichen planus was found to contain mainly small-to-medium-sized lymphocytes but plasma-cells with widely dilated rough endoplasmic reticulum containing a granular substance were frequently seen. Similar changes are seen in other disorders and, therefore, specific diagnostic criteria cannot be established on the basis of the present material.

Basement membranes in experimentally induced skin tumors

Basement membrane changes in the epidermis and hair follicle apparatus resulting from topical 9,10-dimethylbenzanthracene applications were studied in mice, rats, and hamsters by light and electron microscopy and using antibodies to human collagen type IV and laminin. The basement membrane was distinct in epidermal hyperplasia, dysplasia, and papillomas, as well as around most of the keratoacanthomas and squamous cell carcinomas, which showed basement membrane irregularities, thickening, and reduplication in some areas. The invading edges of the squamous cell carcinomas with inflammatory infiltrates were devoid of laminin and collagen. Collagen IV and laminin-positive structures were observed around preserved follicular structures in rat: hair nevi and hair-follicle nevi, but partly absent around trichoepitheliomas and trichofolliculomas. Basal cell tumors were usually surrounded by a distinct basement membrane, which was lacking around some tumor cells.

Ultrastructural observations of skin lesions in MRL mice--dermoepidermal junction

The MRL-lpr/lpr (MRL/l) mouse, a new animal model for the study of human systemic lupus erythematosus (SLE), shows characteristic skin manifestations in addition to several systemic autoimmune phenomena. The ultrastructural changes observed in the dermoepidermal junction (DEJ) and in the uppermost dermis were: infolding of the DEJ; deformities of the basal lamina--partial disappearance, thickening, hanging down, duplication, and separation from the basal cell membrane; basal laminalike dense material in the uppermost dermis and increased anchoring fibrils; particles composed of circulated half-desmosomes between the basal cells and the basal lamina, and in the uppermost dermis with or without an enclosing basal lamina; cell processes of the basal cells; and invagination of the basal lamina in the basal cells. Most of these findings were similar to the ultrastructural changes observed in the skin lesions of human SLE. The skin eruptions of MRL/l mice might be a new aid in the investigation of the pathogenesis of the skin lesions of human SLE.

Ultrastructural changes of epithelium-connective tissue junction in experimental lingual tumors

In this study, plaque-like lesions, epithelial hyperplasias, and papillary invasive carcinomas were produced in the tongues of hamsters by the application of DMBA combined with trauma for 16 weeks. The junction between the neoplastic epithelial cells and the connective tissue was studied ultrastructurally. In plaque-like lesions, the basal lamina was partially decreased in both thickness and density or partially discontinuous. In epithelial hyperplasias, cytoplasmic projections were observed in the portion of the basal cell near the intercellular space, and the basal lamina was absent around these cytoplasmic projections. In papillary invasive carcinomas, however, numerous cytoplasmic projections extended from various portions of the basal surface of the basal cells into the underlying connective tissue. The basal lamina was also absent around these projections. In epithelial hyperplasias and papillary invasive carcinomas, some of the cytoplasmic projections appeared almost empty, some contained a small number of tonofilaments and ribosomes, and others were filled with a large number of ribosomes but did not contain the tonofilaments. The collagen fibrils were markedly reduced in number in the area around cytoplasmic projections. The cytoplasm of some fibroblasts in that area contained many intracellular collagen fibrils.

Ultrastructure of different clinical forms of oral leukoplakia

Twelve cases of oral leukoplakia were studied at the light and electron microscopic levels. In clinical leukoplakia simplex and verrucosa, both light and electron microscopic investigations revealed evidence of increased keratinization. Clinically erosive and histiologically dysplastic leukoplakias showed ultrastructural alterations characteristic of oral carcinomas in some instances.

Oesophageal neoplasia in male Wistar rats due to parenteral di(2-hydroxypropyl)-Nitrosamine (DHPN): a combined histopathological, histochemical and electron microscopic study

Intraperitoneal di(2-hydroxypropyl)-Nitrosamine (DHPN) caused a high incidence of oesophageal squamous carcinoma in male Wistar rats, particularly in rats killed 11 or more months after the start of injections. No control rats (injected intraperitoneally with saline) developed an oesophageal neoplasms. Histopathologically, the tumours were moderately well differentiated. Histochemical studies showed minor increases in mucin staining and mast cell population and a marked increase in bacteria in tumour-bearing oesophaguses. Electron microscopy showed the tumours to be similar to, but to differ in some respects from squamous carcinomas at other sites in humans. The possible implications of this work for human disease are twofold. It could provide a model for further study of aspects of oesophageal carcinoma and it serves to remind us that all potential oesophageal carcinogens need not act during swallowing.

Ultrastructural alterations in experimental lingual leukoplakia and carcinoma

Epidermoid carcinomas, preceded by dysplastic leukoplakic lesions, were produced on the right lateral borders of the tongues of Syrian hamsters by the application, three times per week, of DMBA in acetone after the area had been scratched with a root canal broach. Animals were killed at 12 to 13 weeks and 15 to 16 weeks. Electron microscopic studies of both the dysplastic leukoplakic lesions and the well-differentiated epidermoid carcinomas revealed clumping of tonofilaments and widening of intercellular spaces, in addition to the cellular pleomorphism, altered nuclear-cytoplasmic ratio, and prominent nucleoli observed with the light microscope. In the carcinomas, there were variations in the morphology of mitochondria, with tubular forms in evidence. The basal lamina in the carcinomas was discontinuous. Pseudopodia arising from basal cells were seen in areas of basal lamina discontinuity.

The basement membrane in experimentally induced atypias and carcinoma of the uterine cervix in mice. An immunofluorescence study

Basement membrane-specific antigens of the squamous epithelium of the uterine cervix were investigated in 19 normal mice, in 7 mice with cervical atypia and in 3 mice with invasive carcinoma. Cervical atypia and carcinoma were induced by local application of benzo(a)pyrene. Basement membrane-specific antigens were demonstrated by immunofluorescence with sera from patients with bullous pemphigoid. Both normal squamous cervical epithelium and atypical cervical epithelium showed the presence of a continuous, clearly delineated basement membrane. Clusters of invasive squamous carcinoma were also surrounded by a fluorescent basement membrane which, however, appear fragmented or discontinuous. The results suggest that the ability of cervical squamous cells to secrete basement membrane antigens is not completely lost during carcinogenesis, thus substantiating our previous observations in the cervix of human subjects.

The fate of hemidesmosomes in laryngeal carcinoma

The ultrastructural morphology of the hemidesmosomes in malignant epithelial cells of invasive squamous cell carcinoma of the human larynx was studied by electron microscopy. In the more advanced carcinomas the hemidesmosomes are reduced in number or absent over extensive areas of the epithelial stromal junction. In some places the hemidesmosomes are observed to be in the process of being dislodged from their normal sites at the plasma membrane of the basal carcinoma cell. After dislodgment from the basal plasmalemma into the subepithelial connective tissue the hemidesmosomes are seen to round off with the cytoplasmic attachment plaques lying on their inner circumference. A constant feature of the detached hemidesmosomes is the absence of inserting tonofilaments. Frequently, the detached hemidesmosomes are found to be in close association with detached multilayered basement membrane material in the stroma. The detached hemidesmosome-structures appear to migrate down into the deeper layers of the connective tissue space apparently loosing their distinct ultrastructure. These observations indicate that the detachment of hemidesmosomes and their subsequent downward dermal migration may result in a loss of epithelial-stromal adherence in invasive epithelial cancer of the larynx.

Basement membrane changes under neoplastic oral mucous membrane. Ultrastructural observations, review of the literature, and a unifying concept

This study explores the morphologic nature of the basement membrane under neoplastic oral mucous membrane. Of particular interest is the progression of changes associated with dysplasia, carcinoma in situ, and invasive carcinoma. On the basis of a critical review of the literature and our own ultrastructural observations, we present a unifying concept for the development of these basement membrane changes. This concept proposes that neoplastic epithelial cells may produce a collagenolytic enzyme which is released into the epithelial intercellular spaces. This enzyme permeates to the basement membrane, causes breaks in the basement membrane, and focal loss of stromal area contiguous with intercellular spaces. The neoplastic basal cells develop pseudopodia that eventually extend through the breaks in the basement membrane. This concept suggests that the basement membrane changes herald the progression of carcinoma in situ to invasive carcinoma.

Yolk sac carcinoma (endodermal sinus tumor): ultrastructure and histogenesis of gonadal and extragonadal tumors in comparison with normal human yolk sac

Human yolk sac carcinomas have been studied only twice with the electron microscope, and have never been compared at this level with normal human yolk sac. In the present study, the ultrastructural features of three primary ovarian yolk sac carcinomas, omental metastases from one of these, and a primary retroperitoneal yolk sac carcinoma in a male are reported, as are the ultrastructural findings in human yolk sac from normal 7- and 12-week gestations. The most prominent feature of the tumors is the presence of voluminous basement membrane material (the nature of which is confirmed by indirect enzyme-labeled antibody technique in one case) in both intra-and extracellular location, corresponding to the PAS-positive hyaline globules seen in these tumors by light microscopy. The tumor cells are also demonstrated to produce this material in tussue culture. Although basement membrane has not been described previously in normal human yolk sac at 8 and 10 weeks' gestation, it was present in the 7-week specimen which we studied, suggesting that its production may be a feature of only very young sac. Other ultrastructural findings are also similar in human yolk sac carcinoma, normal human yolk sac, and rodent yolk sac and yolk sac carcinomas. Thus, these studies confirm the suggested germ cell-derived yolk sac origin of the human tumor.

Adenoid cystic carcinoma of minor salivary gland. Histochemical and electron microscopic studies of cystlike space

Five cases of adenoid cystic carcinoma of minor salivary glands were studied. The mucoid material in the characteristic cystlike space of this neoplasm was distaseresistant periodic acid-Schiff (PAS)--positive, alcain blue-positive, toluidine blue-positive, and mucicarmine-positive. Verhoeff-Van Gieson's method and Weighert's method did not reveal elastic tissue in the cystlike spaces. Mallory's method revealed that a central core in cystlike spaces was similar in stainability to collagen. Wilder's method did not reveal reticular fibers in these spaces. Electron microscopy revealed three readily recognizable zones: a juxtacellular zone of a network of replicated basal lamina, and intermediate zone of stellate granules of mucoid material, and a central core of densely packed aperiodic filaments or collagen fibrils. The histogenesis of cystlike spaces and their realtionship with biologic behaviors of the neoplasm were discussed.

A scanning microscope study of vocal cord carcinoma

A scanning electron microscope study of cell surface topography in squamous cell carcinoma of the vocal cord has demonstrated characteristic changes. The malignant cells showed an irregular surface pattern with an abundance of microvilli-like structures of different sizes and shapes. In addition, the contact between the malignant cells was reduced. Normal vocal cord cells were closely associated and had a smooth surface with microridges.