Differential Cytomorphometric Analysis of Keratinized Fiber Cells in Human Oral Carcinoma

Abstract

Background: Use of exfoliative cytology and cyto-analysis is a useful early diagnostic method for epithelial atypia and for human oral neoplasm. Rare occurrences of cytological atypia appear to be very thin, elongated, fibre like structures in oral epithelia is named as keratinized fiber cells (KFCs). In the present study, the aim is to quantify the KFCs and to analyze it morphometrically with a cytodiagnostic approach. Materials and Methods: In a case-control study, exfoliated scraped cytosmears were collected from the affected sites of the clinically diagnosed 136 oral cancer patients over the pre-cleaned microslides and immediately fixed in acetoalcohol. Cytosmears were stained with routine Papanicolaou’s stain and counterstained with the Giemsa’s solution. Out of one thousand screened cells, the KFCs were scored from each stained sample following standard criteria. Cytomorphometry was done by using computer-assisted Cat Cam 1.30 (1.3 Mega Pixel) microscope camera of Catalyst Biotech(Maharashtra, India). Findings were statistically analyzed, interpreted and correlated with the oral sites, sex and nature of addiction. Results: Keratinized fiber cells (KFCs) exhibit both cytological and nuclear pleomorphism. Usually, two types of KFCs–named as Large Keratinized fiber cells (LKFCs) and small Keratinized fiber cells (SKFCs) were observed in 53.76% of total collected samples from the premalignant and malignant cases. Almost all KFCs are moderately differentiated with an elongated fiber contour in each and are the pleomorphic form of normal oral squamous cells. Keratin expression in the cytoplasm in KFCs indicates epidermoid origin. The terminal ends are either pin-pointed or narrowly blunt. The nucleus is also found to be elongated inside the cytoplasm of KFCs. In rare cases, the nucleiof the KFCs may be either polarized or ink-dot shaped. Cytological as well as nuclear pleomorphism, pattern of keratiniztion, hyperchromasia and increased nuclear-cytoplasmic (N/C) ratios in KFCs are of cytopathological importance and are the signs and clear indication of malignancy. Conclusion: Genesis of KFCs in the epithelia of oral neoplasm is a sign of neo-fibrosis. Pattern of keratiniztion, hyperchromasia, nuclear pleomorphism and increased nuclear-cytoplasmic ratios (N/C) in KFCs are of cytopathological importance and thus appearance of KFCs in oral epithelia has a practical utility in early detection and diagnosis of the oral cancer patients.