DOES ORAL EPITHELIAL DYSPLASIA CRITERIA HOLD TRUE FOR DYSPLASTIC EPITHELIUM OF ORAL SUBMUCOUS FIBROSIS?

Abstract

<h3>Background</h3> Oral submucous fibrosis (OSMF) is an oral potentially malignant disorder (OPMD) with an appearance of epithelium from hyperplastic to atrophic depending on the histopathologic staging. Oral epithelial dysplasia (OED) grading is done in OPMD, but it is difficult to grade every architectural and cytologic features when epithelium is atrophic. <h3>Objective</h3> To assess the OED features in OSMF and to compare with those in dysplastic epithelial margins of OSMF with concomitant oral squamous cell carcinoma (OSCC). <h3>Methods</h3> Histopathologic staging of 39 cases was done by the Pindborg and Sirsat system, and OED features were evaluated by the World Health Organization (WHO) grading system and the binary system. The statistical software SPSS 22.0 was used for the descriptive and inferential analysis. <h3>Results</h3> Sixteen cases were diagnosed as OSMF without dysplasia (group 1), 16 cases had dysplasia (group 2), and 7 cases had concomitant oral squamous cell carcinoma (group 3). All the cases (100%) in group 2 and group 3 showed architectural features like irregular epithelial stratification, loss of polarity of basal cells, and cellular features like nuclear- cytoplasmic pleomorphism and altered ratio. Premature keratinization was seen in group 2 (62.5%) and group 3 (85.7%). However, keratin pearl was seen only in group 3 (28.6%). Presence of increased size and number of nucleoli had a significant value (<i>P</i> < .017). <h3>Conclusions</h3> Some of the features of OED are not discernable, however some have striking presence in OSMF. It is not possible to use the WHO system in all cases, rather the binary system can be used with modification of criteria relevant to OSMF.