EXPLORING MICROENVIRONMENTAL ALTERATION ASSOCIATED WITH ORAL SQUAMOUS CELL CARCINOMA IN THE CONTEXT OF ORAL SUBMUCOUS FIBROSIS—SHORT STUDY

Abstract

Background Oral submucous fibrosis (OSMF) is a potentially malignant disorder dominantly noted in South East Asian countries. A prevalence rate of 0.2% to 0.5% has been reported in India, with about 7% to 13% transforming to oral squamous cell carcinoma (OSCC). Authors have stated that cases of OSMF-OSCC may have a better prognosis compared to conventional OSCC, thus recognizing the former as a distinct clinicopathologic entity. Objective To explore and understand microenvironmental alterations in cases of OSMF-oral epithelial dysplasia (OED) and OSMF-OSCC. Methods All cases were staged using the Khanna and Andrade system for OSMF. Epithelial evaluation was achieved using World Health Organization grading for OED and Anneroth's histopathologic assessment for OSCC. Stromal evaluation included quantification and qualification of the inflammatory cell infiltrate and a comparison in both groups. Cases of OSMF with OSCC were further subjected to evaluation using Masson's trichrome and immunohistochemistry for CD-105, TGF-β, and CD-163. Results Cases of OSMF-OED and OSMF-OSCC demonstrated divergent and contrasting stromal features. Based on the demographic and clinical data along with stromal features of OSMF-OSCC, an entity such as concomitant OSMF-OSCC was identified and defined. These cases demonstrated distinct and contrasting stromal alterations, indicative of a relatively poorer prognosis than previously postulated. Conclusions The microenvironmental changes, reported herewith are significant owing to their digression from the conventional stroma as is seen and expected to persist in OSMF. The possibility of a better prognosis remains uncertain and the findings of this study warrant further investigation. Thus, a cautious approach must be exercised toward concomitant cases of OSMF-OSCC.