Carcinoma arising in the background of oral submucous fibrosis

Abstract

Introduction:Oral submucous fibrosis is a chronic debilitating condition with potential for malignant transformation. Squamous cell carcinoma arising from a background of oral submucous fibrosis presents clinically as a distinct disease due to different etiopathogenesis.Methodology:This prospective case series describes thirty cases of oral squamous cell carcinoma (OSCC) alongside oral submucous fibrosis (OSF). Patient clinical data were recorded including type and duration of habits, site of tumor, size, histological grading and nodal status.Results:A total of 76% cases were reported in males and 24% in females. A total of 73.3% cases had a history of use of gutka of which 16% used only arecanut or gutka while the remaining used gutka along with smoking and quid habits and 26.7% cases smoked tobacco products or used smokeless tobacco. Primary site of presentation was buccal mucosa and seven cases of carcinoma at retromolar trigone (RMT) altogether accounting for 66% of the cases. 53.3% cases reported were advanced tumour T4 lesions, 10% T3 lesion, 30% reported as T2 lesions and 6.7% T1 lesion. 55% of cases showed nodal involvement of different level and 46.5% cases were N0. About 60% of cases were histologically well differentiated squamous cell carcinoma.Conclusion:Carcinoma arising from a background of oral submucous fibrosis follows a distinct clinical presentation. Malignant transformation occurs in younger age group and with better histological grading.

Research Achievements of Oral Submucous Fibrosis: Progress and Prospect

“…Studies have also shown that the OSMF-associated OSCC has an earlier age of onset, more aggressive biological characteristics, and a higher rate of metastasis and relapse [ 92 ]. It was reported that OSCC caused by OSMF background follows different clinical manifestations, and malignant transformation occurs in younger age groups and has poorer prognosis [ 93 ]. The OSMF clinical classifications (concerning opening degree and degree of fibrosis) are not positively associated with the canceration rate due to insufficient evidence.…”

Oral submucous fibrosis: Histopathological features with pathophysiologic correlations

“…23 Reduced proliferation index of the cells was described as an additional factor contributing to the reduction of epithelial thickness. 24 Fig. 4: Atrophic surface epithelium and degeneration of superficial muscle layers…”

“…(Figure 5) The atrophic epithelium, dysplasia and other genetic mutations occurring in OSMF make the mucosa susceptible to develop carcinogenetic changes. 24,25 Reduction in vascularity further reduces drainage of accumulated products from the tissue. This allows the carcinogens to remain in contact with the mucosa for a longer duration.…”

“…26 Hence, OSMF is considered as a potentially malignant lesion, which is defined as "morphologically altered tissue, in which external factor makes it vulnerable for malignant transformation". 24 Long term follow-up studies have reported malignant transformation range of OSMF ranging from 7 to 13% over a period of 17 years. [27][28][29] The rapid exfoliation of epithelial cells in OSMF are suggestive of a high turnover rate and subsequent faster differentiation.…”

“…12 This is supported by the fact that the oral squamous cell carcinoma arising from OSMF is generally of better grades of differentiation. 24,30 Fig. 5: High power view of atrophic surface epithelium with mild dysplasia in OSMF…”