Correlation of elevated mast cell and micro-vessel densities with lymph node metastasis in oral squamous cell carcinoma

Abstract

How to cite this article: Nakandala K, Suraweera A, Jayasooriya P. Correlation of elevated mast cell and micro-vessel densities with lymph node metastasis in oral squamous cell carcinoma. AbstractAim: Oral squamous cell carcinoma (OSCC) is a major health problem in Sri Lanka. Tumor-node-metastasis (TNM) staging system is the tool which is used to determine the extent of surgery in patients with OSCC. However, some patients may receive over-treatment with TNM staging. Mast cells can be found in the oral mucosa. Mast cells secrete different angiogenic factors stimulating angiogenesis which is important in metastasis of tumors. This study aimed to evaluate the mast cell density (MCD) and micro-vessel density (MVD) in OSCC and correlate it with nodal metastasis. Methods:The study sample consisted of one hundred OSCC specimens from patients who were treated surgically with both local excision of the tumor and neck dissections. The sections with OSCC present in achieved biopsies were evaluated for MCD and MVD using toluidine blue stain and a vascular marker (polyclonal rabbit anti-human von Willebrand factor) respectively. The correlation between MCD and MVD with nodal metastasis was statistically evaluated using point bi-serial correlation test.Results: There was a statistically significant correlation between MCD and nodal metastasis (P = 0.003) and MVD and nodal metastasis (P ≤ 0.000). These results indicate that MCD and MVD are significantly higher in OSCC with nodal metastasis. In addition, there was a weak positive correlation with MCD and MVD (r = 0.244) (Linear regression and Pearson correlation test). Higher statistically significant MCDs were observed in the buccal mucosal OSCC compared to OSCC of the tongue (n = 100, P = 0.023). There were no statistically significant differences when MCD and MVD were correlated with age, gender or degree of differentiation of the tumor. Conclusion:Significantly, high MCD and MVD at the advancing front of the OSCC might be used to identify tumors that present with nodal metastasis. With further studies, this finding could be applied to determine the extent of surgery required for patients with OSCC.

Correlation of Mast Cell and Angiogenesis in Oral Lichen Planus, Dysplasia (Leukoplakia), and Oral Squamous Cell Carcinoma

“…This was found to be highly statistically significant and consistent with the results by Sathyakumar 23 and Hegde et al 26 In OSCC, our results showed a mild positive correlation between MCD and MVD that was not statistically significant, consistent with the results of Hegde et al 26 and Nakandala et al 11 The mild positive correlation may be due to the failure of migration of mast cells, or factors other than mast cells probably involved in tumor angiogenesis. 11 In other words, initially, mast cells might infiltrate cancerous tissue to suppress tumor activities, but, once invasion occurs, their cytotoxic effects are nullified, thereby enhancing tumor progression rather than supporting angiogenesis. 26 This mast cell-mediated cytotoxicity was reported when the mast cell:tumor ratios are greater than 20:1.…”

“…9 Many studies have proved that mast cells accumulate in many angiogenesis-dependent situations, both in physiological and pathological situations like rheumatoid arthritis, wound healing, ovulation, and hemangioma, 10 and around the tumor margins, as well as releasing pro-angiogenic and angiogenic factors which play a major role in tumor progression. 11,12 Though there are many studies associating mast cells and angiogenesis in many oral lesions (squamous cell carcinoma/dysplasia/lichen planus separately, or combining any of these lesions) (Table 1), to the best of our knowledge none of the studies has correlated all these lesions together. No studies have correlated these two factors in lichen planus so far.…”