Cytomorphometric Analysis of Exfoliative Palatal Mucosal Cells in Reverse Smokers in 4 Villages of Srikakulam District, Andhra Pradesh - An Observational Exfoliative Study

Abstract

Squamous cell carcinoma of palate is found to be the rarest of all the cancers. But the prevalence of palatal cancers in Srikakulam and Visakhapatnam districts (Coastal districts of Andhra Pradesh) was found to be 0.1% 1,2 and noticed to be associated with the habit of reverse smoking in these geographic areas. These palatal cancers were found to arise from the pre-existing precancerous lesions namely Excrescences, White patches and Red areas, which were designated as Reverse smoker's lesions. AIM OF THE STUDYAn observational cytomorphometric analysis study has been undertaken in this region to study quantitatively nuclear diameter, cell diameter and nuclear-to-cytoplasmic ratio from exfoliative smears of various reverse smoker's lesions to assess the type of reaction of palatal mucosal cells to the heat generated during reverse smoking. MATERIALS AND METHODSMaterials used were mouth mirror, tongue depressor, wooden spatula, glass slides, 95% alcohol, rapid PAP kit, Coplin jars, DPX mountant, xylene, coverslips, microscope and micrometre. The smears were collected using wooden spatula from various palatal lesions and fixed in 95% alcohol. Staining of smears was done using rapid PAP kit. The cellular diameter and nuclear diameter of the cells were measured using micrometre and microscope. RESULTSThe mean cellular diameter of White areas and Red areas was decreased compared to normal mucosa cells and the nuclear diameter was increased compared to normal mucosa cells. Both the diameters of both the lesions were nearing to carcinoma cells. The cellular and nuclear diameter of the excrescences were increased when compared to normal mucosa and carcinoma cells. CONCLUSIONExcrescences represent proplastic and hyperplastic reaction of palatal surface epithelium, whereas white areas and red areas represent premalignant changes of palatal surface epithelium. (Figure 1). The rarest oral site is found to be palate, but still high prevalence of palatal cancer in Srikakulum and Visakhapatnam districts was noticed by many research workers. This was found to be associated with the habit of reverse smoking practiced in this geographic area. 2,3,4,5 (Figure 2). The palatal changes produced by reverse smoking are multimorphic consisting of several components namely Financial or Other, Competing Interest: None. Submission 02-08-2016, Peer Review 19-08-2016, Acceptance 22-08-2016, Published 26-08-2016. Corresponding Author: Dr. Sirigala Lavanya, Professor in Charge, Department of Oral Pathology, Government Dental College and Hospital, Kadapa. E-mail: slavanyamds@yahoo.co.in DOI: 10.14260/jemds/2016/1124 Palatal keratosis, Excrescences, Red patches, Ulceration and finally Carcinoma. 1,3,4,5 The malignant potential of these lesions varies and cellular changes in these lesions can be observed in the exfoliated cells. These palatal changes were due to both tobacco by-products and heat generated above 120 0 C during reverse chutta smoking. KEYWORDSThe optimal outcome in the management of any malignancy is dependent upon...