Oral submucous fibrosis in Asian countries

Abstract

Oral submucous fibrosis (OSF) is a chronic, insidious, and progressive oral mucosal disease that affects entire oral cavity and sometimes pharynx. It is precancerous and characterized by blanching and burning sensation of oral mucosa, staining of teeth and gingiva, and restricted mouth opening. It is multifactorial with a high incidence in chewers of areca nut (AN). This oral potentially malignant disorder has a high rate of malignant transformation rate (7%-30%) to oral squamous cell carcinoma (OSCC). 1 It is prevalent in Asian countries and has spread in Europe and North America. The prevalence of OSF was reported to be 1.0%-3.03% in Hunan Province, mainland China, 2 0.15%-14.4% in Vietnam, 3 and 0.086%-17.6% in Taiwan. 4 In the past decades, many efforts have been devoted to etiology, pathogenesis, and treatment of OSF. However, the research progress is still unsatisfactory. For instance, the etiology of OSF is commonly attributed to AN chewing, but some OSF patients did not have the habit. Also, there is no staging or grading scheme universally accepted and employed by clinicians, pathologists, and surgeons. Moreover, the pathogenesis and mechanism of OSF transformation into carcinomas are still obscure. Undoubtedly, it is crucial to make further studies of OSF to fill in the gaps. This article, for the first time, provided a detailed review of research advances of OSF in Asian countries, based on a comprehensive literature search using several primary databases (Figure 1), in which the terminologies, for example, OSF and oral potential malignant diseases (OPMD), were used. The OSF's etiology, histopathology, pathogenesis, clinical manifestations, diagnosis and differential diagnosis, and treatments were reviewed. The main challenges and corresponding measures were also discussed for guiding clinical research and practice concerning the disease. | E TI O LO GYOral submucous fibrosis is characterized by its multifactorial etiology. The most commonly identified factors include AN chewing, nutritional disorders, and genetic predisposition. They act individually or synergistically in the development of OSF. AbstractOral submucous fibrosis (OSF) is a chronic, insidious, and progressive oral mucosal disease that affects entire oral cavity and sometimes pharynx. This oral potentially malignant disorder has a high rate of malignant transformation (7%-30%) to oral squamous cell carcinoma (OSCC), posing global problems for public health. Due to enormous efforts dedicated to this disease in the past decades, there have been significant advances in identification of its etiology and pathogenesis as well as development of corresponding therapeutic approaches, in spite of several challenges. This study reviewed the existing literature concerning OSF in Asian countries, encompassing its etiology, histopathology, pathogenesis, clinical manifestations, diagnosis and differential diagnosis, and treatments. For improving treatment of OSF, the multifactorial etiology analysis, incorporation of effective molecular pathways, cy...

DNA content abnormality in oral submucous fibrosis concomitant leukoplakia: A preliminary evaluation of the diagnostic and clinical implications

“…Moreover, the applicability of the criteria of dysplasia, as seen in the hyperplastic epithelium of leukoplakia, to the atrophic epithelium of OSF is not justified. 1,3 Therefore, adjunctive objective diagnostic techniques are required to early detect indicator of high-risk premalignant and malignant transformation within OSF and contribute to surveillance of OSF progression. The diagnostic techniques based on minimally invasive cytology for intraoperative assessment are potential adjunctive tools.…”

“…5 The pathogenesis and mechanism of OSF development and transformation into OSCC are still obscure; however, it is accepted to be a disease of multifactorial origin, including areca nut chewing, nutritional deficiencies, and genetic and epigenetic dysregulation. 1 DNA content abnormality determined by image cytometry (ICM) is internationally accepted as a marker of malignant transformation of cells, which is the cytometric equivalent of chromosomal aneuploidy. 6 Aneuploidy is thus an important indicator of numerical chromosomal instability, and its emergence is often a critical early event during carcinogenesis.…”

“…The grading of dysplasia is possible when the full strata of epithelium are present. However, the grading of dysplasia is not well applicable to OSF due to the presence of atrophic epithelium 1,3. The limited number of epithelial cells makesT A B L E 1Clinicopathologic characteristics of patients with OSF enrolled…”

DNA aneuploidy with image cytometry for detecting dysplasia and carcinoma in oral potentially malignant disorders: A prospective diagnostic study

“…Histological diagnosis was performed by two oral pathologists blinded to the DNA content results, according to the definition and classification described previously. 5,[13][14][15] Leukoplakia is defined as a predominantly white lesion of the oral mucosa that cannot be characterized as any other definable lesion; A definitive diagnosis of leukoplakia is made when any etiological cause other than tobacco/areca nut use has been excluded and histopathology has not confirmed any other specific disorder. 5 Erythroplakia is defined as a fiery red patch that cannot be characterized clinically or pathologically as any other definable disease; Numerous other red patches/macules that could arise on the oral mucosa should be excluded before considering erythroplakia as the diagnosis.…”

“…OSF is defined as a chronic disorder characterized by fibrosis of the lining mucosa of entire oral cavity and sometimes pharynx. 15 The inclusion and exclusion criteria are as follows: Inclusion criteria: (a) Primary diagnosis of OPMD or OPMD concomitant suspicious OSCC. (b) Both brushing and biopsy samples were obtained.…”