Tobacco As a Trigger for Oral Squamous Cell Carcinoma Arising in The Background of Oral Submucous Fibrosis: A Clinicopathological Study

Main Article Content

Sandra Sagar
Pratibha Ramani
Abilasha.R
Gheena.S

Keywords

Oral squamous cell carcinoma, oral submucous fibrosis, tobacco

Abstract

Background: Oral submucous fibrosis (OSMF) is a well-recognized, potentially malignant disorder of the oral cavity that can affect any part of the oral mucosa, characterized by mucosal rigidity of varying intensity caused by fibro elastic transformation of the juxta-epithelial layer of connective tissue. The habit of betel quid chewing and the usage of tobacco is a popular oral habit with potential links to the development of oral cancer. The oral epithelium in patients with oral submucous fibrosis becomes atrophic and progresses to a clinicopathologically different entity of oral squamous cell carcinoma.
Aim: The aim of the present study is to analyze the common clinical and histopathological features in the cases of OSCC arising in the background of OSMF.
Materials and Methods: A total of five cases reported between May 2019 and May 2021 which were histopathologically diagnosed as oral squamous cell carcinoma with oral submucous fibrosis were selected and the most common clinical and histpathological features were analysed. Immunohistochemical analysis was done using SMA, E-Cadherin and MMP-9 markers.
Results: Smokeless tobacco usage was the most commonly used form of tobacco in these patients. Facial asymmetry, blanching and palpable fibrotic bands were the most common clinical features noted among these patients. Broad bulbous rete ridges was the most common histopathological feature associated with this entity. Positive expression of E-cadherin and SMA markers were noted. Conclusion: OSCC arising from the background of OSMF can be considered as a separate entity.More molecular studies are needed to assess the etiopathogenesis and whether treatment for OSMF has an effect on pathogenesis of this OSCC-OSMF entity.

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References

1. Anastiosis K Marcopoulus(2012)Role of human papillomavirus in the pathogenesis of oral squamous cell carcinoma. World J Exp Med2012 Aug 20;2(4):65-9. doi: 10.5493/wjem.v2.i4.65.
2. Varshitha .A(2015)Prevalence of Oral Cancers in India.A/J. Pharm. Sci. & Res. Vol. 7(10), 2015, 845-848
3. Warnakulasuriya, S. Causes of oral cancer – an appraisal of controversies. Br Dent J 207, 471–475 (2009). https://doi.org/10.1038/sj.bdj.2009.1009
4. Hecht SS. Tobacco carcinogens, their biomarkers and tobacco-induced cancer. Nat Rev Cancer. 2003 Oct;3(10):733-44. doi: 10.1038/nrc1190. Erratum in: Nat Rev Cancer. 2004 Jan;4(1):84. PMID: 14570033
5. Arakeri G, Patil SG, Aljabab AS, Lin KC, Merkx MAW, Gao S, Brennan PA. Oral submucous fibrosis: An update on pathophysiology of malignant transformation. J Oral Pathol Med. 2017 Jul;46(6):413-417. doi: 10.1111/jop.12582. Epub 2017 May 6. PMID: 28391621.
6. Balakrishnan C, Aswath N. Estimation of serum, salivary immunoglobulin G, immunoglobulin A levels and total protein, hemoglobin in smokeless tobacco chewers and oral submucous fibrosis patients. Contemp Clin Dent. 2015 Sep;6(Suppl 1):S157-62. doi: 10.4103/0976-237X.166820. PMID: 26604567; PMCID: PMC4632216.
7. Tilakaratne WM, Klinowski MF, Takashi S, Peters TJ, Warnakulasuriya S. Oral submucous fibrosis: review on etiology and pathogenesis. Oral Oncol 2006;42:561–8.
8. Yang S, Wang Y, Su N, Yu H, Wei C, Yu C, Chang Y. Changes in prevalence of precancerous oral submucous fibrosis from 1996 to 2013 in Taiwan: a nationwide population-based retrospective study. J Formos Med Assoc. 2018;117(2):147–52.
9. Nishant Raj Chourasia ,Rajiv M. Borle ,Ankita Vastani (2015)Concomitant Association of Oral Submucous Fibrosis and Oral Squamous Cell Carcinoma and Incidence of Malignant Transformation of Oral Submucous Fibrosis in a Population of Central India: A Retrospective Study, The Association of Oral and Maxillofacial Surgeons of India.
10. Chiba I (2001)Prevention of Betel Quid Chewers’ Oral Cancer in the Asian-Pacific Area. Asian Pac J Cancer Prev 2: 263-269.
11. Gadbail AR, Chaudhary M, Gawande M, Hande A, Sarode S, Tekade SA, Korde S, Zade P, Bhowate R, Borle R, Patil S. Oral squamous cell carcinoma in the background of oral submucous fibrosis is a distinct clinicopathological entity with better prognosis. J Oral Pathol Med. 2017 Jul;46(6):448-453. doi: 10.1111/jop.12553. Epub 2017 Feb 28. PMID: 28129456.
12. Sandra Sagar,Mogit Gupta.Y(2020).Knowledge, attitude, and awareness of tobacco among tobacco users in South Indian population – A questionnaire-based study.Drug Invention Today;Vol.14 Issue 1.P.179-183
13. Mehta FS, Hammer JE (1993) Tobacco related oral mucosal lesions and conditions in India, III edn. Basic Dental Research Unit, TIFR Publication, Mumbai
14. Subapriya R, Thangavelu A, Mathavan B, Ramachandran CR, Nagini S (2007) Assessment of risk factors for oral squamous cell carcinoma in Chidambaram, Southern India: a case-control study. Eur J Cancer Prev 16(3):251–256
15. Sankaranarayanan R (1990) Oral cancer in India: An epidemiologic and clinical review. Oral Surg Oral Med Oral Path 69(3):325–330
16. Kramer IR, Lucas RB, Pindborg JJ, Sobin LH (1978) World Health Organization Collaborating Center for Oral Precancerous Lesions. Definition of leukoplakia and related lesions: an aid to studies on oral precancer. Oral Surg Oral Med Oral Pathol 46:518–539
17. Pindborg J, Sirsat S (1966) Oral submucous fibrosis. Oral Surg Oral Med Oral Pathol 22(6):764
18. Rajendran R(1994)Oral Submucous Fibrosis:Etiology,pathogenesis, and future research. Bull World Health Organ 72(6):985–996
19. Phatak A (1979) Fibrin producing factor in Oral Submucous Fibrosis. Indian J Otolaryngol Head Neck Surg 31(4):103–104
20. Paymaster JC (1956) Cancer of the buccal mucosa—clinical study of 650 cases in Indian patients. Cancer 9(3):431–435
21. Pindborg JJ, Zachariah J (1965) Frequency of oral submucous fibrosis among 100 South Indians with oral cancer. Bull WHO 32:750–753
22. Pindborg JJ (1972) Is sub mucous fibrosis a pre-cancerous condition in the oral cavity? Int Dent J 22(4):474–480
23. Shiau YY, Kwan HW (1979) Submucous fibrosis in Taiwan. Oral Surg 47(5):453–457
24. Pindborg JJ (1980) Atlas of diseases of the oral mucosa. Ed.3: W. B. Saunders Co., Philadelphia, PA
25. Murti PR, Bhonsle RB, Pindborg JJ, Daftary DK, Gupta PC, Mehta FS (1985) Malignant transformation rate in oral submucous fibrosis over a 17-year period. Commun Dent Oral Epidemiol 13(6):340–341
26. Pindborg JJ, Murti PR, Bhonsle RB, Gupta PC, Daftary DK, Mehta FS (1984) Oral submucous fibrosis as a precancerous condition. Scand J Dent Res 92(3):224–229
27. Zachariah J, Mathew B, Varma NA, Iqbal AM, Pindborg JJ (1966) Frequency of oral mucosal lesions among 5000 individuals in Trivandrum, South India: preliminary report. J Indian Dent Assoc 38(11):290–294.
28. American Joint Committee on Cancer (2002) Manual for staging of cancer. Springer, Heidelberg.
29. Zhou S, Qu X, Yu Z, et al. Survivin as a potential early marker in carcinogenesis of
30. oral submucous fibrosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
31. 2010;109:575–581.
32. Jayasinghe , Peiris PM, Tilakaratne WM, et L. Clinically malignant exophytic lesions in the background of oral submucous fibrosis: report of five cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122: 210-215.
33. Ekanayaka RP, Tilakaratne WM. Oralsubmucous fibrosis: review on mechanisms of malignant Transformation. Oral Surg Oral Med Oral Pathol Oral Radiol 2016;122: 192-199.
34. Moutasim Karwan A, JeneiVeronika, Sapienza Karen, Marsh Daniel, Weinreb Paul H., et al. (2011) Betel-derived alkaloid up-regulates keratinocyte alphavbeta6 integrin expression and promotes oral submucous fibrosis. Journal of Pathology 223: 366-377.
35. Srinivasan M, Jewell SD. Quantitative estimation of PCNA, c-myc, EGFR and TGF-alpha in oral submucous fibrosis- an immunohistochemical study. Oral Oncol 2001;37:461–7.

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