Keratinized strap cells: a rare cytological atypia resembles Anitschkow cells, in human oral neoplasm

Abstract

Background: Cytopathology of human oral squamous cell carcinoma reveals cytological pleomorphism. In this investigation, cytometry was used in an attempt to analyse the importance of the rare occurrence of keratinized strap cells in the buccal mucosa of human oral neoplasms.

Patients and methods: A case-control study was undertaken in which exfoliated cytosmears were collected, by scraping, from 136 clinically diagnosed oral cancer patients. Wet fixed cytosmears were stained by use of Papanicolaou's staining procedure and counter-stained with Giemsa's solution. One thousand cells were screened, and keratinized strap (Anitschkow) cells (KSC-A) and other cytological atypias were counted. Cytomorphometry was performed by use of a computer-assisted microscope camera. The findings were analysed statistically and interpreted in respect of age group, oral site, and sex.

Results: Transformation of an angulated and polygonal normal oral squamous cell into a keratinized narrow strip or ribbon-like flat projection results in what is called a keratinized strap cell (KSC). Nuclear pleomorphism in keratinized strap cells was observed to be narrow spindle, rod, and bar-shaped and to resemble Anitschkow cells. From the nature of the staining, the structural peculiarity, and the resemblance to Anitschkow cells, KSC, a rarely observed oral cytological atypia, were renamed as keratinized strap (Anitschkow) (KSC-A) cells. Cytometrically, the nuclear-to-cytoplasmic (N/C) ratio for KSC-A was calculated to be 1:11.2 for males and 1:11.3 for females; these are more than those for the normal counterparts.

Conclusion: Rare occurrence, cellular keratinization, nuclear pleomorphism, hyperchromasia, and increased N/C ratios for KSC-A in oral carcinoma, for both sexes, indicate a state of malignancy; this finding is, thus, of practical value for early detection and diagnosis of oral squamous cell carcinoma patients.

Keywords: Cytopathology; Exfoliated cytosmears; Keratinized strap (Anitschkow) cells; Nuclear pleomorphism; Nuclear-to-cytoplasmic (N/C) ratio; Oral neoplasm.