Epidemiological and Histopathological Features of Oral Squamous Cell Carcinoma-A Retrospective Study

Abstract

Oral Squamous Cell Carcinoma (OSCC) it was reported to be the 6th on the list of human malignant neoplasms responsible for high morbidity and mortality worldwide. We conducted a retrospective study between 2009-2019, investigating 50 such cancers hospitalized and diagnosed during this period in our institution. The purpose of the study was to establish a clinical-morphological profile of this type of cancer developed in the geographical area served by our institution. The epidemiological study highlighted the predominance of cases in men over 50 years old, mainly affecting the tongue, followed by the lips and oral floor. The histopathological study showed the prevalence of conventional cases of OSCC (70%) and the rest of the cases belonging to rarer forms (acantholytic-18%, verrucous-6%, basaloid-4% and sarcomatoid-2%). In terms of the degree of differentiation, the moderately differentiated cases prevailed (64%) and according to the TNM clinical stage, most cases were diagnosed in stage II (36%) and IV (26%). 70% of investigated cases presented muscle invasion and 38% perineural invasion. Our investigation highlighted the existence of particular morpho-clinical profiles depending on the tumor topography. Thus, tumors developed at the tongue level reached the maximum frequency in the 6th decade of life, being absent in the 8th decade and most often associated muscle invasion and perineural invasion, being diagnosed in advanced pTNM stages.

Keywords: Epidemiology; Histopathology; Oral cavity; Oral squamous cell carcinomas.

Figure 1

Oral Squamous Cell Carcinoma (OSCC). A. Lip with conventional well-differentiated SCC, neoplastic proliferations with squamous epithelial architecture and dyskeratosis with keratin pearls formation. HE staining, 100x; B. Lip with verrucous SCC, neoplastic proliferation with abundant keratosis and parakeratosis in an acanthotic squamous epithelium accomplishing the “church spires” appearance. HE staining, 25x; C. Tongue with conventional moderate-differentiated SCC, neoplastic proliferation with obvious malignancy appearances and few keratin pearls formation. HE staining, 100x; D. Tongue with conventional moderate-differentiated SCC, invading the underlying striated muscle fiber bundles. HE staining, 200x; E. Oral floor with conventional moderate-differentiated SCC, with vascular invasion. HE staining, 200x; F. Oral floor with conventional moderate-differentiated SCC, developing locoregional lymph node metastases. HE staining, 25x.

Figure 2

Oral Squamous Cell Carcinoma (OSCC) A. Alveolar ridge with acantholytic SCC, characteristically having the presence of pseudoglandular spaces in the central part of insular neoplastic proliferations created by acantholysis process. HE staining, 25x; B. Tongue with conventional poor-differentiated SCC, the neoplastic proliferations do no longer resembles squamous epithelium, keratinization is minimal and nuclear atypia are evident. HE staining, 200x; C. Tongue with conventional poor-differentiated SCC, with perineural invasion. HE staining, 100x; D. Tongue with conventional poor-differentiated SCC, invading minor salivary glands. HE staining, 200x: E. Oral floor with basaloid SCC, in which the neoplastic cells at the periphery of the proliferations have a basaloid morphology (cubic-cylindrical cells with little cytoplasm and tachychromatic nuclei) and have a "palisaded" arrangement. HE staining, 100x; F. Oral floor with sarcomatoid SCC, in which there were areas of conventional squamous carcinoma mixed with foci of malignant neoplastic proliferation with spindle cell morphology. HE staining, 100x

Figure 3

Oral Squamous Cell Carcinoma (OSCC)-statistical analysis A. The distribution of cases stratified by age and location; B. The distribution of perineural invasion stratified by location; C. The distribution of muscular invasion stratified by location; D. Linear regression analysis showing the influence of tumor grading on Bryne score of the investigated cases.