Keratinocytes in oral submucous fibrosis: A cytomorphometric analysis using computer aided image analyser

Aim: To examine and compare cytomorphometric changes in the keratinocytes obtained from buccal mucosa of oral submucous fibrosis (OSF) cases in different clinical stages with healthy subjects and oral squamous cell carcinoma (OSCC) cases. Materials and Methods: Buccal mucosal smears of OSF cases [n = 30], OSCC cases [n = 30] and age-sex matched healthy controls [n = 30] were stained with Papanicolou stain and observed under light microscope (40x objective magnification) and 100 cells in each case were analysed cytomorphometrically using an image analyser. The average nuclear area (NA), cell area (CA), ratio of nuclear area/cell area, nuclear diameter (ND), cell diameter (CD) and ratio of nuclear diameter/cell diameter was obtained for each case. One-way ANOVA and Tukey-HSD procedure (P < 0.05) were used to analyze all the parametric variables. Results: The comparison of mean values of the NA, CA, NA:CA, ND, CD, ND:CD shows statistically significant difference among the healthy, OSF and OSCC groups [P < 0.05]. OSF group showed significant increase in nuclear dimensions and N/C ratio and significant decrease in cell dimensions compared to healthy group (P < 0.05). Among the parameters analysed ND:CD and NA:CA showed a highly statistically significant difference between the OSF and healthy group (P < 0.001). Conclusions: There are significant alterations in the cell and nuclear dimensions of the buccal mucosal cells in OSF patients. These alterations could be attributed to usage of various tobacco and areca nut preparations and due to the mucosal changes (atrophic epithelium, high epithelial turnover) in the OSF. Atrophic epithelium, in OSF is envisaged to predispose malignant transformation with persistent exposure oral carcinogens. As the mean values of CA, NA:CA in stage IV OSF are close to OSCC cases, it strengthens the view that advancement of fibrosis increases the risk of development of epithelial dysplasia