Background & objective: Changes in submucosal vascularization and
inflammation, determined by immunohistochemistry staining, were shown to be
correlated with the development of dysplasia and invasiveness of epithelial cells in
premalignant and malignant lesions. This study evaluated changes in sections
routinely stained with Hematoxylin and Eosin (H&E) in order to investigate vascular
density and intensity of inflammatory cells infiltration during the progression of oral
leukoplakia with mild dysplasia to Squamous Cell Carcinoma (SCC).The aim of the
research was to determine whether changes in sub-mucosal vascularity and
inflammatory infiltration of leukoplakia in routine H&E-stained sections could
contribute to the assessment of severity of the lesion.
Methods: In this cross-sectional, comparative and descriptive study, vascular
density and inflammation intensity of 125 available samples of H&E-stained
sections, consisting of 35 cases of mild and moderate dysplasia, 38 severe dysplasia
and carcinoma in situ, and 52 SCC, were investigated. To analyze the data, chi-square
test, Mann-Whitney test, Kruskal-Wallis test, Tukey’s post hoc test, and cumulative
ordinal logistic regression were conducted.
Results: There was a significantly higher vascular density in cases with severe
dysplasia, in situ carcinoma, and SCC compared to those with mild to moderate
dysplasia (P<0.0001). However, the difference in vascularity was not statically
significant between severe dysplasia, carcinoma in situ, and SCC (P=0.78). Intensity
of inflammatory cells infiltration in the underlying connective tissue was
significantly different among the three groups (P<0.0001), and the highest intensity
of inflammatory cells infiltration was seen in the SCC group.
Conclusions: Increased submucosal vascularization and inflammatory cells
infiltration can contribute further to predicting more aggressive epithelial dysplasia
