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      Evaluation of cytomorphometric changes in tobacco users and diagnosed oral squamous cell carcinoma individuals

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          Abstract

          Aims:

          To determine the cellular and nuclear area of keratinocytes in smears obtained from the oral mucosa of tobacco users, those with oral squamous cell carcinoma (OSCC), and from normal healthy persons and resolve if any significant difference exists in these three groups.

          Materials and Methods:

          The study group comprised 100 subjects 20 controls, (40 OSCC patients-20 from lesional sites and 20 from nonlesional sites, 20 tobacco smokers and 20 tobacco chewers) in the age group of 25-75 years. Oral mucosal smears obtained by using a cytobrush were stained with Papanicolaou (PAP) stain and using 20X objective in trinocular Olympus model BX53 with Jenoptik scientific grade-dedicated microphotographic camera images were taken. With ProgRes version 8.0 image analysis software, 20 cells with defined borders were evaluated from each slide. Finally, one-way analysis of variance (ANOVA) was used to compare the above parameters in the studied groups.

          Statistical Analysis Used:

          Minitab and Excel software were used to analyze the data. One-way ANOVA was used to compare the above parameters in the studied groups.

          Results:

          The mean value of the cell area for groups I, II, III, IV, and V were 2838 ± 275.2, 2762.1 ± 511.4, 2861.9 ± 512.9, 2643.8 ± 333.3, and 3064.3 ± 362.7, respectively, the nuclear area (NA) was 83.88 ± 9.86, 106.19 ± 13.45, 95.11 ± 14.24, 85.55 ± 21.11, and 80.83 ± 13.45, respectively, and nuclear-to-cellular (N:C) ratio was 0.0297, 0.03924, 0.0337, 0.03257, and 0.02678, respectively.

          Conclusions:

          Thus, our study elucidates that cytomorphology gauges the effect of tobacco on the oral mucosa and possibly establishes a link between premalignant and malignant transformations even before a lesion is visibly noted.

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          Most cited references22

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          Tobacco smoking history and presentation of oral squamous cell carcinoma.

          The association between tobacco smoking and oral squamous cell carcinoma is well established. However, few studies have evaluated the smoking history based on a smoking versus never-smoking history or analyzed the relationship between smoking history and site and stage of presentation. The purpose of this study was to examine the relationship between smoking versus never-smoking history and the stage and site of presentation of oral squamous cell carcinoma. The design of this study was a retrospective review of all patients presented at the Legacy Emanuel Hospital Head and Neck Tumor Board in Portland, Oregon, with a biopsy-proven oral squamous cell carcinoma between 1998 and 2000. Data collected included age, gender, smoking history (smoker versus never smoker), pack-years of tobacco, site, and stage (T, N, and group stage) at presentation. A total of 67 patients were reviewed; 33% of patients were never smokers and 67% of patients had a history of smoking with an average of 49.4 pack-years. The floor of mouth and gingiva were the most commonly affected sites. There was a statistically significant difference between site of presentation and a history of smoking (P =.0007). The 2 sites that showed a significant association with smoking were posterolateral tongue and floor of mouth. The findings of this study demonstrate that approximately one third of patients with oral squamous cell carcinoma will report that they have never smoked. There was a strong association between a history of smoking and carcinoma involving the posterolateral tongue and floor of mouth.
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            Cytomorphometric analysis of squames obtained from normal oral mucosa and lesions of oral leukoplakia and squamous cell carcinoma.

            Cell and nuclear diameters (CD and ND) were measured in squames obtained from normal buccal mucosa and lesions of oral leukoplakia and squamous carcinoma (SCC) also from buccal mucosa. The study groups consisted of Group 1: normal buccal mucosa (n = 40); Group 2: lesions with no epithelial dysplasia (n = 58); Group 3: lesions with epithelial dysplasia (n = 27); and Group 4: SCC lesions (n = 51). The mean CD and ND values were: Group 1: 51.78 (+/- 0.11) and 8.36 (+/- 0.49); Group 2: 45.73 (+/- 0.16) and 8.31 (+/- 0.68); Group 3: 41.32 (+/- 0.13) and 9.04 (+/- 0.46); Group 4: 38.58 (+/- 0.11) and 10.10 (+/- 0.56) microns, respectively. Correlation between the ND and CD was positive for Group 1 (r = 0.78, P < 0.05) and Group 2 (r = 0.33, P < 0.05). There were no significant correlations in Groups 3 and 4. ANOVA showed significant differences (P < 0.05) for CD between all four groups. Except between Groups 1 and 2, the ND was significantly different (P < 0.05) between all groups. The results indicate that ND and CD could possibly be sensitive parameters in the diagnosis of oral premalignant and malignant lesions.
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              Cytomorphometric analysis of buccal mucosa of tobacco chewers.

              The objective of the present study was to assess the effect of tobacco chewing on buccal mucosa by using cytomorphometry. We compared the cellular diameter (CD), nuclear diameter (ND) and the ratio of nuclear diameter to cellular diameter (N/C) of buccal mucosa squames of normal subjects (N) with buccal mucosa squames of tobacco users without lesion (A), with tobacco-lime lesion (B), leukoplakia (C), and oral squamous cell carcinoma (D). The study group consisted of 125 patients divided into five groups (N, A, B, C and D) between the ages of 21 and 75 years. The mean of the cellular diameter (in micrometers) of group N, A, B, C, and D was 72.86+/-5.26, 68.30+/-3.02, 62.13+/-3.29, 57.75+/-4.66, 54.51+/-4.66 respectively (p<0.01). The mean of the nuclear diameter (in micrometers) of group N, A, B, C, and D was 8.70+/-1.30, 8.98+/-1.08, 9.06+/-0.83, 9.12+/-1.06, and 11.04+/-1.46 respectively (p<0.01). The mean of the ratio of nuclear diameter to cellular diameter of group N, A, B, C, and D was 0.11+/-2.00, 0.13+/-1.82, 0.14+/-1.35, 0.16+/-3.11, 0.21+/-4.51 respectively (p<0.01). Univariate analysis of variance (ANOVA) showed a significant group effect for cellular diameter, nuclear diameter and ratio of nuclear diameter to cellular diameter. Multiple comparison tests by Tukey-HSD procedure revealed a significant decrease in the mean cellular diameter, increase in the nuclear diameter and ratio of nuclear diameter to cellular diameter. Cytomorphometric changes could be the earliest indicators of cellular alterations. There is progressive decrease in cellular diameter, increase in nuclear diameter and increase in ratio of nuclear diameter to cellular diameter in smears from all tobacco users, as compared to normal subjects. This indicates that there could be cause-effect relationship between tobacco and quantitative alterations.
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                Author and article information

                Journal
                J Cytol
                J Cytol
                JCytol
                Journal of Cytology / Indian Academy of Cytologists
                Medknow Publications & Media Pvt Ltd (India )
                0970-9371
                0974-5165
                Jul-Sep 2016
                : 33
                : 3
                : 125-129
                Affiliations
                [1]Department of Oral and Maxillofacial Pathology, St. Joseph Dental College, Eluru, Andhra Pradesh, India
                Author notes
                Address for correspondence: Dr. Urmila Udayashankar, Department of Oral and Maxillofacial Pathology, St. Joseph Dental College, Eluru - 534 004, Andhra Pradesh, India. E-mail: udayanandhikatti@ 123456gmail.com
                Article
                JCytol-33-125
                10.4103/0970-9371.188047
                4995868
                27756983
                35f31859-91ad-45e4-85a7-4af7fd003a8e
                Copyright: © 2016 Journal of Cytology

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Categories
                Original Article

                Pathology
                cellular area (ca),exfoliative cytology,nuclear-to-cellular (n:c) ratio,nuclear area (na),oral squamous cell carcinoma (oscc)

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