Epithelial dysplasia immediately adjacent to oral squamous cell carcinomas.

A number of workers have attempted to identify dysplastic features which may be predictors of malignant change, by prospective studies of dysplastic lesions. In the present study we have looked at dysplastic changes immediately adjacent to established squamous carcinomas in an attempt to determine whether any predictors can be identified in this way. Eighty cases were included in the study for whom information on tobacco usage was known. Clinical details were recorded. Histological features in epithelium immediately adjacent to the carcinoma were studied in representative sections. Eighteen specific histological characteristics were noted as present or absent. Data were transferred by Conversational Monitoring System (CMS) terminal, processed and analyzed by the Statistical Analysis System (SAS) Computer package. Only 8 patients were non-smokers (10%). Dysplastic changes in adjacent epithelium were frequently multicentric. Changes appear to occur first in the basal layer in the form of disturbance of polarity or basal cell hyperplasia, while other dysplastic features are absent. The feature referred to as basal cell hyperplasia appears, in fact, to represent disturbed epithelial maturation. In 80% of cases increased nucleo-cytoplasmic ratio appears to result from a decrease in cytoplasmic volume rather than increased nuclear size. A defect in RNA synthesis may be a factor. A sharp decrease in inflammatory cells in the lamina propria of adjacent epithelium, compared with that of the carcinoma, was observed. Russell bodies were noted in 5 of the 8 lesions in non-smokers (63%) and in 16 of 72 lesions in smokers (22%) (p less than 0.001; Chi2 17.65).