“SUBMUCOSAL FIBROSIS AS A BARRIER TO TUMOR EXTENSION: ANATOMICAL AND HISTOLOGICAL INTERPRETATION”

Abstract

Background: Oral submucous fibrosis (OSF) is a precancerous disorder that is associated with extensive submucosal collagen accretion. Its possible use as a hindrance to the spread of lymphatic tumors in oral squamous cell carcinoma is under-researched.

Objective: To determine submucosal fibrosis as an anatomical and histologic barrier to lymphatic metastasis and extranodal spread of oral squamous cell carcinoma at its advanced stage.

Materials and Methods: It was a 5-year prospective observational study involving 80 oral squamous cell carcinoma patients at stage III-IV, where the buccal mucosa, alveolus, or retromolar trigone showed the bony involvement. There were 50 patients with concomitant submucosal fibrosis (mostly at stage 3) and 30 without. Each of them was resected at the primary level with the modified radical neck dissection (levels I-V). The histopathologic parameters included nodal yield, metastatic involvement, and extranodal extension.

Results: Patients who had submucosal fibrosis had small nodal metastases (only to levels I-II in 40% and none in 60%), and no extranodal extension. Conversely, the extensive multi-level nodal disease (10 -17 positive nodes) in all patients without fibrosis was common, and the extranodal spread was common.

Conclusion: Submucosal fibrosis is a protective barrier that limits lymphatic dissemination and extranodal progression, which may improve the prognosis of OSF-related advanced oral cancers.