Cytologic diagnosis combined with DNA-image cytometry to measure DNA aneuploidy has proven to have high specificity and sensitivity for malignancy in studies of patients evaluated with premalignant lesions in the oral cavity (Remmerbach et al. 2001; Maraki et al. 2004). In fact, cytology combined with DNA-image cytometry may predict malignant transformation up to 15 months before its histologic confirmation (Remmerbach et al. 2003; Maraki et al. 2004).
Article Molecular predictors of clinical outcome in patients with he...
Immunohistochemistry with an antibody against cytokeratins may help you, evidencing small clusters or single invasive cells in subepithelial tissue. However when subepithelial tissue is scant and not well oriented, you should be aware that cutting artefacts could cause overestimation of infiltration.
that is what precisely I want to know. When the subepithelial tissue is scant , how to differentiate between small islands of infiltration and arttefacts
As there is no staining for sqamous cell carcinoma in oral cavity ,you can search for in situ component helpful for your question. In spite of small islands of infiltration means carcinoma.in artifacts structures are disorganized and not properly oriented.
It is very easy to determine whether the tumor cells invaded the underlining tissue with tumors of epithelial origin.
You may simply stain the slide with P.A.S. to examine the position of the tumor cells.
If the tumor is invasive you can see the tumor cells beneath the basement membrane (basal lamina). It is more accurate if you examine the area of basal lamina with transmission electron microscope.
The main factors are the size and orientation of the biopsy add to these is crush artefacts produced by the biopsy foreceps. Immunohistochemistry and special stains might help. Most imortant is the morphology, but I agree sometimes it is difficult to give a final verdict.
Oral cancers: In real diagnostic pathology we use only histologic patterns of invasion - yes spread beyond basement membrane, yes- stromal desmoplasia, yes- single cells in the stroma, yes- tongues of neoplastic cells not round clusters. and of course we always consider artefacts and sometimes it is not possible to diagnose invasion due to small sample. No biomarkers are useful to answer this question in current clinical practice. This does not mean that the research in this area is invalid.
If infiltration beyond basal layer is not clear inmunohistochemestry with pancitokeratina could be usefull.
I find a Gomori methenamine silver stain helpful for the question of invasion or not. It highlights the basement membrane, and one can see if it's still intact or not.
Best wishes for 2014 from Berlin!
Histology is the main method for diagnosing invsion. One may use collagen type 4 or PAS to locate the basment membrane along with a CK to stain for single cells embedede in the stroma if there is any. however the stromal reaction and presence of single cells or irregular small nests of cells should help.
Hi Rashmi
i agree with dr. Nikita but in very recent study Dec. 2013 by Takayuki Ishida found that Expression of E‑cadherin was investigated as a hallmark of Epithelial‑mesenchymal transition (EMT) is an early step in the acquisition of invasiveness by malignant tumors by immunohistochemical examination by this link
http://www.spandidos-publications.com/ol/6/5/1201?text=fulltext
As far as I know there is not reliable indicator of early invasion, expecially in oral cavity lesions ( squamous cell dysplasia - carcinoma sequence). The best way to differenciate reactive pseudoepitheliomatous hyperplasia and early squamous cell carcinoma is to consult more experienced colleague :) since consequences of overdiagnosis or underdiagnosis are terrible. And it is only a combination of periepithelial early fibrosis, chronic inflammary infiltrate and luck of spotting early invasive group of cells with morphologic characteristics depicted in relevant recent publications using multiple seriál sections which will lead to final diagnosis, although sometimes inconclusive with recomendation for another biopsy.
The answer by Nikita Makretsov is most likely correct. This is sad and shocking. Despite all the things we have learned about squamous carcinogenesis, even the simplest and most relevant questions cannot be answered by modern molecular biology, at least not in a way that is applicable in the daily routine of a pathology lab.
Is this the consensus here? What are we looking for beyond histopathology? Would a marker for invasion be helpful? How many sections would have to be analyzed to make a decent and reliable statement that no signs of invasion were found. Would such an assay be really useful keeping in mind the average patient with field cancerization?
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