Studies in oral leukoplakias. XI. Histopathology of leukoplakias in Indians chewing "pan" with tobacco

Characterization of epithelial cell activity in patients with oral cancer

Accurate, predictive assessment of the clinical behaviour and progression of individual oral cancers and premalignant lesions requires reproducible and quantitative analyses of diseased tissue. In this paper we describe the use of in vitro double labelling (sequential tritiated thymidine and bromodeoxyuridine staining of proliferating epithelial cells) to calculate S phase labelling indices (LIs), estimation of S phase duration (tS), and measurement of variables of flux to and from S for excised specimens of oral squamous cell carcinoma, premalignant lesions, and clinically normal mucosa from patients with oral cancer. There was a significant increase in mean LIs in buccal mucosa leukoplakias (14.5%) compared with normal mucosa (10.3%); P = 0.03. LIs were also increased in patients with cancers of the floor of mouth and ventral tongue but neither these changes nor alterations in flux parameters or S Phase durations were significant. Twenty-one kinetic profiles of dysplastic and malignant tissue were compared with conventional histopathological results, however, and these showed a 2.2% increase in LIs with each increase in grade of dysplasia (P = 0.004) and a 12% increase in LIs with each reduction in tumour differentiation (P = 0.02).

Diurnal variation in labelling index in human buccal epithelium

Diurnal variations in the number of DNA-synthesizing cells (labelling index) in human buccal epithelium were studied by in vitro pulse labelling with tritiated deoxythymidine. Eleven male volunteers provided 33 biopsy specimens at six time periods. The results showed a 24-h periodicity in the labelling index in this tissue. The mean peak labelling index obtained at 22:00 h (3.20 +/- 0.18) was significantly different from the means obtained at the rest of the times. The 24-h mean labelling index (labelled cells/100 cells) was 2.48 +/- 0.47 for three subjects who volunteered samples at all six time periods. The labelling index obtained around the middle part of the day for all subjects (2.44-2.59) appears to be representative of a 24-h basal or reference value.

Epithelial cells kinetics. A review of methods of study and their application to oral mucosa in health and disease. Part B. Comparison of cell kinetics in normal and abnormal epithelia

In Part A, the techniques most commonly used to study epithelial cell kinetics and their suitability for use in man are reviewed. In Part B, the application of such methods to comparative studies of normal and abnormal oral epithelial of both man and experimental animals is examined. Claims regarding the possible prognostic value of LI's or MI's of biopsies of potentially or overtly malignant human oral lesions are also considered. Normal and abnormal kinetic data for other lining epithelia, e.g., skin, uterine cervix and gastrointestinal mucosa are assessed where they provide a better illustration of some of the problems arising in such comparative investigations. Finally, the present and likely future areas in which cell kinetic studies may provide a guide to expected tumour prognosis and optimum treatment are summarized.

[Some measures of proliferative activity in normal and leukoplakic buccal mucosa (author's transl)]

In 29 patients, the DNA synthesis rate of clinically healthy buccal mucosa epithelium in comparison to benign buccal leukoplakias has been studied by in vitro-autoradiography. The proliferative activity has been determined by means of the 3H-labelling indices of basal cells (LBC) and suprabasal cells (LSBC) including the total of labelled epithelium cells and the quotient of LBC:LSBC as well. The progenitor compartment of both leukoplakic and normal buccal epithelium comprises the stratum basale and the adjacent 2-3 layers of suprabasal cells. Around 70% of the DNA synthesis of normal mucosa was found in the suprabasal nuclei of the progenitor compartment. In the leukoplakic mucosa, some displacement of the labelled nuclei in the progenitor compartment resulting in a statistically significant change of the quotient of LBC:LSBC in favour of LBC was determined. Moreover, the leukoplakic specimens showed a moderate decrease of the mean proliferative activity of the total of labelled epithelial cells which may be due to a diminished exfoliation of cornified cells from the hyper(ortho)keratotic surface. It is supposed that in chronic oral leukoplakias some variation of the steady state between renewal and desquamative loss of epithelial cells is operating as far as no precancerous condition is present.

[Comparative histological and autoradiographic investigations on benign oral leukoplakias (author's transl)]

Proliferation was studied in 18 patients with benign oral leukoplakias of the buccal mucosa by in vitro labelling with 3H-TdR. Identical investigations were performed in clinically normal mucosa of the same patients. Significant differences were found between the LI of both groups. On the other hand the total of labelled cells per 100 micron length of the basal membrane was approximately equal in leukoplakias and normal mucosa. In the majority of cases the LI was increased in leukoplakic regions whereas the number of labelled suprabasal cells was lowered compared to normal. These findings are supposed to be a consequence of shifting of epithelial keratinization to the lower stratum spinosum. From that results an increased proliferation in the basal cell layer.

The effects of betel-nut chewing on the buccal mucosa of 296 Indians and Malays in West Malaysia. A clinical study

Changes in the buccal mucosa of 296 Indian and Malay betel-nut chewers in Perak, West Malaysia, were studied clinically. 167 out of 212 Indian subjects incorporated tobacco in their quids, while 45 out of 84 Malay subjects incorporated. "Gambir". The Indians appeared to show a higher proportion of mucosal changes, particularly when tobacco was used. "Gambir" did not appear to be potent in the production of mucosal changes. Comparison with studies in other parts of the world suggested comparable findings with respect to both tobacco and non-tobacco chewing samples, and there would appear to be some evidence that tobacco-containing quids are likely to produce a higher proportion of mucosal changes as compared to non-tobacco-containing quids. An attempt to demonstrate a dose-effect relationship by dividing the subjects into "slight" and "heavy" chewers did not yield significant differences between these two categories in each of the groups.