Evaluation of the Cytological Changes of the Oral Mucosa Among Smokers in Al Madinah Al Munawara Using Argyrophilic Nucleolar Organizer Region (AgNOR) Counts and Papanicolaus Stain

Objective To evaluate the cytological changes of the oral mucosa among smokers using Argyrophilic nucleolar organizer region (AgNOR) counts and Papanicolaou (Pap) staining. Methodology The oral mucosal exfoliate smears of 500 individuals (200 nonsmokers and 300 smokers) aged between 18 and 80 years were prepared in Al Madinah. The AgNOR count and Pap stain were used to generate a cytogenic smear to assess the presence of cytological changes suggestive of atypia, inflammation, dysplasia, keratinization, and proliferative activity of epithelial cells. Results Smokers have a considerably higher number of AgNORs per nucleus than nonsmokers (1.99 3.53 vs. 0.42 1.22). There were inflammatory changes in 127 (42.3%) of the cases and 40 (20%) of the controls. Multinucleated cells and atypia were found in 33 (11%) and 14 (4.5%) of the cases but not in the controls. The results indicate higher proliferative activity in smoking patients compared to nonsmoking patients, even in the absence of clinical lesions. Conclusion To detect the effects of smoking on the oral mucosa, Pap staining alone is insufficient. Combining Pap staining with the AgNOR technique produces the desired results.

Cytological Changes and Immunocytochemistry Expression of P53 in Oral Mucosa Among Waterpipe Users in the Kingdom of Saudi Arabia

Objective In this study, we aimed to assess cytological changes and p53 expression in oral mucosa among waterpipe users in the Kingdom of Saudi Arabia (KSA). Methodology A case-control study was conducted in KSA from January to October 2022. Two cytologic oral smear samples each were taken from 500 volunteers; 300 were waterpipe users (case) while 200 did not use a waterpipe (control). They were then stained using the Papanicolaou staining procedure and immunocytochemical method to show the expression of P53. Results The interpretation of the Papanicolaou staining outcomes showed the presence of four results with different proportions: inflammation, infection, atypia, and keratinization. Cytological inflammation was identified among 77/300 (25.6%) waterpipe smokers, which was higher than that among non-users (12/200, 6%). The reverse cytological infection and atypia were also higher in waterpipe smokers compared with controls (9% vs. 4.5% and 4.3% vs. 0.5%, respectively), and keratinization was detected only in waterpipe users (3.6%) compared with controls. Waterpipe users had higher p53 protein expression than non-users. Conclusion Using a waterpipe is an effective way to change the oral mucosa. In atypia and keratinization, there was high p53 expression. These results could indicate that p53 is involved in both the change from normal to cancerous cells and the growth of new cells, but the presence or absence of p53 staining could not be used to predict the outcome of potentially cancerous oral mucosal lesions.

Oral Epithelial Dysplasia Grading Systems: A Systematic Review & Meta-Analysis

This systematic review and meta-analysis aims to provide a robust qualitative and quantitative analysis of the different systems used to assess the grade of oral epithelial dysplasia (OED). This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyzes (PRISMA) statement. Six electronic databases were searched for primary research published over the past four decades. Overall quality and level of evidence were based on the Johns Hopkins Research Evidence Appraisal Tool, while evidence of heterogeneity was determined by the Q-statistic and I^{^2} statistic. Evidence of publication bias was determined using Egger's regression and the Rank correlation tests. A total of 170 records were identified. Only 9 primary research articles were included in the qualitative systematic review. Four studies (4/9) were included in the final quantitative meta-analysis. The grading systems analyzed included the WHO, binary, Ljubljana, Smith and Pindborg, Brothwell, and the oral intraepithelial neoplasia. The results demonstrate the binary system to be superior to the WHO system in grading OED, by providing better inter-observer agreement, however, the substantial error among the inter-observer κ values analyzed indicates the significance of this finding to be of minimal impact. Lack of reliable reproducibility of the grading systems and lack of common effect size (heterogeneity analysis) were noted.

Nasal and Tracheal Cytological Changes After Total Laryngectomy in Long-Term Survivors

OBJECTIVE

Complete separation of upper and lower respiratory tract after total laryngectomy results in permanent effects on nasal cavities and tracheo-bronchial airways. Aim of this study is evaluating nasal and tracheal cytological alterations of mucosa in laryngectomy long-term survivors, analyzing the feasibility of scraping for cytological examination of tracheal mucosa.

METHODS

Twenty-five laryngectomy patients underwent symptoms' evaluation, endoscopic fiber optic examination, prick tests, and nasal and tracheal scraping for cytological exam. Twenty-five healthy subjects underwent the same assessment, except for tracheal scraping. Eleven laryngectomy patients accepted inferior turbinate biopsy for histological examination.

RESULTS

Nasal cytological analysis demonstrated mucous cell metaplasia in 20% of laryngectomized patients, but it was absent in all healthy subjects; no squamous cell metaplasia was found in both groups. In 15 patients (60%), bacteria were present, without inflammatory infiltrate. Tracheal cytological analysis demonstrated a quite high rate of squamous cell metaplasia (24%), neutrophilic infiltrate (32%), and presence of bacteria (40%). Histological examination of inferior turbinate showed submucosal stromal fibrosis in all patients and submucosal inflammatory infiltrate in 1 case (9%).

CONCLUSION

Nasal cavities and trachea of laryngectomy patients undergo long-term cytological and histological changes of mucosa and submucosa, probably due to airflow modifications.

Cytologic changes of ovarian epithelial cancer induced by neoadjuvant chemotherapy

OBJECTIVE

Neoadjuvant chemotherapy (NACT) followed by cytoreduction has now become a part of standard care for patients with advanced ovarian cancer. Cytologic changes of the cancer cells induced by NACT, however, sometimes may cause confusion in terms of pathologic diagnosis and therefore inappropriate management. The objective of this study was to characterize the histologic or cytologic features of the ovarian cancers from those patients who received NACT in order to improve the diagnostic accuracy and reduce unnecessary clinical workup.

METHODS

Specimens from 120 patients with advanced ovarian cancer who received NACT were studied. All 120 cases had either cytologic samples from ascites (n=108) or fine needle aspiration (n=12) and the diagnosis of consistent with cancers of ovarian origin was made prior to NACT. There were 70 (58.3%) patients received subsequent tumor debulking surgery after NACT. The time frame between NACT and debulking surgery ranged from 28 to 65 with an average of 45 days. Among the 70 cases with cytoreductive surgery, 48 cases containing both pre-NACT cytology/histology and subsequent debulking specimens were suitable for the study. All 48 post-NACT ovarian cancers were reviewed and the characteristic pathologic features in gross were summarized. Microscopic evaluation and immunohistochemical stainings with antibodies against ER, PR, p53, WT1, PAX8, CK7, CK20, and CDX2 were performed to confirm the primary site and histologic type of the cancers.

RESULTS

Grossly, tumor size within the ovaries from those debulking specimens ranged from 2.3 to 6.5 cm in greatest dimension. The cancers were mainly solid (average of 65%) and cystic areas had more or less hemorrhagic appearance. Extensive tumor necrosis and some with fibrosis were present. Microscopically, the non-necrotic cancer cells were arranged in cords, islands and sometimes as scattered single large cells with large amount of eosinophilic cytoplasm with vacuoles. The viable cancer cells contained more or less vacuolated cytoplasm in almost all post chemotherapy cases. Multinucleated tumor giant cells were noted in close to half of the cases. The cancer cells commonly had large hyperchromatic bizarre nuclei with coarse chromatin clumping and sometimes prominent nucleoli. Due to the unusual cytologic changes after NACT, there was a concern of non-ovarian origin or the different histologic type of the cancers. Therefore, immunohistochemical (IHC) staining with the antibodies against ER, PR, PAX8, WT1, CK7, CK20, and CDX2 was performed in all 48 pairs of the cases. The 48 paired samples showed identical immunophenotype in pre- and post-NACT cancers, confirming there was no metastatic or new primary cancer involved in the study.

CONCLUSIONS

NACT can apparently induce significant cytologic/histologic changes in ovarian cancer. Aware of such NACT induced changes will be useful to make correct diagnosis for those patients who have received NACT. IHC with appropriate panels of the antibodies will be helpful to aid the diagnosis, particularly when nuclear change is dramatic and the clinical history of ovarian cancer is not available.