{"id":8072,"date":"2016-08-21T09:06:58","date_gmt":"2016-08-21T09:06:58","guid":{"rendered":"http:\/\/biomedpharmajournal.org\/?p=8072"},"modified":"2016-08-30T10:47:27","modified_gmt":"2016-08-30T10:47:27","slug":"grading-of-oral-epithelial-dysplasia-a-review","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol9no2\/grading-of-oral-epithelial-dysplasia-a-review\/","title":{"rendered":"Grading of Oral Epithelial Dysplasia \u2013 A Review"},"content":{"rendered":"

Introduction\u00a0<\/strong><\/p>\n

Oral squamous cell carcinoma is a most common changes in the oral mucosa1<\/sup>. leukoplakia is one of the most common potentially malignant disorders2<\/sup>. Dysplasia is reversible. When the stimulus is removed , the dysplastic changes will revert back to normal. When the irritant is removed , epithelium shows cellular atrophy3<\/sup>. It manifest as a cell death or neoplastic transformation. In epithelial dysplasia malignant development is more important than the clinical characteristics2,4.<\/sup><\/p>\n

Grading in dysplasia\u00a0<\/strong><\/p>\n

Many combinations of dysplastic features are used in grading system and there is difficulty in assessing the various degrees of epithelial dysplasia . To assess the severity of the dysplastic features many grading systems have been proposed . There are various grading systems given by many authors , following are the most commonly used grading systems<\/p>\n

Smith and Pindborg\u2019s classification5<\/sup><\/p>\n

1978 WHO classification6<\/sup><\/p>\n

Ljubljana classification squamous intraepithelial\u00a0lesions (SIL)7,8<\/sup><\/p>\n

2005 WHO classification9<\/sup><\/p>\n

New Binary system10<\/sup><\/p>\n

Smith and Pindborg Classification5<\/sup><\/strong><\/p>\n

In the year 1969 Smith and Pindborg\u00a0 were first\u00a0 to standardize the grading\u00a0 for epithelial dysplasia\u00a0 . This system was based on the means of the different histological changes and\u00a0 photographic method. In this method standardized photographs are being compared with histologic sections and given 13 histologic features. Now they graded the epithelial dysplasia as absent , marked or slightly and also the score is given. For absent the score was given as zero and for marked or slightly the score was between 1 and 10<\/p>\n

1978 WHO Classifi cation6<\/sup><\/strong><\/p>\n

The \u201chistopathological typing of cancer and precancer lesions \u201d was given by WHO in the year 1997 . They have given 12 characteristics of the epithelial dysplasia which was graded as mild , moderate and severe according to the characters which are present.<\/p>\n

List of Characteristic \u00a0features are<\/p>\n

Loss of polarity of basal cells<\/p>\n

An increased nuclear-cytoplasmic ratio<\/p>\n

Drop shaped rete pegs<\/p>\n

The presence of more than one layer of cells havingthe basaloid appearance<\/p>\n

Increased number of mitotic figures<\/p>\n

Irregular epithelial stratification<\/p>\n

The presence of mitotic figures in the superficial halfof the epithelium<\/p>\n

Nuclear hyperchromatism<\/p>\n

Cellular polymorphism<\/p>\n

Reduction of cellular cohesion<\/p>\n

Enlarged nucleoli<\/p>\n

Keratinization of single cells or cell groups in the<\/p>\n

prickle cell layer<\/p>\n

They graded epithelial dysplasia as<\/strong><\/p>\n

Mild<\/p>\n

Moderate<\/p>\n

Severe<\/p>\n

Mild dysplasia<\/strong><\/p>\n

Nuclear abnormality is slight in the basal third of epithelium \u00a0and it was minimal in the upper layer with cell maturation. Few abnormal mitosis maybe seen accompanied by chronic inflammation.<\/p>\n

Moderate dysplasia<\/strong><\/p>\n

Basal 2\/3rd of the epithelium shows \u00a0nuclear abnormalities persisting up to thesurface. Cell maturation and stratification are seen in the upper layer. Mitosis occurs in the Parabasal and intermediate layer.<\/p>\n

Severe dysplasia<\/strong><\/p>\n

More than 2\/3rd of the epithelium shows \u00a0nuclearabnormalities and cell maturation is lost. stratification and abnormal mitosis\u00a0 is seen in the superficial layers. Carcinoma in situ was mergedinto severe dysplasia.<\/p>\n

Ljubljana Classifi cation SIL<\/strong><\/p>\n

In the \u00a0year 2003 zeodner proposed criteria for grading hyperplastic epithelial lesions of the oral cavity as simple , atypical and abnormal hyperplasia<\/p>\n

Simple hyperplasia<\/strong><\/p>\n

Basal and parabasal layer remains intact without any cellular atypia and thickening of the prickle cell layer is seen.<\/p>\n

Abnormal hyperplasia<\/strong><\/p>\n

It shows increase in size from basal layer up to halfof the epithelial thickness. Stratification remains unchanged with moderately enlarged nuclei. Basal cell layer shows mitosis and dyskeratosis is seen less than 5% of the epithelial cells<\/p>\n

Atypical hyperplasia (risky epithelium)<\/strong><\/p>\n

Cells of the epithelium \u00a0are altered showing malignant changes but it is not to form carcinomatous cells . Epithelial stratification remains unchanged and nuclei is enlarged with irregular contour. Mitotic figures is increased upto to the \u00a02\/3rd of the epithelium with increasednuclear-cytoplasmic ratio. Civatte bodies and\u00a0 Dyskeratotic cells may be present.<\/p>\n

Carcinoma in situ<\/strong><\/p>\n

Stratification is completely lost and mitotic figures are seen all over the epithelium7<\/sup><\/p>\n

2005 WHO Classifi cation9<\/sup><\/strong><\/p>\n

In the year 2003 WHO classified the oral epithelial dysplasia as \u00a0Mild, moderate,severe, carcinoma in situ or hyperplasia based on the\u00a0 architectural changes and the presence or severity of cellular atypia according tothe presence and severity of cellular atypia and thearchitectural features. It was issued by WHO in the new book \u00a0\u201cclassification of tumors of the head andneck.\u201d9<\/sup><\/p>\n

Architectural characteristics<\/p>\n

Abnormally superficial mitoses<\/p>\n

Irregular epithelial stratification<\/p>\n

Drop-shaped rete ridges<\/p>\n

Keratin pearls within rete pegs<\/p>\n

Loss of polarity of basal cells<\/p>\n

Increased number of mitotic figures<\/p>\n

Cellular characteristics<\/strong><\/p>\n

Anisonucleosis and Anisocytosis<\/p>\n

Nuclear and Cellular pleomorphism<\/p>\n

Dyskeratosis<\/p>\n

Increased number and size of nucleoli<\/p>\n

Increased nuclear-cytoplasmic ratio<\/p>\n

Atypical mitotic figures<\/p>\n

Grading systems of oral epithelial dysplasia<\/strong><\/p>\n

Mild dysplasia<\/strong><\/p>\n

Architectural changes limited only tothe lower third of the epithelium along with the cytological atypia<\/p>\n

Moderate dysplasia<\/strong><\/p>\n

Architectural changes is seen extending tothe middle third of the epithelium. Degree of cytologicatypia requires upgradation<\/p>\n

Severe dysplasia<\/strong><\/p>\n

Architectural disturbances is seen Greater than 2\/3rd of the epithelium and the increasednumber of the cytologic atypia<\/p>\n

Carcinoma in situ<\/strong><\/p>\n

Architectural disturbances are seen throughout the full thickness of the epithelium. Abnormal mitosis is seen on the superficial layer with atypical figures<\/p>\n

Conclusion\u00a0<\/strong><\/p>\n

Histopathological assessed severity of oral epithelial dysplasia remains the gold standard for the prediction of malignant transformation of precancerous lesions<\/p>\n

References<\/strong><\/p>\n

    \n
  1. Warnakulasuriya S, Johnson NW, van der Waal I. Nomenclatureand classification of potentially malignant disorders of the oral mucosa. J Oral Pathol Med 2007;36:575\u201180.<\/li>\n
  2. van der Waal I, Schepman KP, van der Meij EH, Smeele LE.Oral leukoplakia: A clinicopathological review. Oral Oncol1997;33:291\u2011301.<\/li>\n
  3. Rajendran R, Sivapada Sundaram B. Benign and malignant tumors of the oral cavity. Shafer, Hine, Lavy, editors Shafer’s Text book of Oral Pathology India: Elsevier2009:120-7.<\/li>\n
  4. Lumerman H, Freedman P, Kerpel S. Oral epithelial dysplasia and the development of invasive squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;79:321-9.<\/li>\n
  5. Kramer IR, Lucas RB, Pindborg JJ, Sobin LH. Definition ofleukoplakia and related lesions: An aid to studies on oral precancers. WHO Collaborating Centre for Oral Precancerouslesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod\u00a01994;67:22-9.<\/li>\n
  6. Warnakulasuriya S. Histological grading of oral epithelial dysplasia:revisited. J Pathol 2001;194:294-7.<\/li>\n
  7. Fleskens S, Slootweg P. Grading systems in head and neckdysplasia: Their prognostic value, weaknesses and utility. HeadNeck Oncol 2009;1:11-9.<\/li>\n
  8. Mahajan MC, Hazarey VK. An assessment of oral epithelialdysplasia using criteria of smith and Pindborg grading system &Ljubljana grading system in oral pre-cancerous lesions. J OralMaxillofac Pathol 2004;8:73-81.<\/li>\n
  9. Branes L, Eveson JW, Reichart P, World DS. Tumours of the oralcavity and oropharynx. Pathol Genet 2005;67:177-9.<\/li>\n
  10. Kujan O, Oliver RJ, Khattab A, Roberts SA, Thakker N, Sloan P.Evaluation of a new binary system of grading oral epithelialdysplasia for prediction of malignant transformation. Oral Oncol2006;42:987-93.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Introduction\u00a0 Oral squamous cell carcinoma is a most common changes […]<\/p>\n","protected":false},"author":8,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[32],"tags":[],"class_list":["post-8072","post","type-post","status-publish","format-standard","hentry","category-vol9no2"],"_links":{"self":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/8072","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/comments?post=8072"}],"version-history":[{"count":5,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/8072\/revisions"}],"predecessor-version":[{"id":8288,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/8072\/revisions\/8288"}],"wp:attachment":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/media?parent=8072"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/categories?post=8072"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/tags?post=8072"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}