Differential diagnosis of well‐differentiated squamous cell carcinoma from non‐neoplastic oral mucosal lesions: New cytopathologic evaluation method dependent on keratinization‐related parameters but not nuclear atypism

Abstract

Recognition of the present five parameters is useful for oral SCC cytology. Diagn. Cytopathol. 2017;45:406-417. © 2017 Wiley Periodicals, Inc.

Usefulness of Five-Parameter System Reconfirmed for Cytopathology of Oral Squamous Cell Carcinoma regardless of Differentiation Degree

“…Their narrow cytoplasm with sharply demarcated cell margins becomes deeply stained and has a glittering appearance. Although we previously described keratoglobules as not derived from keratin pearls but from single cell keratosis scattered in oral SCC/CIS foci [7], the present study, which examined an approximately four times greater number of SCC/CIS specimens, showed keratoglobules generated also within keratin pearls. Mohanta et al [19] reported "small keratinized round cells" as evidence of malignancy in oral cytology.…”

“…Among the five parameters of FPS, concentric arrangement of orangeophilic cells (parameter i) and keratoglobules (iv) were reconfirmed in the present study as highly characteristic and specific to oral malignancy, as they were exclusively found in malignant specimens, while not-definitely malignant specimens possessed none of them. Concentric arrangement of orangeophilic cells (i) represents small keratin pearls, probably in the initial phase [7]. In our previous studies, it was demonstrated that round-shaped dyskeratotic foci (small keratin pearls) in oral CIS are initiated from collapsed intraepithelial blood vessels [15, 17].…”

“…After confirming TBS categorization, each specimen was evaluated whether any of the FPS parameters were included. Details of the FPS protocol have been presented [7]. In brief, FPS is used to evaluate cytology specimens according to five cytoplasmic parameters: (i) concentric arrangement of orangeophilic cells (indicating initial stage of keratin pearl formation); (ii) large number of orangeophilic cells; (iii) bizarre-shaped orangeophilic cells with a spindle or caudate shape, deep orange-yellow color, and distinct cell borders, but without nuclear atypia; (iv) keratoglobules, a term used to designate small round-shaped cells with deep orangeophilic cytoplasm and pyknotic nuclei; and (v) uneven filamentous cytoplasm.…”

“…Regarding the latter, oral cytology is considered useful as a diagnostic method and also known to have a low level of invasiveness and low cost. As a standardized and generalized cytology reporting system, The Bethesda System (TBS) utilizing Papanicolaou-stained specimens provides accurate diagnosis and reasonable detection rates for cervical cancer [5], but its general concept has also been applied to the other malignancies in the other organs including the thyroid, pancreas, urine [5], and oral cavity [6, 7].…”

The use of cytopathology to identify disturbances in oral squamous cell carcinoma at early stage: A case report

“…This methodology, however, is not indicated to examine oral cytopathological samples due toits poor diagnostic accuracy in oral tissues. The cytoplasmic morphological characteristics recently described by Hara et al should be included as a new parameter to increase the accuracy of this preventive diagnostic method for OSCC. In this regard, the absence of a cytological sample of normal tissue from the same patient is a limitation of this report, as cytopathological results are known to present individual variations within normal standards.…”