Stromal Changes In Leukoplakia: Exploring New Vistas

Introduction: Leukoplakia is a potentially malignant disorder which may histologically present with
hyperplastic or dysplastic changes in the epithelium. There is an increased potential for malignant
transformation with higher grades of epithelial dysplasia. The stimulus produced by the dysplastic
cell may evoke a connective tissue response in the form of changes in vascularity, collagen fiber
activity and inflammatory cell infiltration.
Aim and Objectives: This study is designed to analyze and compare stromal changes involving
inflammatory cell infiltration, vascularity and collagen fibers in leukoplakia with and without
dysplasia with an aim to determine whether the changes in the connective tissue could be related to
the dysplastic changes in the epithelium.
Materials and method: The study group comprised of 40 specimens of clinically diagnosed
leukoplakia. These were divided into two groups (20 cases of leukoplakia without dysplasia and 20
cases of leukoplakia with dysplasia). Hematoxylin and eosin stained sections were evaluated for
inflammatory cell infiltrate and vascularity while picrosirius red stained sections were used to study
collagen under polarizing microscope. Statistical analysis was performed by employing ANOVA test
using SPSS version21 (p<0.05)
Result: There was a significant increase in the number of thick green fibers and decrease in number
of red fibers in leukoplakia with dysplasia as compared to non-dysplastic leukoplakia.. Also a
significant increase in the number of blood vessels and inflammatory cells was noted in dysplastic
leukoplakia.
Conclusion: Stromal modifications in the form of collagen fiber remodeling indicated by an increase
in the number of green fibers and a decrease in the number of red fibers along with an increase in
inflammatory cells and vascularity, suggests an important role of connective tissue components in
leukoplakia with epithelial dysplasia.