CYTOLOGICAL CHANGES IN ORAL LEUKOPLAKIA BEFORE AND AFTER DEEP X-RAY IRRADIATION
The relative frequency of the different types of cells seen in various stages of leukoplakia and the cellular changes induced by fractionated doses of deep x irradiation were studied in 104 patients. All these cases received intraoral treatment with a 55-kv machine with 0.5-mm Cu and 1.0-mm Al filtration; 400 r was administered to the diseased area of the cheek or tongue six days a week to give a total dose of 3600--4000 r. Cytologically, pretreatment smears could be classified into the following 3 types: Type I (predominantly acidophilic squamous cells with pyknotic nuclei, groups of hyperkeratinized cells with no visible nuclei, and squamous cells with perinuclear vacuoles and cytoplasmic granules; Type II (squamous cells with moderate variation in nuclear shape, size, and staining quality; nuclei contained one or two small nucleoli, and superficial squamous cells with acidophilic cytoplasm and pyknotic nuclei with perinuclear vacuoles were also present; Type III (cells had acidophilic cytoplasm and cell limits were ill defined; nuclei showed anisonucleosis, hyperchromatism and presence of distinct nucleoli). The radioinduced changes varied in three different types of smears. Lesions which were characterized by Type I smears manifested mild alteration in cell morphology during the course of irradiation. Acidophilic and basophilic squamous cells were moderately enlarged in size but the shape, size, and staining affinity of the nuclei did not change. Cytoplasmic vacuoles were evident. A constant findings was a great increase in the number of ceils with cytoplasmic granules. Occasional cells showed the presence of two nuclei, especially after a total dose of 2000 r. At the end of treatment (after a total dose of 3600 to 4000 r) the cell picture remained the same. The radioinduced changes in the Type II lesions exhibited some alterations similar to those described in Type I; however, a difference in the intensity of reaction was evident. Cells with marked variation in nuclear size and with distinct nucleoli were prominent, and an increase in the number of binucleated and multinucleated squamous cells was also observed. These changes became evident after a dose of 1200 to 1600 r and a few enlarged cells persisted until the end of the treatment. The cytologic response to radiation of Type III lesions was seen as sheets of cells with ill-defined cell boundaries and opaque cytoplasm. Their nuclei showed marked enlargment, thick nuclear membranes, chromatin clumping, and prominent nucleoli. Occasionally bizarre ceiis and multinucleated cells were seen. These smears also contained degenerated cells, leukocytes and histocytes. These changes were noted after 1200 to 1600 r and were pronounced following 2400 to 2800 r. With progressive irradiation the nuclei showed various types of degeneration, such as pyknosis and karyolysis. The different types of response elicited were explained as follows: the predominant cells seen in Type I and II are precornlfied and cornlfied superficial squamous cells while the cells from the deeper layers, viz. the parabasal and intermediate cells, are generally absent in Type I and rare in Type II. Hence, the following irradiation, morphological alterations would be observed in the superficial squamous cells only and the nature of the changes induced in the parabasal and intermediate cells cannot be assessed as they do not appear in the smears of these two types of leukoplakia. In lesions with a Type III smear the parabasal and intermediate cells with atypical nuclei predominant and the alterations produced by irradiation in the cells become manifest. The presence of persistence of cells with atypical nuclei during treatment could be regarded as a sign of unfavorable response to irradiation therapy. Apparentiy some of these lesions with Type III smears are premalignant conditions and may in the course of time become malignant. (BBB)
- Research Organization:
- Atomic Energy Establishment, Trombay, India
- NSA Number:
- NSA-18-019624
- OSTI ID:
- 4024180
- Journal Information:
- Indian Journal of Medical Sciences (India), Journal Name: Indian Journal of Medical Sciences (India) Vol. Vol: 16; ISSN INJMA
- Country of Publication:
- Country unknown/Code not available
- Language:
- English
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