Original Research

Morphological Analysis of Elastic Fibers in Various Grades of Oral Squamous Cell Carcinoma and Epithelial Dysplasia Using Verhoeff–Van Gieson Stain

Janardhanam Dineshshankar, Nalliappan Ganapathy, Thuckanaickenpalayam Ragunathan Yoithapprabhunath, Jeyaraman Swathiraman, Thangadurai Maheswaran, and Vadivel Ilayaraja


Background: Oral squamous cell carcinoma (OSCC) is the sixth most common malignancy in India. The aggressiveness of OSCC is analyzed not only based on the dysplastic features and tumor infiltration pattern, but also by means of the stromal changes that pave the way for an invasion into the connective tissue. The role of elastic fibers in the progression of OSCC is still unknown because of sparse literature and the masking effect of overlying inflammatory cells and the lower number of elastic fibers in the lamina propria. The present study provides further insight into the qualitative assessment of elastic fibers in various grades of dysplasia and OSCC. Objectives: To analyze the morphological changes exhibited by the elastic fibers in epithelial dysplasia and OSCC. Materials and methods: Two sections were cut from each of 60 samples of varying grades of OSCC and 60 samples of varying grades of epithelial dysplasia followed by staining with hematoxylin and eosin and Verhoeff–Van Gieson stain. Results: Statistically significant results were obtained for qualitative analysis of elastic fibers. A change in density and orientation to overlying epithelium and tumor islands was seen on progressing from well-differentiated to poorly differentiated OSCC and in progressing grades of dysplasia. Conclusion: The uniqueness of this study lies in the exploration of elastic fibers in dysplasia and well-differentiated OSCC, a less explored field. The study of the connective tissue stromal changes can be used as an adjunct to histological grading.

Rambam Maimonides Med J 2019;10(3):e0014