|Year : 2013 | Volume
| Issue : 3 | Page : 199-202
Pattern of oral cavity lesions in a tertiary care hospital in Manipur, India
Dilem Modi, Rajesh Singh Laishram, Laimayum Durlav Chandra Sharma, Kaushik Debnath
Department of Pathology, Regional Institute of Medical Sciences, Imphal, Manipur, India
|Date of Web Publication||19-Feb-2014|
Rajesh Singh Laishram
Department of Pathology, Regional Institute of Medical Sciences, Imphal-795 004, Manipur
Source of Support: None, Conflict of Interest: None
Objective: To study the pattern of various oral cavity lesions in a tertiary care hospital in Manipur, India. Materials and Methods: This is a 5 year retrospective study from January 2006 to December 2011. All the oral cavity specimens received in the Department of Pathology, Regional Institute of Medical Sciences (RIMS) during the study period was included for the study. Data such as age, sex, and site of the lesion was collected and restaining of the slides with hematoxylin and eosin (H and E) was performed whenever required. Data's collected were analyzed. Results: A total of 119 cases was analyzed during the study period. Age ranged from 3 to 90 years in the study. Overall females were affected more than the male with male:female (M:F) ratio of 1:1.5. Buccal mucosa (26.9%) was the commonest site involved followed by tongue (26%). Neoplastic lesions accounted for 61.4% cases and nonneoplastic accounted for 38.6% cases. Among the neoplastic lesion, squamous cell carcinoma (SCC) was seen in 82% cases; verrucous carcinoma and ameloblastic carcinoma in 5.1% cases each; and mucoepidermoid carcinoma, adenosquamous carcinoma, and small cell carcinoma in 2.6% cases each. Most of the neoplastic lesions were located in the tongue (30.8%), followed by buccal mucosa (28.2%), alveolus (5.1%), floor of mouth (10.3%), and palate and lips (12.8%) each. The M:F ratio of the neoplastic lesion was 1:1.2. Chronic inflammatory lesions accounted for the maximum number of nonneoplastic lesions (26.1%), followed by fibrosis (23.9%), and fibrous hyperplasia and cystic changes, 17.4% each. Epulis accounted for 10.8% and ranula and hamartoma accounting for 2.2% each. The commonest site of involvement was gingiva and buccal mucosa with 32.6% each. Conclusion: A variety of lesions were encountered in the study with predominance of malignant lesions. SCC was the commonest malignant lesion. A larger epidemiopathological study in this region needs to be carried out.
Keywords: Ameloblastic carcinoma, Buccal mucosa, Epulis, Malignancy, Mucoepidermoid carcinoma, Oral cavity lesions
|How to cite this article:|
Modi D, Laishram RS, Sharma LD, Debnath K. Pattern of oral cavity lesions in a tertiary care hospital in Manipur, India. J Med Soc 2013;27:199-202
|How to cite this URL:|
Modi D, Laishram RS, Sharma LD, Debnath K. Pattern of oral cavity lesions in a tertiary care hospital in Manipur, India. J Med Soc [serial online] 2013 [cited 2020 Oct 30];27:199-202. Available from: https://www.jmedsoc.org/text.asp?2013/27/3/199/127393
| Introduction|| |
The state of Manipur ranks 5 th in consumption of tobacco among all the states of India According to the Global Adults Tobacco Survey (GATS) Factsheet of Manipur, 2009-2010 which was released recently at Imphal, 54% of the total population in Manipur (66.6% men and 41.8% women) are using tobacco products in general, while 44% of the population is into smokeless or chewing tobacco products like Gutka, Khaini, Zarda, etc., which are responsible for the high incidence of oral cancer cases in this tiny hilly state. It is said that about 930-950 new cases of cancer are reported annually in Manipur, out of which about 390 are tobacco related cases. That accounts to 34% of the total cancer cases in the state.  Globally, incidence rates for oral cancer vary in men from 1 to 10 cases per 100,000 population in many countries. In south-central Asia, cancer of the oral cavity ranks among the three most common types of cancer. In India, the age standardized incidence rate of oral cancer is 12.6 per 100,000 population. According to the World Health Report 2004, cancer accounted for 7.1 million deaths in 2003. 
Alterations of the tissues of the oral cavity can manifest in a great variety of ways. The clinical manifestations of many diseases of the oral cavity can be similar to the oral manifestations of certain systemic disorders; thus often making it difficult to establish a correct clinical diagnosis. In some cases, early-stage malignant lesions can be mistaken for benign lesions. This in turn can lead to incorrect treatment, and thus to potentially fatal consequences for the patient.  Proper management of a patient with an oral lesion starts with an accurate diagnosis. There are lesions whose diagnosis can be made verifying on data gathered during the history and/or physical examination while there are others which need further confirmation through specialized procedures. Among the various methods available for diagnosing oral lesions, the histopathological examination of a tissue biopsy of the suspicious lesion is regarded as the 'Gold Standard'. 
It is essential to establish an accurate diagnosis to initiate optimal therapy for oral cavity lesions. An adequate incision biopsy taken from an area representative of the lesion can provide over 98% diagnostic accuracy as to whether the lesion is malignant or not, when routine pathological techniques are used.  Most oropharyngeal cancers in India present in advanced stages of malignancy.
Retrospective studies to assess the distribution of oromucosal lesions are helpful and important in estimating the prevalence of a disease in the population and thus identifying high risk subpopulation and help in preventive and curative services. Different sites in oral cavity show predilection for different types of lesions.  Carcinomas are common in buccal mucosa, mucoceles are more commonly seen on lower lip, while minor salivary gland tumors are seen most commonly on upper lip.  Knowledge of site predilection for different diseases will be useful in acknowledging the factors responsible for the same. 
The present retrospective study was carried out to assess the patterns of various oral cavity lesions among already existing data of 119 patients whose biopsy specimens were received in the department of pathology at Regional Institute of Medical Sciences (RIMS), Imphal during a period of 5 years (2006-2011).
| Materials and Methods|| |
This is was a 5 year retrospective study carried out from January 2006-December 2011. All the oral cavity specimens received in the Department of Pathology, RIMS during the study period was included for the study. Data such as age, sex, and site of the lesion was collected and restaining of the slides with hematoxylin and eosin (H and E) was performed whenever required. Data collected were analyzed.
| Results|| |
A total of 119 cases were analyzed during the study period. Age [Table 1] ranged from 3 to 90 years in the study of which 47 (39.5%) were males and 72 (60.5%) were females with an male:female (M:F) ratio of 1:1.5. Youngest was a 3-year-old female child diagnosed with chronic inflammatory lesion and the oldest a 90-year-old female diagnosed with squamous cell carcinoma (SCC). In the neoplastic lesions [Table 2] the age ranged from 30 to 90 years. Most of the carcinomas were seen between 41 and 70 years (82.1%).
As occupation and habits of the patients was not mentioned in the biopsy reports, it was not included in our study.
Of all the biopsy specimens taken sites [Table 3], buccal mucosa with 32 (26.9%) cases was the commonest site of involvement followed by tongue 31 (26%) cases, gingiva was involved in 25 (21%) cases, palate in 13 (10.9%), and lips accounted for 10 (8.4%) cases, and alveolus and floor of mouth saw four (3.4%) cases each. SCC mostly involved the base of tongue (66.7%). Among the benign lesions gingival was involved in 10 (29.5%), tongue nine (26.5%), palate and mucosa six (17.6%) each, and lip three (8.8%). Of the inflammatory lesions, mucosa and gingival were equally affected (32.6% each), tongue 21.7%, and alveolus 4.4%.
Neoplastic lesions accounted for 61.4% cases and nonneoplastic accounted for 38.6% cases. Among the neoplastic lesion, males were more affected than the females, benign lesions accounted for 46.6% of cases and malignant lesions accounted for 53.4% cases with a M:F ratio of 1.2:1. Among the benign lesions, granuloma pyogenicum was seen in 47% cases, papilloma in 26.5%, hemangioma in 23.5% and pleomorphic adenoma in 3% of the cases. Chronic inflammatory lesions accounted for the maximum number of nonneoplastic lesions (26.1%), followed by fibrosis (23.9%), and fibrous hyperplasia and cystic changes (17.4% each). Epulis accounted for 10.8% and ranula and hamartoma accounting for 2.2% each [Table 4].
Of the total 39 (53.4%) malignant lesions, SCC was seen in 82% cases, verrucous carcinoma and ameloblastic carcinoma in 5.1% cases each, mucoepidermoid carcinoma, adenosquamous carcinoma and small cell carcinoma in 2.6% cases each. Males were more affected than the females with a M:F ratio of 1.2:1. [Table 5].
| Discussion|| |
This retrospective study was done for assessment and distribution of oral cavity lesions among the biopsy specimens. The study was carried out by reassessing all the slides received and by restaining slides whenever required. The importance was given for the specimens rather than the individual as the study was done on the received specimens that were sent from the Department of Surgery and Ear, Nose, and Throat (ENT) of this institute to Pathology Department, RIMS for the study period.
There were a total of 119 case of various oral cavity lesion received during the study period. In the present study, more number of female subjects were suffering from oromucosal lesions as compared to males which was similar to that reported by Claudia et al.  It could be due to the increasing prevalence of deleterious oral habits among females than males in the state of Manipur. But the neoplastic lesions were more common in males than females with a M:F ratio of 1.2:1, similar to the findings of Iype et al.  This could be attributable to more unhygienic oral habits by males. Interestingly, there was no biopsy specimen received for white lesions like leukoplakia.
Regarding the site for the development of oromucosal lesions, the main site reported in this study was buccal mucosa which was similar as that reported by Wahi et al.  This indicates more prevalence of habits like pan-chewing, khaini, etc. The most common site of carcinoma was tongue reported in this study similar to findings by Mirbong and Ahing  who reported the posterior ventrolateral border of the tongue to be the commonest site. Percentage of subjects who had cysts of soft tissues like mucocele in the study were comparable to the study done by Mathew et al. 
As expected, there were only eight cases below 20 years of age, most of which were inflammatory lesion, a finding similar to Claudia et al.,  and others could be due to congenital and developmental abnormalities.
It has been found that oromucosal lesions had high prevalence in the age group of 40-70 years (52.9%), but Saraswati et al.,  observed this age group to be between 40 and 61 years. This could be attributed to their long-standing oral habits. Soft tissue lesions and potentially malignant disorders were the most common finding in the study subjects which correlated with other studies. There was also marked age-related increase in oral cancer in the study which was same as that reported by Malaovalla et al.  But two cases of SCC reported in our study in the age group of 21-30 years, reflects an increased in incidence of this tumor in younger age groups as reported by Lund.  This could be attributable to early development of oral habits and easy availability of tobacco and other products in the state.
The most common finding in this study was benign and nonneoplastic soft tissue lesions (67.3%) presenting as fibroma, pyogenic grauloma, chronic inflammatory lesions, etc. Pyogenic granuloma (13.5%) was the commonest benign lesion, much higher than the 7.6% findings of Riaz and Warriach.  Among men, potentially malignant disorders and carcinomas were more prevalent as compared to other soft tissue lesions, whereas among women soft tissue tumors and infections were more prevalent.
Out of the 119 cases neoplastic lesions (61.4%) accounted for the maximum number of cases. Mehrotra et al.,  found nonneoplastic lesions more.
The observed overall SCC prevalence of 26.9% is much higher than the observed 7.8% by Gambhir et al.,  but 82% prevalence of the malignancy is similar to the 90% prevalence reported by Riaz and Warriach  and is quiet similar to overall incidence of 80% SCC detected in the aerodigestive tract as reported by Lund. 
We are of the opinion that individual demographic details such as age, gender, occupation, food habits, other deleterious oral habits, religion, and oral hygiene measures should have a provision in biopsy request sheet and should be duly filled which will help in identifying risk groups.
| References|| |
|1.||Global Adult Tobacco Survey Gates, Manipur Factsheet: 2009-10. Available from: http://www.manipur.org/news/2013/01/31/manipur-in-5th-position-in-tobacco-usage-in-india [Last accessed on 2013 Mar 3]. |
|2.||Petersen PE. Strenghtening the prevention of oral cancer: The WHO perspective. Community Dent Oral Epidemiol 2005;33:397-9. |
|3.||Satorres Nieto M, Faura Solé M, Brescó Salinas M, Berini Aytés L, Gay Escoda C. Prevalence of oral lesions biopsied in a Department of Oral Surgery. Med Oral Patol Oral Cir Buc 2001;6:296-305. |
|4.||Malaovalla AM, Silverman S, Mani NJ, Bilimoria KF, Smith LW. Oral cancer in 57,518 industrial workers of Gujarat, India: A prevalence and follow-up study. Cancer 1976;37:1882-6. |
|5.||Misra V, Singh PA, Lal N, Agarwal P, Singh M. Changing pattern of oral cavity lesions and personal habits over a decade: Hospital based record analysis from Allahabad. Indian J Community Med 2009;34:321-5. |
|6.||Rooban T, Rao A, Joshua E, Ranganathan K. The prevalence of oral mucosal lesions in alcohol misusers in Chennai, south India. Indian J Dent Res 2009;20:41-6. |
|7.||Mikkonen M, Nyyssönen V, Paunio I, Rajala M. Prevalence of oral mucosal lesions associated with wearing removable dentures in Finnish adults. Community Dent Oral Epidemiol 1984;12:191-4. |
|8.||Vasconcelos BC, Novaes M, Sandrini FA, Maranhão Filho AW, Coimbra LS. Prevalence of oral mucosa lesions in diabetic patients: A preliminary study. Braz J Otorhinolaryngol 2008;74:423-8. |
|9.||Claudia F G, Marqués NA, Berini-Aytés L, Gay-Escoda C. Prevalence of biopsied oral lesions in a Department of Oral Surgery 2007-2009). J Clin Exp Dent 2011;3:e73-7. |
|10.||Iype EM, Pandey M, Mathew A, Thomas G, Sebastian P, Nair MK. Oral cancer among patients under the age of 35 years. J Postgrad Med 1995;47:171-6. |
|11.||Wahi PN, Kapur VL, Luthra UK, Srivastava MC. Submucous fibrosis of the oral cavity: 2: Studies on epidemiological. Bull World Health Organ 1966;35:793-9. |
|12.||Mirbod SM, Ahing SI. Tobacco-associated lesions of the oral cavity: Part II. Malignant lesions. J Can Dent Assoc 2000;66:308-11. |
|13.||Mathew AA, Pai KM, Sholapurkar AA, Vengal M. The prevalence of oral mucosal lesions in patients visiting a dental school southern india. Indian J Dent Res 2008;19:99-103. |
|14.||Saraswati TR, Ranganathan K, Shanmugam S, Ramesh S, Narasimhan PD, Gunaseelan R. Prevalence of oral lesions in relation to habits: Cross-sectional study in south India. Indian J Dent Res 2006;17:121-5. |
|15.||Lund VJ. Malignancy of the nose and sinuses: Epidemiological and aetiological considerations. Rhinology 1991;29:57-68. |
|16.||Riaz N, Warriach RA. Tumors and tumor - like lesions of the oro - facial region at Mayo Hospital, Lahore - A 54 study. Annals 2011;17:123-9. |
|17.||Mehrotra R, Pandya S, Chaudhary AK, Kumar M, Singh M. Prevalence of oral pre-malignant and malignant lesions at a tertiary level Hospital in Allahabad, India. Asian Pacific J Cancer Prev 2008;9:263-6. |
|18.||Gambhir RS, Veeresha KL, Sohi R, Kakkar H, Aggarwal A, Gupta D. The prevalence of oral mucosal lesions in the patients visiting a dental school in Northern India in relation to sex, site and distribution: A retrospective study. J Clin Exp Dent 2011;3:e10-7. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]