Morphometric analysis of the mucosal vasculature in oral submucous fibrosis and its comparison with oral squamous cell carcinoma

Oral submucous fibrosis (OSMF) is a chronic fibrotic disorder in which the degree of vascularity has always been a matter of dispute; however, morphological studies of the blood vessels in OSMF have been sparse. This study was performed to assess the mucosal vasculature in normal oral mucosa, early and advanced OSMF, and well differentiated squamous cell carcinoma (WDSCC) using morphometry. The study included histologically diagnosed cases of early (n = 30) and advanced (n = 30) OSMF, and WDSCC (n = 30), with normal oral mucosa (n = 10) as a control. Morphometric image analysis of blood vessels was performed on H&E-stained sections for evaluation of vascular density, vascular luminal diameter, area and percentage area. A significant increase in all of the parameters was noted in the test groups relative to the controls. The mean vascular density and mean vascular percentage area were significantly increased in early OSMF and WDSCC relative to controls, and also in advanced OSMF and WDSCC in comparison with early OSMF. The vascularity increased progressively from normal to premalignancy and malignancy, emphasizing the importance of angiogenesis in tumor development and progression. The vascularity was increased in early OSMF and reduced in advanced OSMF, suggesting that inflammation may play a role in the early stages while progressive fibrosis may predispose to atrophy of the epithelium and subsequent malignant changes.