Oral Cytology Ravi Mehrotra Editor Oral Cytology A Concise Guide Editor Ravi Mehrotra, MD, PhD, MIAC, FRCPath Institute of Cytology and Preventive Oncology (ICPO) Noida - 201301, Uttar Pradesh, India ISBN 978-1-4614-5220-1 ISBN 978-1-4614-5221-8 (eBook) DOI 10.1007/978-1-4614-5221-8 Springer New York Heidelberg Dordrecht London Library of Congress Control Number: 2012951676 © Springer Science+Business Media New York 2013 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, speci fi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on micro fi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied speci fi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher’s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a speci fi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Foreword Oral cancer is a major public health problem all over the world but particularly in the Indian subcontinent. With well-known risk factors—tobacco and alcohol—and the potential for screening, effective measures for prevention and control are warranted. Cytological examination is a well-established and effective method of screening for cervical cancer, and signi fi cant gains have been made in the control of this form of cancer by the routine use of exfoliative cytology. Application of cytology in the oral cavity is not common but it could be used for screening of patients with suspi- cious premalignant and malignant conditions of the oral cavity. Hence this mono- graph, designed to provide a state-of-the-art review of the major issues speci fi c to the fi eld of oral cytology, is very timely . This book provides a comprehensive review of all aspects of oral cytology including sample collection, manual/automated anal- ysis, pitfalls, gray zones, and controversies in diagnosis. Ancillary techniques such as DNA ploidy, molecular biology, and biomarkers are also discussed. The book is extensively illustrated with excellent cytological images. This book will fi ll a critical need for reliable knowledge on oral cytology and will be useful for pathologists currently in training as well as pathologists and clinicians dealing with the diagnosis of oral lesions. The editors and authors are to be com- mended for this effort, since it fi lls an important gap in our current knowledge. Chicago , IL , USA Vinay Kumar Donald N. Pritzker Professor and Chairman Department of Pathology, Biologic Sciences Division and the Pritzker School of Medicine University of Chicago v Acknowledgements The goal of this book is to form a blend between new and existing information about oral cytopathology. It will hopefully serve as a bench-side companion to the general cytopathologist, oral pathologist, specialist in oral medicine, and head and neck experts. This compendium is a combined effort from authors of different specialties including cytopathologists, oral pathologists, and basic scientists—all of whom have in common an interest in the diagnosis of oral cancer. Experts from four differ- ent continents viz. Asia, Africa, Europe, and the Americas have contributed their vast knowledge and experiences in this fi eld. Acknowledgments are due to my source of inspiration my beloved; my wife, Deepa Mehrotra, my children, Aditi, Shayak and Vinayak; and my well-wishers, especially my teachers/mentors, Drs. Mamta Singh and Premala A. Singh, Allahabad. They are also due to my colleagues, Drs. Vatsala Misra, Kachnar Verma, Vishal Dhingra, Pallavi Singh, and Anshul Singh of the Department of Pathology, Moti Lal Nehru Medical College, Allahabad; Dr. R. Khanna, Allahabad; Drs. V.L. Lahiri and Atul Gupta, Agra; Drs. Raj Mehrotra and M.M. Goel, Lucknow; Col. S.K.P. Matwanakar, Pune; Dr. Maqsood Siddiqi, Kolkatta; Dr. Bernard Fitzharris, Christchurch; Dr. Raj K. Gupta, Wellington, New Zealand; Dr. Svante Orell, Adelaide, Australia; Dr. Bernard Fox, Portland; Dr. Raj Puri, Bethesda; Dr. Vinod B. Shidham, Detroit; Dr. Prabodh Gupta, Philadelphia; Dr. Carlos Bedrossian, Chicago; Dr. Kamlesh Asotra, California; Dr. Rajesh Sharan, Shillong; my numer- ous MD and Ph.D students around the world including Madhu, Neeta, Anurag, Mayank, Sanjay, Smita, Santosh, Shruti, Ajay, and Rahela; and, of course, the great- est teacher any doctor can possibly have—my patients. vii viii Acknowledgements I have special word of thanks to Prof. Vinay Kumar, Chicago Editor-in Chief, Robbins Pathologic Basis of Disease (which provided my fi rst introduction to this fascinating fi eld and help motivate me to embark on this journey) for kindly agree- ing to write the preface. This book is dedicated to my respected mother, Raj Rani Mehrotra and to the fond memory of my father Prof. T.N. Mehrotra, MD, Ph.D. Founder Professor of Pathology and Principal, Moti Lal Nehru Medical College, Allahabad, without whose inspiration and constant guidance, this book would never have seen the light of the day. Finally, grateful thanks are due to the ever-helpful and dynamic team at Springer, especially Richard Hruska, Senior Editor, Clinical Medicine, William Loob, Development Editor, Andy Kwan, Assistant Editor and Maria Luz Calibo, Project Offi cer without whose support, this monograph would never have seen the light of the day. Noida , UP , India Ravi Mehrotra, MD, PhD, MIAC, FRCPath Contents 1 Introduction ............................................................................................. 1 Ravi Mehrotra 2 Historical Development of Oral Cytology ............................................. 5 Vishal Dhingra and Ravi Mehrotra 3 Oral Cytology Techniques ...................................................................... 11 Kachnar Varma, Jos Hille, Amir Afrogheh, and Ravi Mehrotra 4 Diagnosis of Infectious Diseases by Oral Cytology .............................. 27 Mamta Singh, Rahela Ibrahim, and Ravi Mehrotra 5 Cytological Diagnosis of Benign Lesions of the Oral Cavity............... 49 Deborah J. Carroll 6 The Development of a Novel Oral Cytologic Grading System ........... 73 Amir Afrogheh, Jos Hille, and Ravi Mehrotra 7 Liquid-Based Oral Cytology and Microhistology ................................ 91 Roberto Navone, Monica Pentenero, and Sergio Gandolfo 8 The Role of Ploidy Analysis in Oral Cytology ...................................... 109 Torsten W. Remmerbach 9 Diagnostic Cytometry ............................................................................. 125 Alfred Böcking, David Friedrich, Chen Jin, André Bell, Thomas Wür fl inger, Dietrich Meyer-Ebrecht, Yu Zhang, Stefan Biesterfeld, Natalia Pomjanski, Leonid Berynskyy, Richard Yeung, Jörg Handschel, Branko Palcic, and Til Aach ix