Epithelial Dysplasia — MFDS Part 1 MCQ

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HardOral PathologyEpithelial DysplasiaMFDS Part 1

A biopsy from an oral white patch shows architectural and cytological atypia. Which histological finding would preclude classification as oral epithelial dysplasia alone and instead establish invasive squamous cell carcinoma?

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Correct answer: C — Basement-membrane breach by atypical epithelial cells

The correct answer is C. Oral epithelial dysplasia comprises architectural disturbance and cytological atypia while the abnormal epithelial cells remain non-invasive. Breach of the basement membrane by atypical epithelial cells, with invasion into the underlying connective tissue, establishes squamous cell carcinoma rather than dysplasia alone. Drop-shaped rete ridges are an architectural dysplastic feature. Nuclear hyperchromatism and an increased nuclear-to-cytoplasmic ratio are cytological abnormalities reflecting atypical nuclear enlargement and altered maturation. Atypical mitotic figures are also recognised evidence of dysregulated epithelial proliferation. The original surface-keratinisation option was unsuitable because hyperkeratosis and altered keratinisation patterns can accompany oral epithelial dysplasia, particularly differentiated or verrucous patterns, although keratosis alone does not prove dysplasia.

Reference: Rekha R et al. Clinico-Pathological Assessment and Malignant Transformation in Patients with Oral Epithelial Dysplasia: A Follow-up Cohort Study. 2025. https://pubmed.ncbi.nlm.nih.gov/32939744/