Evaluation of the presence of myofibroblasts and matrix metalloproteinase 1 expression in the stroma of oral verrucous hyperplasia and verrucous carcinoma

Indian J Pathol Microbiol. 2020 Jul-Sep;63(3):369-375. doi: 10.4103/IJPM.IJPM_548_19.


Background: Oral verrucous carcinoma is a low-grade subtype of oral squamous cell carcinoma that should be differentiated from oral verrucous hyperplasia, a premalignant lesion. Stromal activated myofibroblasts known as cancer-associated fibroblasts have an active role in the initiation and progression of the cancers via secretion of different molecules including matrix metalloproteinases.

Aims: This study is designed to understand the differences in the presence of myofibroblasts and expression of matrix metalloproteinase-1 in the adjacent stroma of verrucous carcinoma and oral verrucous hyperplasia (OVH).

Settings and design: Cross-sectional study.

Material and methods: Twenty-seven OVH, 19 oral verrucous carcinoma (OVC), and 8 cutaneous verrucous carcinoma (CVC) specimens were analyzed for immunohistochemical (IHC) expression of α-smooth muscle actin (αSMA) and MMP-1.

Results: IHC studies for αSMA expression in nonvascular stromal cells of the adjacent stroma revealed mild or no expression in 81.4%, 73.7%, and 62.5% of the cases of OVH, OVC, and CVC groups, respectively. No significant difference was seen in αSMA expression index between OVH and OVC groups (Adj. Sig. = 0.220) and between OVC and CVC groups (Adj. Sig. = 1.00). Pairwise analysis revealed a significant difference in MMP-1 expression index between the groups. No significant correlation was observed between MMP-1 expression index and αSMA expression index in OVH (pv = 0.358) and OVC (pv = 0.388) groups.

Conclusion: The differences in MMP-1 expression between OVH and OVC can be used as an adjunctive aid in challenging cases including disoriented or inadequate samples.

Keywords: Cancer-associated fibroblasts; matrix metalloproteinase-1; oral verrucous hyperplasia; smooth muscle actin; verrucous carcinoma.

MeSH terms

  • Aged
  • Biomarkers, Tumor / analysis
  • Carcinoma, Squamous Cell / genetics*
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Verrucous / diagnosis
  • Carcinoma, Verrucous / genetics*
  • Carcinoma, Verrucous / pathology
  • Cross-Sectional Studies
  • Female
  • Humans
  • Hyperplasia
  • Immunohistochemistry
  • Male
  • Matrix Metalloproteinase 1 / genetics*
  • Middle Aged
  • Mouth Mucosa / pathology
  • Myofibroblasts / pathology*
  • Paraffin Embedding


  • Biomarkers, Tumor
  • MMP1 protein, human
  • Matrix Metalloproteinase 1