Exotic Keratin Pearl Degradation Mechanism by Giant Cells in Oral Squamous Cell Carcinoma and its Plausible Hypothesis.

Introduction: Oral squamous cell carcinoma (OSCC) is a formidable malignancy in the Indian subcontinent, characterized by high morbidity and mortality, with a dismal 5-year survival rate of 40-50%. The tumor's histopathological heterogeneity is well documented, particularly in its differentiation status, which ranges from well-differentiated lesions with prominent keratin pearls to poorly differentiated forms lacking such structures.

Objectives: Existing literature has elucidated the role of neutrophils and macrophages in the degradation of keratin pearls, the involvement of multinucleated giant cells (MNGCs) in this process remains cryptic.

Case report: This study reports a novel case of a 49-year-old male with moderately differentiated OSCC, characterized by ulcerative growth in the left buccal mucosa. Histopathological analysis revealed neoplastic cell infiltration, keratinization, and abnormal mitoses, alongside the degradation of keratin pearls by large foreign body and Langhans MNGCs. This intricate keratin pearl degradation by MNGCs in OSCC highlights tumor heterogeneity and aggressiveness, offering profound insights into surgical, radiotherapy, and chemotherapy strategies. Surgeons must meticulously consider this process as a marker of aggressive behavior, warranting precise surgical planning and a multidisciplinary approach for optimal outcomes.

Conclusion: This case emphasizes the critical role of foreign body and Langhans MNGCs in the degradation of keratin pearls within OSCC, revealing a hitherto unrecognized facet of tumor biology. This discovery holds profound implications for understanding OSCC progression, prognosis, and therapeutic responsiveness, warranting further investigation into the molecular mechanisms underpinning this process.