• Zumrud Momin Department of Pathology, Mekran Medical College, Turbat-Pakistan
  • Noshaba Rahat Department of Basic Medical Sciences Institute, Jinnah Postgraduate Medical Center Karachi-Pakistan
  • Humera Shahzad Department of Basic Medical Sciences Institute, Jinnah Postgraduate Medical Center Karachi-Pakistan
  • Marvi Umair Department of Pathology, Sir Syed College of Medical Sciences Trust, Karachi-Pakistan
  • Raima Kaleemi Department of Radiology, Jinnah Postgraduate Medical Center Karachi-Pakistan
  • Asma Khursheed Sindh Blood Transfusion Authority, Karachi-Pakistan



CD44 ,Oral potentially malignant disorder, Squamous cell carcinoma


Background: Oral cavity cancer is one of the most widespread head and neck cancers in the world. 90 percent of oral cavity cancers are squamous cell carcinoma (SCC). Oral Potentially Malignant Disorder (OPMD), are well known to develop into squamous cell carcinoma. CD44 is a glycoprotein present on the cell surface and plays a vital role in cancer cell invasion, migration, metastasis of cancers and prognosis. The present study aims to detect the frequency of CD44 immunomarker expression in epithelial dysplasia and squamous cell carcinoma samples and correlates the expression with histologic grades of this lesion. Methods: cross sectional study at the Department of Pathology, BMSI, JPMC, Karachi between 01-01-2018 to 31-12-2021. 95 patients diagnosed on morphological characterization of the lesion as squamous cell carcinoma/dysplasia were selected by using non-probability purposive sampling technique, among them 41 were diagnosed as epithelial dysplasia and 54 as SCC and were subjected to immunohistochemistry. Results: A total of 95 cases were selected. The mean age was 49.32 years. The majority of cases were seen in 4th and 5th decades. 69 (72.6%) were males and 26 (27.4%) were females with male to female ratio 2.65:1. The closest site was buccal mucosa 75(78.9%). Among 41 cases of dysplasia, 36 showed membranous positivity for CD44 (87.8%), and 45 showed positive membranous CD44 immunoreactivity (83.3%) among 54 cases of squamous cell carcinoma. Conclusion:  Increased frequency of CD44 expression was found with increasing grades of dysplasia and squamous cell carcinoma, which may be a possible indicator of malignant transformation and can serve as a prognostic biomarker for oral SCC.

Author Biographies

Zumrud Momin, Department of Pathology, Mekran Medical College, Turbat-Pakistan


Noshaba Rahat, Department of Basic Medical Sciences Institute, Jinnah Postgraduate Medical Center Karachi-Pakistan


Humera Shahzad, Department of Basic Medical Sciences Institute, Jinnah Postgraduate Medical Center Karachi-Pakistan


Marvi Umair, Department of Pathology, Sir Syed College of Medical Sciences Trust, Karachi-Pakistan


Raima Kaleemi, Department of Radiology, Jinnah Postgraduate Medical Center Karachi-Pakistan


Asma Khursheed, Sindh Blood Transfusion Authority, Karachi-Pakistan



Anwar N, Pervez S, Chundriger Q, Awan S, Moatter T, Ali TS. Oral cancer: Clinicopathological features and associated risk factors in a high risk population presenting to a major tertiary care center in Pakistan. PLoS One 2020;15(8):e0236359.

Su YF, Chen YJ, Tsai FT, Li WC, Hsu ML, Wang DH, et al. Current insights into oral cancer diagnostics. Diagnostics (Basel) 2021;11(7):1287.

International Agency for Research on Cancer. Pakistan. The Global Cancer Observatory. [Internet]. (2021c, March). [cited 2023 March]. Available from: stan-fact- sheets.pdf

Sakurai K, Tomihara K, Yamazaki M, Heshiki W, Moniruzzaman R, Sekido K, et al. CD36 expression on oral squamous cell carcinoma cells correlates with enhanced proliferation and migratory activity. Oral Dis 2020;26(4):745–55.

Coletta RD, Yeudall WA, Salo T. Grand challenges in oral cancers. Fron Oral Health 2020;1:3.

Jaber MA, Elameen EM. Long-term follow-up of oral epithelial dysplasia: A hospital based cross-sectional study. J Dent Sci 2021;16(1):304–10.

Bavle RM, Paremala K, Soumya M, Reshma V, Sudhakara M. Immunohistochemical expression of p63 in oral premalignant disorders and its correlation with oral squamous cell carcinoma. J Datta Meghe Inst Med Sci Univ 2020;15(2):255.

Borse V, Konwar AN, Buragohain P. Oral cancer diagnosis and perspectives in India. Sens Int 2020;1:100046.

Ghazi N, Saghravanian N, Ghazi A, Shakeri MT, Khajehbahrami H. CD44 expression in dysplastic and non-dysplastic oral lichen planus. Int J Cancer Manag 2020;13(1)e98061.

Xu H, Niu M, Yuan X, Wu K, Liu A. CD44 as a tumor biomarker and therapeutic target. Exp Hematol Oncol 2020;9(1):1–4.

Saghravanian N, Anvari K, Ghazi N, Memar B, Shahsavari M, Aghaee MA. Expression of p63 and CD44 in oral squamous cell carcinoma and correlation with clinicopathological parameters. Arch Oral Biol 2017;82:160–5.

Chen C, Zhao S, Karnad A, Freeman JW. The biology and role of CD44 in cancer progression: therapeutic implications. J Hematol Oncol 2018;11(1):64.

Wang YY, Vadhan A, Chen PH, Lee YL, Chao CY, Cheng KH, et al. Cd44 promotes lung cancer cell metastasis through erk–zeb1 signaling. Cancers 2021;13(16):4057.

Ranganathan K, Kavitha L. Oral epithelial dysplasia: Classifications and clinical relevance in risk assessment of oral potentially malignant disorders. J Oral Maxillofac Pathol 2019;23(1):19.

Yousaf A, Mahmood S, Faraz R, Quader Q. Annual cancer registry report-2018, of the Shaukat Khanum Memorial Cancer Hospital & Research Center, Pakistan. 2018; p.1–28.

Singh S, Singh J, Chandra S, Samadi FM. Prevalence of oral cancer and oral epithelial dysplasia among North Indian population: A retrospective institutional study. J Oral Maxillofac Pathol 2020;24(1):87.

Barma P, Khalil I, Yeasmin T. Rural profile of oral squamous cell carcinoma (OSCC) survival patients attending in tertiary level hospital in Bogura: a hospital based retrospective observational study. Update Dent Coll J 2020;10(1):3–5.

Siriwardena BS, Karunathilaka HD, Kumarasiri PV, Tilakaratne WM. Impact of histological and molecular parameters on prognosis of oral squamous cell carcinoma: analysis of 290 cases. Biomed Res Int 2020;2020:2059240.

Dzudzilo M, Kleina R, Čēma I, Dabuzinskiene A, Svirskis Š. Expression and localisation of cd44 antigen as a prognostic factor of oral leukoplakia. InProceedings of the Latvian Academy of Sciences. Section B. Nat Exact Appl Sci 2021;75(2):68–74.

Pervez S, Jabbar AA, Haider G, Ashraf S, Qureshi MA, Lateef F, et al. Karachi cancer registry (KCR): Age-Standardized incidence rate by age-group and gender in a Mega city of Pakistan. Asian Pac J Cancer Prev 2020;21(11):3251–8.

Costa AM, Pontes FS, Souza LL, Lopes MA, Santos-Silva AR, Vargas PA, et al. What is the frequency of floor of the mouth lesions? A descritive study of 4,016 cases. Med Oral Patol Oral Cir Bucal 2021;26(6):e738.

Lin NC, Hsien SI, Hsu JT, Chen MY. Impact on patients with oral squamous cell carcinoma in different anatomical subsites: a single-center study in Taiwan. Sci Rep 2021;11(1):1–9.

Ghazi N, Saghravanian N, Shakeri MT, Jamali M. Evaluation of CD44 and TGF-B expression in oral carcinogenesis. J Dent 2021;22(1):33.

Khamis AK, Fouad HA, Raslan HS, Fata MM, Fayad AI. Diagnostic and prognostic value of cancer stem cell marker CD44 and soluble CD44 in the peripheral Blood of patients with oral Squamous cell carcinoma. Open Sci J 2017;2(3):2–23.

Boxberg M, Götz C, Haidari S, Dorfner C, Jesinghaus M, Drecoll E, et al. Immunohistochemical expression of CD44 in oral squamous cell carcinoma in relation to histomorphological parameters and clinicopathological factors. Histopathology 2018;73(4):559–72.

Kaza S, Kantheti LP, Poosarla C, Gontu SR, Kattappagari KK, Baddam VR. A study on the expression of CD44 adhesion molecule in oral squamous cell carcinoma and its correlation with tumor histological grading. J Orofac Sci 2018;10(1):42–9.

Takei J, Kaneko MK, Ohishi T, Hosono H, Nakamura T, Yanaka M, et al. A defucosylated anti CD44 monoclonal antibody 5 mG2a f exerts antitumor effects in mouse xenograft models of oral squamous cell carcinoma. Oncol Rep 2020;44(5):1949–60.

Additional Files