Submucous fibrosis in non-betel nut chewing subjects

Six patients with the typical features of submucous fibrosis (SF) but without a history of betel nut chewing or an abnormal intake of chillies are described. All had palpable fibrous bands in their mouths and limited mouth opening as well as a variety of symptoms associated with SF. Biopsy specimens of the cheeks showed the classic features of SF, an atrophic epithelium and a very dense lamina propria. Also seen were hyperkeratosis, atypia and signet cell-like degeneration of the epithelium and chronic inflammation of the lamina propria. In 3 cases the fibrosis extended into the submucosa. As no reason for the disease could be demonstrated the question is asked whether people with a genetic predisposition can develop SF spontaneously.