Nuclear DNA in anaplastic thyroid carcinoma with a differentiated component

Fifteen cases of anaplastic thyroid carcinoma, including eight cases with a differentiated component, were studied by DNA analysis. All areas of anaplastic carcinoma showed an aneuploid DNA content. The eight cases of anaplastic carcinoma with differentiated component (two follicular carcinomas, two papillary carcinomas, one Hürthle cell carcinoma and three poorly differentiated carcinomas) exhibited aneuploid DNA content in the differentiated area of the tumour. Karyometric parameters allowed a fairly clear separation between giant cell, spindle cell and differentiated components. The results support the hypothesis that patients with aneuploid differentiated carcinoma represent a higher risk group and are probably more prone to developing anaplastic carcinoma.     

The tall cell variant of papillary carcinoma of the thyroid gland. Comparison with the common form of papillary carcinoma by DNA and morphometric analysis

The tall cell variant of papillary carcinoma of the thyroid manifests a more aggressive behavior than the usual form of papillary carcinoma of the thyroid. Morphometric analysis of nuclear features and DNA analysis may yield information predictive of aggressive behavior. Accordingly, the DNA content and morphometric features of the neoplastic cells of the tall cell variant were measured and compared with measurements obtained from neoplastic cells of the usual form of papillary carcinoma. Six of the 11 tall cell neoplasms were aneuploid, as were four of the eight usual papillary neoplasms. Although benign cells were separated from malignant cells in each case, differences between tall and usual papillary carcinoma cells were not observed regarding DNA content, chromatin texture, or nuclear size and shape. Differences in the clinical behavior of these neoplasms will likely need to be explained on the basis of other characteristics.     

Squamous papillary neoplasia of the adult upper aerodigestive tract

Selected papillary squamous tumors of the upper aerodigestive tract (UADT) mucosa in adult patients do not have well-defined histologic criteria and the clinical behavior is poorly understood. To better characterize this spectrum of neoplasms, UADT papillary neoplasms were evaluated by routine histology, determination of cellular DNA content using Feulgen-stained tissue sections, and the typing of human papillomavirus (HPV) by in situ hybridization. Solitary papillomas were studied in two patients; there was no recurrence in either case, both had normal DNA content, and one was typed as HPV-6 while the other was typed as HPV-11. Seven adult patients with recurrent papillomatosis and at least one biopsy with dysplasia/atypia were identified (mean age at diagnosis, 13.3 years; mean age at last contact, 42.7 years). Six of seven patients had abnormal DNA cellular content in foci of epithelial atypia. In all biopsies evaluated, the papillomas of the seven patients were consistently typed as either HPV-6 or HPV-11. Six patients with malignant papillary neoplasms also had abnormal DNA cellular content, but none revealed evidence of HPV type 6, 11, 16, or 18 by in situ hybridization of tissue sections. In many of the recurrent papillomas, the degree of epithelial atypia encountered was pronounced and was commonly misdiagnosed as carcinoma in situ or papillary carcinoma. The aneuploid DNA content of these foci of atypia reflected the abnormal cellular appearance and partially explained the overdiagnosis of malignancy. However, none of the seven patients were treated for malignant disease and none progressed to invasive carcinoma, with an average follow-up period of almost 30 years. We conclude that histologic and cytologic atypia in HPV-containing papillomatosis may be appreciable. The aneuploid DNA content may represent premalignant conditions and the patient may be at an increased risk for the subsequent development of squamous cancer. However, none of the seven patients with recurrent papillomatosis developed any evidence of malignancy. In addition, none of the patients with papillary carcinomas had previous recurrent papillomatosis.     

Comparison of computerized analysis of nuclear DNA changes in uterine cervix dysplasia and in urothelial non-invasive papillary carcinoma

The nuclear DNA content was measured in preneoplastic lesions of the uterine cervix and in papillary carcinomas of the bladder. Three groups of features were calculated from the raw data: basic DNA, DNA deviation and DNA distribution. The basic DNA features, concerning both the cervix and the bladder, showed a progressive increase in the mean DNA content, a decrease in the percentage of diploid nuclei and steadily increasing values of polyploid and aneuploid nuclei. Among the DNA deviation features, the malignancy grade value was zero in the normal cervical epithelium and in the normal urothelium. An increase in this value was evident in moderate dysplasia and in urothelial papillary carcinoma of grade 2, the highest value being in CIS and in grade 3. Concerning the DNA distribution features, the values of the 15th and 95th percentiles and their difference were progressively higher both in the cervix and in the bladder, expressing a continuous shift and spread of the DNA content measurements in the different diagnostic categories, with respect to normal epithelium and urothelium. The statistical analysis showed that the strongest correlation is between 2c D.I. and % of polyploid nuclei in the cervix and between M.I. and % of aneuploid nuclei greater than 4c in the bladder. In the cervix the most discriminating feature is the Malignancy Grade, whereas in the bladder it is the percentage of diploid nuclei. The comparison between the results of the three groups of features showed that: 1) Mild dysplasia of the cervix and urothelial papillary carcinoma of grade 1 showed similar changes in DNA features. Both were basically characterized by increased proliferative activity.(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparison of nuclear DNA content in primary and metastatic differentiated thyroid carcinoma

Nuclear DNA content of 20 cases of primary differentiated thyroid carcinoma, 27 corresponding cervical lymph node metastases, and 2 local recurrent tumors was determined by flow cytometry. Evidence of DNA aneuploidy was found in either the primary tumor or in the corresponding metastases in 10 (63%) of the 16 papillary carcinomas, in all 3 follicular carcinomas, and in the case of medullary carcinoma studied. In all but one case, the aneuploid stemlines found in the regional metastases were also found in the primary or in the recurrent tumor. In four cases diploid metastatic tissue was found to originate from a tumor with DNA aneuploidy, and in three other cases two stemlines of tumor cells with different DNA indices could be shown in the primary tumor, further indicating clonal heterogeneity in differentiated thyroid carcinomas. None of the 11 patients with either diploid or aneuploid primary tumor with a DNA index less than 1.2 evaluated for 4-12 years died from thyroid cancer, whereas 5 of the 7 patients with primary tumor DNA index greater than 1.2 died from thyroid cancer (P less than 0.01).     

Flow cytometry of DNA in research on kidney tumors

The DNA content was studied in 22 patients (including 10 children) with renal tumours. Renal clear cell carcinomas were mainly diploid (5 of 6 cases); one clear cell and other variants of renal cell carcinoma were aneuploid. There was a correlation between the degree of tumour cell anaplasia and ploidy of renal cell carcinomas: all diploid carcinomas were of I and II degree of anaplasia, aneuploid carcinomas, except one case, were of degree III of anaplasia. 5 out of 9 nephroblastomas were diploid, 4, aneuploid. The distinctive features of nephroblastoma were pronounced proliferative activity of tumour cells and a low DNA index of the aneuploid cell line which in all cases was localized in the vicinity of the diploid region. The remaining tumours (papillary epithelial nephroma, juxtaglomerular cell tumour and malignant schwannoma) were diploid with a relatively low proliferative activity of tumour cells.     

Fetal adenomas and minimally invasive follicular carcinomas of the thyroid frequently display a triploid or near triploid DNA pattern

The ploidy pattern and the percentage of S-phase cells were investigated by means of flow cytometry using fresh or frozen samples in a series of 143 tumors and tumor-like lesions of the thyroid in an attempt to find whether there is any relationship between the histological characteristics of the lesions and their DNA content. The percentages of aneuploidy cases per category were: nodular goiter, 18.5% (15/81); fetal adenoma (including cases with trabecular/solid growth pattern), 58.3% (14/24); follicular adenoma other than fetal adenoma, 0% (0/18); papillary carcinoma, 11.1% (1/9); and minimally invasive follicular carcinoma, 57.1% (4/7). Regardless of the histological category, aneuploid lesions had a significantly higher (P < 0.001) percentage of S-phase cells (7.3%) than diploid lesions (4.1%). All the six cases with a DNA content within the triploid range were fetal adenomas, but one was a follicular carcinoma displaying a fetal adenoma-like growth pattern. The other three follicular carcinomas with an aneuploid DNA pattern also displayed foci of fetal adenoma-like growth pattern. Image cytometry of the four aneuploid follicular carcinomas showed similar DNA indexes in the peripheral, invasive foci of the lesions and in the central fetal adenoma-like areas. These results demonstrate that aneuploidy in benign tumors is restricted to adenomas displaying a fetal or fetal/embryonal growth pattern and support the concept that chromosome instability is a major pathway of tumorigenesis in thyroid follicular neoplasms.     

Supportive role of image analysis and DNA ploidy pattern in the diagnosis of thyroid tumors.

To evaluate the supportive role of image cytometry and DNA ploidy pattern in the diagnosis of thyroid tumors, a preliminary study was performed on fine needle aspirates of 30 cases. Of these, 10 cases each were of colloid goiter, follicular neoplasm, and papillary carcinoma. The nuclear area and DNA value of 50 cells in each case were measured. The mean nuclear area in colloid goiter (69.50 + 12.62 sq.microns) was significantly lower than the mean nuclear area in a follicular neoplasm (88.71 + 15.51 sq.microns) (P less than 0.05). Similar differences between the mean nuclear area in colloid goiter and papillary carcinoma (124.0 + 12.27 sq microns) was also highly significant (P less than 0.001). The results obtained by image cytometry were compared with estimated DNA ploidy pattern of follicular cells from the same cases. All colloid goiter had mean nuclear area below 100 sq.microns with diploid DNA value. However, papillary carcinoma showed aneuploid DNA pattern in eight cases (80.0%), but mean nuclear area was above 100 sq.microns. A diagnostically useful finding obtained in two of the 10 cases of follicular neoplasm was the association of aneuploid DNA pattern with mean nuclear area of the follicular cells above 100 sq.microns indicating a high probability of carcinoma and thus demanding an urgent open biopsy. These cases were readily distinguished from other cases of the same category showing diploid DNA pattern and mean nuclear area of follicular cells below 100 sq.microns.     

Evaluation of DNA content in gastric dysplasia and carcinoma by image cytometry

In 30 cases of gastric dysplasia and 10 cases of gastric carcinoma, DNA content was studied by IBAS image analysis system. The mean DNA level increased steadily with the advance of histologic gradation, and the highest DNA content was observed in gastric carcinoma. No case of aneuploidy was found in mild dysplasia. In moderate dysplasia, aneuploid cells were occasionally encountered. Severe dysplasia had a lower percentage (4.48%), and gastric carcinoma was characterized by a high percentage of aneuploid cells (14.54%).     

DNA content in gallbladder carcinoma: a flow cytometric study of 96 cases

The DNA content in gallbladder carcinoma and its relation to histological and cytological features was studied in 79 primary gallbladder carcinomas and 16 metastases. Abnormal DNA content was observed in 48 (51%) of 95 cases. In primary carcinomas, 44 (55.6%)showed a diploid DNA content, and 35 (44.4%) were aneuploid. The majority of the metastatic lesions were aneuploid DNA (81.3%; P =0.006). Marked differences in the coefficient of variation estimated by manual, Kosugi and Dean methods were detected ( P =0.005). Seventy-one per cent of early gallbladder carcinomas had a normal DNA content. In contrast 54% of the cases with subserosal or serosal infiltration had normal DNA content. In primary tumours the degree of architectural atypia had a close relationship with the degree of cellular atypia ( P =0.00001). Only two (15%) of 13 cases with mild architectural atypia, and 34 (51.5%) of 66 cases with marked architectural atypia were aneuploid. Only one (10%) of 10 cases with mild cellular atypia and 35 (51%) of 69 with high cellular atypia had abnormal DNA content ( P =0.01) The importance of DNA content as a marker in gallbladder carcinoma remains uncertain and its clinical importance requires further clinicopathological studies.     

Cell proliferation,nuclear ploidy,and EGFr and HER2/neu tyrosine kinase oncoproteins in infiltrating ductal breast carcinoma

The purpose of this work was to study if the variations in the nuclear DNA content and the expression of EGFr and HER2/neu transmembrane oncoproteins were related and if this influences the rate of cell proliferation modifying, in each case, the potential aggressivity of the neoplasia. Thirty-four ductal breast carcinoma tissue samples of tumors of up to 2 cm in diameter were analyzed by flow cytometry. HER2/neu and EGFr were measured by immunohistochemical methods. Twenty cases were diploid (DNA index of 1) and 14 cases were aneuploid (DNA index other than 1). The expression of EGFr and HER2/neu was significantly higher in aneuploid tumors compared with diploid tumors. The cell proliferation rate was significantly higher in tumors with an aneuploid pattern. The expression of EGFr was associated with a higher rate of cell proliferation. The higher expression of EGFr and HER 2/neu oncoproteins in aneuploid tumors suggests that the increased proliferative activity of aneuploid carcinomas is influenced by the activity of such oncoproteins, which favors a more aggressive biological behavior.     

Pure and mixed mucinous breast carcinomas: DNA stemline and prognosis.

The DNA stemline of 45 mucinous breast carcinomas was determined by flow cytometry using paraffin embedded archival tissue sections. The material consisted of 26 pure mucinous and 19 mixed mucinous carcinomas. The patients were followed up for at least 15 years or until death. Nearly all pure mucinous carcinomas had a normal DNA stemline (25 of 26) with only one aneuploid tumour. Mixed mucinous carcinomas had a DNA content resembling that of common ductal carcinoma with 11 aneuploid tumours. Aneuploid tumours tended to be of higher grade and stage than diploid tumours. The survival of patients with pure mucinous carcinoma was better than that of patients with mixed mucinous carcinoma. Mucinous carcinoma should be classified as such only if it is a pure mucinous carcinoma.     

p53 and c-erbB-2 expression in schistosomal urinary bladder carcinomas and schistosomal cystitis with premalignant lesions

The purpose of this study was to ascertain whether DNA ploidy status and S-phase fraction affected the prognosis of patients with carcinoma of the thyroid gland. We reviewed all malignant thyroid tumours diagnosed in Iceland from 1955 to 1990. In all, 494 thyroid carcinomas were diagnosed during that period. By analysing tumour material from paraffin blocks by flow cytometry we were able to evaluate the ploidy status in 424 tumours and the S-phase value in 417 tumours. We detected aneuploid cell populations in 9.7% of papillary carcinomas, 24.3% of follicular carcinomas, 42.9% of medullary carcinomas and 78.6% of anaplastic carcinomas. Some 57% of tumours, mainly papillary carcinomas, had an S-phase value of less then 3%, whereas most of the other histological types of carcinoma, including all the anaplastic tumours, had an S-phase value of 3%. Univariate analysis indicated that both ploidy status and S-phase fraction were significant variables. When taking into account known prognostic variables of thyroid carcinoma in a multivariate analysis, however, neither ploidy status nor S-phase value proved significant. We conclude that DNA ploidy status and S-phase values are not independent prognostic factors in thyroid carcinoma.     

Allelic losses of 17p, 5q, and 18q loci in diploid and aneuploid populations of multiploid colorectal carcinomas

17p, 5q, and 18q allelic losses are involved in the pathogenesis and progression of colorectal carcinoma, and DNA aneuploidy in this type of cancer is thought to result from alterations of these chromosomal loci. However, genetic differences between diploid and aneuploid populations of multiploid carcinoma, defined as the coexistence of diploid and aneuploid populations in the same area, remain unclear. The differences in 17p, 5q, and 18q allelic losses between the diploid and aneuploid populations in 24 sporadic DNA multiploid colorectal carcinomas were analyzed by use of crypt isolation coupled with DNA cytometric sorting and polymerase chain reaction assay. 17p Allelic loss was observed in 7 of 22 diploid populations excluding 1 case of microsatellite instability but was found in 21 of 23 aneuploid populations. Although 5q allelic loss was detected in only 3 of 22 diploid populations, 13 of 22 aneuploid populations had 5q allelic loss. Losses of the 18q allele were frequently found in aneuploid populations (15 of 20), although no 18q allelic loss was detected in corresponding diploid populations. 17p Allelic losses may play an important role in the progression from a diploid status to an aneuploid status in a specific subset of colorectal cancer. However, 18q or 5q allelic losses do not appear to precede nor to facilitate the aneuploid clonal divergence of cancer cells. Multiploidy is a useful model to study genetic alterations between diploid and aneuploid populations.     

DNA content as a prognostic marker in patients with oral leukoplakia

BACKGROUND: Oral leukoplakia may develop into squamous-cell carcinoma, which has a poor prognosis. Risk factors for oral carcinoma have been identified, but there are no reliable predictors of the outcome in individual patients with oral leukoplakia. METHODS: We identified 150 patients with oral leukoplakia that was classified as epithelial dysplasia and measured the nuclear DNA content (ploidy) of the lesions to determine whether DNA ploidy could be used to predict the clinical outcome. Biopsy specimens obtained at annual follow-up visits were graded histologically and classified with respect to DNA content in a blinded fashion. Disease-free survival was assessed in relation to DNA ploidy and the histologic grade. The mean duration of follow-up was 103 months (range, 4 to 165). RESULTS: Among 150 patients with verified epithelial dysplasia, a carcinoma developed in 36 (24 percent). Of the 150 patients, 105 (70 percent) had diploid (normal) lesions, 20 (13 percent) had tetraploid (intermediate) lesions, and 25 (17 percent) had aneuploid (abnormal) lesions at the time of the initial diagnosis. A carcinoma developed in 3 of the 105 patients with diploid lesions (3 percent), as compared with 21 of the 25 patients with aneuploid lesions (84 percent), yielding a negative predictive value of 97 percent with respect to the diploid lesions and a positive predictive value of 84 percent with respect to the aneuploid lesions. Carcinoma developed in 12 of 20 patients with tetraploid lesions (60 percent). The mean time from the initial assessment of the DNA content to the development of a carcinoma was 35 months (range, 4 to 57) in the group with aneuploid lesions and 49 months (range, 8 to 78) in the group with tetraploid lesions (P=0.02). The cumulative disease-free survival rate was 97 percent among the group with diploid lesions, 40 percent among the group with tetraploid lesions, and 16 percent among the group with aneuploid lesions (P<0.001). CONCLUSIONS: The DNA content in cells of oral leukoplakia can be used to predict the risk of oral carcinoma.     

Degree of malignancy of thymic epithelial tumors in terms of nuclear DNA content and nuclear area. An analysis of 39 cases.

For determination of the degree of malignancy among thymic epithelial tumors, the DNA content and area of nuclei in 13 cases each of noninvasive thymoma, invasive thymoma, and thymic carcinoma were investigated by cytofluorometry and morphometry. The nuclear DNA content was determined in terms of the mean nuclear DNA content, DNA histogram pattern, and the occurrence of the aneuploid stem cell line. The mean nuclear DNA content of the thymic carcinoma was significantly higher than that of both subgroups of thymoma (P less than 0.01), but there was no significant difference between noninvasive and invasive thymomas. The aneuploid stem cell line appeared in 92.3% of thymic carcinomas, one case (7.7%) of invasive thymomas, and none of noninvasive thymomas. Abnormal DNA histogram patterns were seen in 53.8% of thymic carcinomas and none of the thymomas. The mean nuclear area increased significantly in the increasing order of noninvasive thymoma, invasive thymoma, and thymic carcinoma (P less than 0.01). The cytofluorometric and morphometric results demonstrated a significant difference in degree of malignancy between thymic carcinoma and thymoma; however, there was a trend toward an increasing degree of malignancy from noninvasive to invasive thymomas, yet there was a sizeable overlap in results between the two groups. Therefore, these two methods are not satisfactory for predicting the behavior of an individual case of noninvasive or invasive thymoma.     

Relation of steroid receptors, tumor ploidy, and cell proliferation in various histologic types of breast cancer

The receptor status of the tumors examined in 74 patients with breast cancer was found to correlate with its ploidy and proliferative activity as evidenced by flow cytometry and it failed to correlate with a histological tumor type and metastatic involvement of regional lymph nodes. In terms of DNA content, the receptor-positive tumors were more frequently diploid, the receptor-negative ones were aneuploid. The proliferation index (PI) for the receptor-negative tumors was significantly higher than that for the receptor-positive ones. The diploid tumors showed lower proliferative activity than the aneuploid ones. Among the aneuploid tumors, PI for infiltrative lobular cancer was significantly lower than that for infiltrative duct cancer. Early in invasion, duct carcinoma was predominantly diploid, of grade I-IIA malignancy and more infrequently metastasized into regional lymph nodes. Grade IIB-III malignant tumors were chiefly aneuploid and more frequently metastasized into regional lymph nodes.     

Follicular neoplasms of the thyroid in men older than 50 years of age. A DNA flow cytometric study

The clinical behavior of follicular neoplasms of the thyroid in elderly men can be difficult to predict on histologic grounds alone. To assess the usefulness of DNA flow cytometry in predicting the metastatic potential of these tumors, the authors studied 44 primary and metastatic follicular neoplasms of the thyroid by DNA flow cytometry of paraffin-embedded tissue. The neoplasms were obtained from 44 men ranging in age from 50 to 79 years (mean, 60). There were 29 follicular adenomas, 11 primary follicular carcinomas (neoplasms with capsular and/or vascular invasion), and 4 metastatic follicular carcinomas. Follow-up information was available on 40 of the 44 patients. The mean follow-up was 114 months. Twenty-five of the 29 follicular adenomas had a diploid DNA content, 2 (7%) were tetraploid, and the DNA histograms on 2 were not interpretable. All patients with follicular adenomas had no evidence of disease (NED) at last follow-up. Eight of the 11 primary follicular carcinomas were diploid. Six of these patients had NED, one died with carcinoma at 82 months, and no follow-up was available on one. Three (27%) of the primary follicular carcinomas were aneuploid or tetraploid. Two of these patients had NED, and the third died with carcinoma 84 months after diagnosis. Two of the four metastatic follicular carcinomas were diploid and two (50%) were aneuploid or tetraploid. One of the two patients with diploid metastatic follicular carcinomas died with carcinoma, as did one of the two patients with aneuploid metastatic follicular carcinomas. These results suggest the following: (1) follicular carcinomas are more likely to be aneuploid or tetraploid than are follicular adenomas; (2) follicular neoplasms without capsular or vascular invasion may include a small number of aneuploid or tetraploid tumors; and (3) DNA ploidy does not add to the prognostic value of histologic studies alone.     

DNA cytophotometry in malignant thyroid tumors— use of different evaluation schemes for prognostic statements

Summary Quantitative evaluation of nuclear DNA has been found to provide information on diagnosis and prognosis in a number of malignant tumours and borderline lesions. Using 53 carcinomas of the thyroid with varying differentiation we examined the prognostic information obtained by DNA cytophotometry with respect to clinical outcome, applying three different evaluation schemes. DNA cytophotometry allowed the discrimination of euploid carcinomas with good prognosis from aneuploid tumours with bad prognosis and a generally shortened life span. However, the encapsulated variants of follicular and papillary thyroid carcinomas, with their generally excellent prognosis, exhibited DNA histograms similar to those of their widely invasive counterparts. Thus, the favourable prognosis of these minimal invasive subtypes may primarily be related to the tumours' encapsulation and cannot be ascribed to a particular DNA content. We conclude that DNA cytophotometry can provide additional prognostic information for the individual patient suffering from thyroid carcinoma and may probably lead to an individualization of the therapeutic strategies.     

宫颈癌细胞DNA含量与临床及病理特性的关系

Nuclear DNA content was determined by flow cytometry in biopsy samples taken from cervical carcinomas of 33 patients. Aneuploid DNA content was found in 24 cases (72.7%). The relationship between DNA content of carcinoma cells and the clinicopathological features was investigated. Carcinomas with aneuploid DNA content were clinically more advanced and histologically poorly differentiated as compared with those with diploid DNA content. DNA content was found neither correlated with the patient's age nor with the growing type of the tumor; and analysis of DNA content by flow cytometry was considered helpful in evaluating tumor malignancy, efficacy of treatment and prognosis.