Morphometric analysis of nuclear features, ploidy status, and staging in rectal carcinoma

Genetic heterogeneity in sporadic colorectal adenomas

The majority of colorectal cancers develop from adenomatous polyps under the influence of factors that are still poorly understood. Tumourigenesis is generally considered a multistep process in which multiple genetic alterations occur, eventually reflected in abnormalities of the cellular DNA content. Macroscopical features such as tumour size and tumour architecture (tubular, tubulovillous, or villous) are correlated wit the chance of malignancy in the lesion. Grade of dysplasia can be considered an indicator for the level of progression of the adenoma towards invasive carcinoma. These characteristics were correlated with the presence or absence of K-ras mutations and the DNA ploidy in a prospective study performed on 46 large sporadic colorectal adenomas resected by endoscopy. DNA ploidy and K-ras mutations were analysed in two samples taken at distant sites in the adenomas. Aneuploidy was present in 12 adenomas (26 per cent) and K-ras mutations occurred in 26 (57 per cent). A highly significant correlation was found between aneuploidy and adenoma size, architecture, and grade of dysplasia. The presence of K-ras mutations was significantly correlated only with the size of the adenomas. The proportion of adenomas with aneuploidy and/or a K-ras mutation increased when two samples were analysed instead of one. This observation suggests that the prevalence of genetic mutations and of aneuploidy is probably underestimated, as generally only one sample is investigated. No correlation was observed between K-ras mutations and ploidy. This study demonstrates the presence of genetic heterogeneity in colorectal adenomas and supports the notion that K-ras mutation is an early event, while aneuploidy is a late event in the adenoma-carcinoma sequence.

Mean nuclear area and chromosomal DNA content of squamous cell carcinomas of the oral cavity using computerized image analysis

Morphometric measurements of nuclei may be of prognostic value in some cancers. In this present study we have evaluated the mean nuclear area (MNA) of 50 squamous cell carcinomas of the oral cavity (SCCOC) using computerized image analysis. Since chromosomal DNA content is a reflection of the DNA content in the nucleus, we have evaluated the relationship between MNA and chromosomal DNA. Thirteen tumours had a MNA greater than 49.9 microns2 and 37 had a MNA less than this. Six tumours were classified as hypodiploid, 29 as diploid and 15 as aneuploid. There were 44 node-negative patients and six node-positive. When comparing MNA in these groups, 50 per cent of node-positive patients had a larger MNA whilst only 20 per cent of the node-negative group had a large MNA. The correlation coefficient between MNA and DNA indices was r = 0.75. The greater nuclear size is possibly a reflection of a more aggressive tumour biology in the node-positive patients. We conclude that a large MNA may be a marker of aggressive tumour biology in this group. In the future, we aim to evaluate the prognostic significance of MNA in patients with SCCOC.

Nucleolar and dispersed nucleolar organiser regions (NORs) in differentiating neoplastic from atypical non-neoplastic lesions of the pancreas

Our objective was to compare the accuracy of differentiation of pancreatic carcinoma from the benign ductular aggregation of chronic pancreatitis using two methods, nuclear morphometric analysis and modified argyrophilic nucleolar organiser region (AgNOR) staining for nucleoli and dispersed NORs (AgNU staining). We evaluated 35 metastatic or invasive lesions of pancreatic carcinoma with low-grade atypia, 16 lesions of ductular aggregation and 12 lesions of proper epithelium. Four parameters, consisting of the size of nucleus: mean area, mean minor axis, mean major axis and mean perimeter, and two parameters of AgNu staining: mean number of AgNu-stained dots per nucleus (equal to mean number of nucleoli and dispersed NORs) and mean area of the largest AgNu-stained dot (equal to mean area of the largest nucleolus) of pancreatic carcinomas were significantly larger than those of ductular aggregations and of proper epithelia. In the discriminant analysis of four parameters of nuclear size, the discrimination of carcinomas was correct in 82.9% and that of ductular aggregations in 81.3%. Discriminant analysis by two parameters of AgNu staining showed 2 correct discrimination of lesions in 88.6% and 100%. Thus, AgNu staining was more accurate than nuclear morphometric analysis in discriminating a pancreatic carcinoma from ductular aggregation.

Prognostic correlation of morphometric values with survival in invasive transitional cell carcinoma of the bladder

A morphometric study was made of 95 invasive bladder tumours, differentiating 34 papillary and 61 solid carcinomas. In the invasive papillary tumours, the deeper the zone of the tumour measured, the higher the value of the mean nuclear area. A higher histological grade was also seen to correspond to a higher mean nuclear area value except for Grade IV tumours, whose nuclear area was no larger than that for Grade III tumours. This led us to separate Grade IV tumours from transitional cell carcinomas and classify them as undifferentiated. A better prognosis was found for those tumours whose mean nuclear area was < or = 30 microns2 in category T2. For T3 and T4A tumours no conclusive results were obtained in this respect.

DNA content in primary tumours and lymph node metastases in colorectal adenocarcinoma

In 18 consecutive patients operated on for colorectal carcinoma of Dukes' stage C, the DNA patterns were determined in multiple samples of the primary tumours and in all detected lymph node metastases. Single-cell microspectrophotometry on Feulgen-stained smears of fine-needle aspirates was used. When the most aggressive DNA pattern was considered representative, 12 primary tumours (67%) were designated as aneuploid. The frequency of aneuploidy among the metastases was almost the same (63%). In 15 cases (83%) the DNA patterns displayed by the metastatic lymph nodes were also found in the corresponding primary tumour, while in the remaining three cases (17%) the DNA pattern in the lymph node metastases was not seen in any of the multiple samples from the primary tumour. The observed tumour DNA heterogeneity may reflect either the multicellular origin of the tumour cells or the continuous evolution and progression of a neoplasm of unicellular origin, and may partly explain the dissimilarities between the DNA patterns of the primary tumour and the lymph node metastases. Biopsy samples from a number of metastatic lymph nodes are therefore required to ensure representativeness and to permit an adequate analysis of the prognostic role of the DNA ploidy status in lymph node metastases from colorectal cancer.

Video image analysis of AgNOR distribution in the normal and adenomatous colorectum

The nucleolar organizer regions (AgNORs) have been studied by video image analysis in the normal colorectum and in adenomas arising there. Total AgNOR area was measured in conjunction with the total area of nuclei and expressed as a ratio. AgNORs are found to predominate in the proliferative regions of the normal mucosal crypt, and the ratio of AgNOR to nuclear area proved significantly greater in the normal colon than in the rectum and far greater in colorectal adenomas. Further, there is a significant difference between the ratio in tubular as opposed to villous patterns of adenomatous growth in the colon but not in the rectum. When classified according to their degree of dysplasia, adenomas in the rectum exhibit a significantly higher ratio of AgNOR to nuclear area as the degree of dysplasia increases in severity. This correlation is not shown in the colon.

How malignant is malignant? A brief review of the microscopic assessment of human neoplasms, and the prediction of whether they will metastasize and kill

This review examines ways in which histopathologists can attempt to predict the degree of malignancy from the microscopic examination of surgically removed samples of human neoplasms. These include mitotic counts, measurement of DNA content, analysis of DNA turnover, measurement of proliferation antigens, measurement of nucleolar organizing areas, counting nucleoli, morphometry of nuclei, identification of genetic change, measurement of lysis of basement membrane, and measurement of invasion in vitro. The latter two are not currently of practical value. Of the rest none is uniformly capable of predicting the degree of malignancy of a human neoplasm. After further refinement and control measurement of several such parameters may however contribute more to the prediction of malignancy than present subjective assessments.

Comparative ploidy studies using cytological and paraffin section preparations

The ploidy profiles of benign and malignant tumours can be obtained using image analysis. However, the results of ploidy studies have varied according to the type of specimen used. We compared the ploidy profiles of paraffin embedded thin sections, cytospin preparations of disaggregated cells, and cytological smears from the same specimen as defined by image analysis. Ten benign breast lesions, 10 breast carcinomas and 10 malignant melanomas were investigated in this way. Preparations stained by the Feulgen technique were examined using the MD20 video image analysis densitometry system. Ploidy profiles were obtained by measuring the integrated optical density of at least 200 nuclei. By paying proper attention to the quality of fixation and presence or absence of cytoplasm around cells, comparable results were found for all preparations in each case. We therefore conclude that if careful attention is paid to the technical quality of the material, reliable ploidy results can be obtained by image analysis.