Flow cytometric analysis of the nuclear DNA content of hepatocellular carcinoma

Prognostic significance of the DNA-index in liver transplantation for hepatocellular carcinoma in cirrhosis

OBJECTIVE

This study was conducted to evaluate the prognostic significance of the tumor DNA index in patients receiving liver transplantation for hepatocellular carcinoma (HCC) in cirrhosis.

BACKGROUND

In patients suffering from HCC in cirrhosis, the current selection for liver transplantation does not optimally achieve the goal to simultaneously maximize the number of viable transplant candidates and reject the smallest number of those who could have benefited. This is the first report on the prognostic significance of the tumor DNA index.

PATIENTS AND METHODS

From 1988 to 2007, liver transplantation for HCC in cirrhosis was performed in 246 consecutive patients. The DNA-index was determined by Feulgen staining and semiautomatical image analysis. Interpretation of DNA histograms followed the recommendations outlined in the European Society for Analytical Cellular Pathology consensus report on diagnostic DNA image cytometry.

RESULTS

A DNA-index <or=1.5 was detected in the HCC of 159 patients (65%). Five- and 10-year post-transplant survival rates in this group were 86% and 80%, respectively. The DNA-index exceeded 1.5 in 87 patients (35%). These patients had 5- and 10-year survival rates of 27% and 6%, respectively, which were significantly lower than in the DNA-index <or=1.5 group (P < 0.0001). On univariate analysis, DNA-index, vascular invasion, fulfillment of the Milan criteria, and histopathological grading were prognostic parameters. In the multivariate analysis, only DNA-index (odds ratio: 11.9; 95% confidence interval: 7.1-20.0; P < 0.0001) and vascular infiltration (odds ratio: 1.7; 95% confidence interval: 1.1-2.6; P < 0.01) were identified as prognostic variables.

CONCLUSION

This is the first study to describe the DNA-index as a strong prognostic indicator after liver transplantation for HCC in cirrhosis. At this time, determination of the DNA-index is likely to be the most promising diagnostic tool in the selection of transplant candidates.

C-erb B2 (Her2/neu) is neither overexpressed nor amplified in hepatic neoplasms

The human c-erb B2 proto-oncogene (Her2/ ) encodes a 185-kD transmembrane putative growth factor receptor of the tyrosine kinase family. Overexpression or amplification of this oncoprotein/oncogene has been established in breast, ovarian, salivary gland, and gastric carcinomas and has been implicated in other neoplasms. Recently, overexpression of c-erb B2 has been demonstrated in hepatocellular carcinoma using enzyme-linked immunosorbent assay. Patients with hepatocellular carcinoma have a poor prognosis, and overexpression of c-erb B2 may have prognostic and treatment implications. The authors evaluated the expression and amplification of c-erb B2 in hepatic neoplasms utilizing routine immunohistochemistry and fluorescence in situ hybridization. Formalin-fixed paraffin-embedded tissue sections from 27 hepatocellular carcinomas and 7 hepatocellular adenomas were immunostained with anti-c-erb B2 utilizing a modified avidin-biotin technique following heat induced antigen retrieval. Ten sections from hepatocellular carcinomas were subjected to fluorescence in situ hybridization assay. Positive and negative controls stained appropriately. Slides were evaluated independently by two pathologists. None of the hepatocellular carcinomas or hepatocellular adenomas was immunoreactive with anti-c-erb B2. Adjacent cirrhotic liver parenchyma, present in 11 cases, was also uniformly negative. None of hepatocellular carcinomas showed any evidence of c-erb B2 amplification by fluorescence in situ hybridization. Immunoreactivity for c-erb B2 was not demonstrated in hepatocellular adenomas, cirrhotic livers, or hepatocellular carcinomas using routine immunohistochemical methods. C-erb B2 amplification was not demonstrated in hepatocellular carcinomas. Neither overexpression nor amplification of c-erb B2 (Her2/ ) can be regarded as a useful prognostic factor in hepatocellular carcinoma.

Retrospective evaluation of DNA ploidy of hepatocarcinoma on cytologic samples

DNA ploidy was evaluated by image cytometry in a series of 84 hepatocellular carcinomas diagnosed by fine-needle aspiration biopsy. In the series were included eight cases originally diagnosed as suspect and reclassified as well-differentiated hepatocarcinoma. The study was retrospectively performed on Papanicolaou-destained, Feulgen-restained smears. The 5c exceeding rate and the visual interpretation of the corresponding histograms were evaluated and compared with size of the tumors, serum alpha-fetoprotein values, hepatic functional staging, and patient survival. Sixty-eight cases were aneuploid and 16 euploid (9 diploid and 7 polyploid). Four of the eight cytologically suspect cases were aneuploid. Statistical analysis showed an association between size and cytologic grading, 5c exceeding rate and cytologic grading, and between aneuploidy and multiple tumors; in a Cox multivariate DNA content analysis, aneuploidy and multiple tumors were the two prognostically significant variables. DNA ploidy evaluation by static cytometry of hepatic tumors may be useful in the diagnosis on cytologic samples and could represent an independent prognostic parameter in predicting the survival outcome of patients with hepatocellular carcinoma.

Genomic fluidity is a necessary event preceding the acquisition of tumorigenicity during spontaneous neoplastic transformation of WB-F344 rat liver epithelial cells

The genomic evolution of a cohort of WB-F344 rat liver epithelial cell lineages undergoing spontaneous neoplastic transformation was followed to define the mechanistic relationship between genomic instability and progression to the neoplastic phenotype. Eighteen independent populations of WB-F344 cells (initiated from a single diploid-founding population) were subjected to 12 cycles of selective growth at confluent cell density, and cellular DNA contents were measured after each selection cycle. Flow cytometry demonstrated significant gains in the amount of G1 DNA after selection cycles 3, 6, and 7 in 44% (8 of 18), 89% (16 of 18), and 39% (7 of 18) of the cell populations, respectively. All populations subsequently lost DNA and returned to a diploid or pseudo-diploid DNA content within 1 to 2 selection cycles after the appearance of an increased DNA content. Additionally, appearance and subsequent disappearance of aneuploid or tetraploid subpopulations was observed in 11% (2 of 18) and 83% (15 of 18) of the experimental lineages, respectively. Although perturbations of G1 DNA content were apparent as early as selection cycle 3, at least 8 cycles of selective growth were required for the acquisition of tumorigenicity. While the independent lineages demonstrated significant fluctuations in G1 DNA content between selection cycles 3 and 8, the majority (11 of 13) of the populations contained a diploid or pseudo-diploid DNA content at the time tumorigenicity was expressed. Genomic instability preceded the acquisition of tumorigenic potential in rat liver epithelial cells subjected to selective growth conditions of maintenance at confluence, and may be required for its expression.

Prognostic significance of pathological and biological factors in hepatocellular carcinoma

Prognostic factors in hepatocellular carcinoma (HCC) conventionally consist of staging with the tumour node metastasis system and grading by tumour cellular differentiation. There are also other factors useful in prognostication but most of them are clinical. With new discoveries in the pathobiology of cancers and introduction of new medical technology, pathological and biological factors of HCC in relation to prognosis have been studied quite extensively. Morphological features of the tumour, both gross and histological, have been found to be significantly related to tumour recurrence and patient survival. Recently, applications of new antibodies and techniques have enabled studies on cellular proliferation using different antibodies such as those for proliferating cell nuclear antigen and Ki-67 protein. These studies on cellular proliferation, as well as assessment of argyrophilic nucleolar organizing regions, have been shown to provide good prognostic significance. Flow cytometric studies on DNA ploidy and studies on expression of genes including the p53 gene, hormone receptors and others show less unanimous results in their prognostic significance. The influence of gender on survival is also reviewed. In conclusion, pathological and biological factors are useful and help to guide clinicians in the management of patients and in assessment of long-term prognosis.

Ki-67 expression as a prognostic marker in patients with hepatocellular carcinoma

Ki-67 expression in tumours has been shown to be associated with prognosis in patients with hepatocellular carcinoma (HCC). In this study, primary HCC samples were obtained from 67 patients undergoing surgical resection. None of these patients had been subjected previously to any other form of therapy, such as arterial embolization or chemotherapy. Histologically normal liver tissues from liver resection for metastatic colon cancer were taken as controls (n = 8). Monoclonal antibody against Ki-67 was used for immunostaining and flow cytometry was used to measure tumour DNA ploidy. The mean Ki-67 labelling index (percentage of Ki-67-positive cells) of the HCC (26 +/- 22%; range 0.1-89%) was significantly higher than that of the normal controls (39 +/- 0.8%, P < 0.05). The mean Ki-67 labelling index (19 +/- 15%; n = 28) of the tumours with diploid DNA pattern was significantly lower than those with aneuploid DNA pattern (32 +/- 25%, n = 39; P = 0.01). Hepatocellular carcinoma patients (n = 47) with Ki-67 index > 10% had a significantly lower disease-free and overall survival than those (n = 20) with Ki-67 index < or = 10% (P = 0.0009 and P = 0.02, respectively). Multivariate analysis showed that Ki-67 expression and tumour node metastasis stage were two independent prognostic factors for disease-free and overall survival rates. Our results suggest that the expression of Ki-67 is an independent prognostic indicator for patients with HCC after resection and could be of assistance in the decision-making of adjuvant therapy.

Progression of hepatocellular carcinoma as reflected by nuclear DNA ploidy and cellular differentiation

BACKGROUND/AIMS

Intratumor heterogeneity of DNA ploidy within a single hepatocellular carcinoma is not well understood. The present study was designed to examine the histologic distribution of intratumor DNA ploidy in hepatocellular carcinomas of different growth types in relation to cell differentiation.

METHODS

Twenty patients (16 men and four women; mean age, 60.2 years) with hepatocellular carcinoma (mean diameter, 4.3 cm) were studied. One hundred and twenty-seven samples from different sites of each tumor were analyzed by determination of the nuclear DNA content and histological examination.

RESULTS

The DNA ploidy was heterogeneous in nine (45%) of the 20 tumors. Five tumors had a mixture of diploid and aneuploid regions, and the remaining four consisted of aneuploid regions with different DNA indices. There was no significant difference in patient characteristics between the heterogeneous and homogeneous groups. A significant correlation was found between tumor growth type and the incidence of heterogeneity. Only 16% of single nodular carcinomas without intratumor septal formation exhibited heterogeneity, while single nodular tumors with septal formation or confluent multinodular tumors were associated with high incidences of different DNA ploidy patterns or DNA indices. There was no aneuploidy in well-differentiated foci, while aneuploidy was frequently found in moderately or poorly differentiated foci (incidences of 67% and 74%, respectively).

CONCLUSIONS

Heterogeneity of DNA ploidy may develop along with changes in growth pattern and cell dedifferentiation or by confluence of nodules originating from different tumor cell clones.

Loss of heterozygosity of the retinoblastoma gene in liver cirrhosis accompanying hepatocellular carcinoma

Carcinogenesis is a multistep process. Most hepatocellular carcinoma (HCC) is preceded by liver cirrhosis, but the genetic changes involved in cirrhosis are not known well. The present study was conducted to evaluate aberration of the retinoblastoma (RB) gene in HCC and adjacent non-tumorous liver using 22 patients with chronic liver damage accompanying HCC. The specimens obtained by microdissection from paraffin-embedded tissues were analyzed using an assay based on the polymerase chain reaction for highly polymorphic nucleotide sequences of microsatellites in the RB gene. Out of 22 cases, 15 showed constitutional heterozygosity for the microsatellite markers. In 11 (73.3%) of these 15 informative cases, the primary HCC foci showed loss of heterozygosity (LOH). In 8 of these 11 doubly informative (informative and LOH-positive in primary HCC) cases, LOH was found in 20 (64.5%) of 31 microdissected non-tumorous foci. All of the non-tumorous foci showing RB loss were cirrhotic lesions but there were no foci of chronic hepatitis. The remaining 4 cases without LOH in HCC foci showed no LOH in non-tumorous lesions. In our study, LOH of the RB gene was frequently observed in liver cirrhosis surrounding tumor.

DNA ploidy study of resected hepatocellular carcinoma in cirrhotic liver

BACKGROUND/AIMS

Results of several studies on DNA ploidy as a prognostic indicator in hepatocellular carcinoma are contradictory. The present study analysed the correlations between DNA ploidy of resected hepatocellular carcinoma and tumour characteristics, tumour recurrence, risk factors and survival.

METHODS

Tumoural DNA ploidy of hepatocellular carcinomas from 37 patients with cirrhosis who underwent curative tumour resection was studied by flow cytometry.

RESULTS

A diploid pattern was found in 23 hepatocellular carcinomas (62.2%) and an aneuploid pattern in 14 (37.8%). The tumour recurrence rate did not differ statistically between diploid (69.6%) and aneuploid (50%) hepatocellular carcinomas. The only prognostic variable with significant difference in DNA pattern was the histologic tumour type; the majority of non-trabecular tumours were aneuploid while most trabecular hepatocellular carcinomas had a diploid DNA pattern. Actuarial survival at 1, 2, 3 and 4 years of patients with diploid and aneuploid tumours was 69.6%, 40.6%, 16.2% and 0%, and 69.3%, 59.4%, 49.5% and 32.9%, respectively (log rank p = 0.1927).

CONCLUSION

These results indicate that DNA ploidy has no prognostic value in hepatocellular carcinoma.

Frequent loss in chromosome 8p loci in liver cirrhosis accompanying hepatocellular carcinoma

Most hepatocellular carcinoma (HCC) is preceded by liver cirrhosis, but the genetic changes involved in cirrhosis are not well understood. We therefore studied loss of heterozygosity (LOH) in cirrhotic and neoplastic foci in livers of 14 patients with HCC. The samples, microdissected from paraffin-embedded tissues, were analyzed using a polymerase-chain-reaction-based assay for dinucleotide repeat polymorphisms on 8p. Of the 14 cases, 13 showed constitutional heterozygosity for the microsatellite markers. In 7 (54%) of these 13 informative cases, LOH was detected in the primary HCC and, in these 7 doubly informative (informative and LOH-positive in primary HCC) cases, LOH was found in 16 (70%) of 23 liver cirrhotic foci. The pattern of 8p allelic loss was identical in each doubly informative tumor; however, some of the liver cirrhotic foci harbored an 8p loss identical to that seen in the primary HCC, some harbored a different 8p loss, and some did not harbor any 8p loss. The remaining 6 cases without LOH on 8p in HCC showed no 8p loss in any cirrhotic foci. Presumably HCC could develop from cirrhotic cells harboring 8p loss.

[DNA content of the tumor cell. A new prognostic parameter in hepatocellular carcinoma?]

Hepatocellular carcinoma is a heterogeneous disease with considerable differences in malignant behaviour. Some relevant factors for prognosis are known. In this study we analysed DNA ploidy as a potential prognostic parameter. With DNA image cytometry we were able to differentiate between diploid, hypotriploid, triploid, hypertriploid, tetraploid and aneuploid tumours. The best prognosis was for patients with diploid, hypotriploid and tetraploid tumours with a median survival time of 41 months in contrast to 3 months for patients with triploid, hypertriploid or aneuploid tumours. There was a strong correlation between histomorphological parameters and the DNA content. The DNA content of tumour cells may be considerable clinical relevance in hepatocellular carcinoma regarding the decision as to whether or not to perform a resection. In patients with prognostically unfavorable parameters adjuvant oncological therapy may improve the prognosis.

DNA flow cytometry in patients undergoing liver transplantation for hepatocellular carcinoma

The purpose of the study was to analyse patterns of DNA content in hepatocellular carcinomas (HCC) submitted to orthotopic liver transplantation (OLT). Paraffin-embedded archival material from 15 patients (ten men, five women, mean age 51 +/- 1.78 years) transplanted in St-Roch Hospital between 1988 and 1991 was available for laboratory evaluation by flow cytometry. Five out of 15 were incidental HCC. The analysis was performed by a FACSscan flow cytometer coupled to a Hewlett-Packard computer. The cellular DNA content was defined as diploid or aneuploid in the presence of a single (DNA index of 1) or two distinct (DNA index different from 1) Gzero/G1 peaks, respectively. All incidental HCC (five patients) were diploid, the tumour size was 1.2 +/- 0.2 cm, the number of nodules was 1.4 +/- 0.24 and the mortality rate was 40%. No death in the incidental HCC group was related to neoplastic recurrence. In the remaining ten patients transplanted for HCC, we observed 50% diploid tumours, the tumour size was 5.2 +/- 1.55 cm and the number of nodules was 2.7 +/- 0.56. In this group six patients died of neoplastic recurrence (two were diploid and four aneuploid). The diameter of the neoplasm in diploid patients who died of neoplastic recurrence was over 5 cm and the number of nodules was over three. Moreover, in aneuploid patients who died of neoplastic recurrence, the diameter of the neoplasm was less than 5 cm in three cases and the number of nodules was less than three in two patients. This study indicates that incidental HCC may be a less aggressive malignancy and may have a better prognosis. In this group, no patient recurred after OLT and all tumours were diploid. Aneuploidy, tumour size (> 5 cm) and number of lesions (> 3) are prognostic indicators for neoplastic recurrence in patients transplanted for hepatocellular carcinoma.

Intratumoral DNA heterogeneity of small hepatocellular carcinoma

BACKGROUND

Intratumoral DNA heterogeneity provides important information regarding biologic and clinical behavior. The purpose of this study was to evaluate the incidence of DNA heterogeneity in small hepatocellular carcinoma (HCC) nodules.

METHODS

The DNA content of 28 surgically resected small HCC nodules (< or = 3.0 cm) was measured using flow cytometry of fresh or frozen samples taken from different parts of each nodule with reference to the macroscopic features.

RESULTS

Of the 28 small HCC nodules, 14 (50.0%) had only DNA diploid stemline characteristics. Five nodules (17.9%) manifested DNA diploid and DNA aneuploidy within the same tumor. Of the remaining nine nodules (32.1%) that showed only DNA aneuploidy, two contained tumor tissues with apparently different DNA content. Thus, DNA heterogeneity was found in 7 (25.0%) of 28 nodules. DNA heterogeneity correlated well with macroscopic histologic features. All four early HCC were composed of only DNA diploid cells, whereas three of six nodule-in-nodule lesions were composed of DNA heterogeneous cells, in which the inner obviously cancerous nodule showed DNA aneuploidy and the outer well differentiated HCC portion demonstrated DNA diploid. Four of 18 overt HCC nodules showed DNA heterogeneity; 2 of these 4 nodules showed both diploid and aneuploid peaks, and the other 2 two showed different aneuploid peaks within the same nodule.

CONCLUSIONS

DNA heterogeneity correlating with macroscopic features is found frequently even in small HCC nodules. Therefore, multiple sampling based on macroscopic features is required for the accurate assessment of DNA ploidy, particularly when the information about DNA ploidy is used as a prognostic indicator.

DNA ploidy of fibrolamellar hepatocellular carcinoma by image analysis

Twelve cases of fibrolamellar hepatocellular carcinoma (FLC) were evaluated for DNA ploidy by means of image analysis of Feulgen-stained tissue sections. All of the tumors showed a nondiploid DNA distribution (six aneuploid and six tetraploid); no diploid pattern was found. The nuclear area of the tumors (53.8 microns 2 +/- 18.0; mean +/- standard deviation) was significantly larger than that of the surrounding noncancerous livers (33.2 +/- 4.7; P < .0001). These findings suggest that DNA content in fibrolamellar carcinoma (FLC) is not directly related to the clinical behavior and that other factors may be responsible for the better prognosis of this variant of HCC.

Prospective flow cytometric DNA analysis of hepatocellular carcinoma specimens collected by ultrasound-guided fine needle aspiration

BACKGROUND

The survival of 52 patients with hepatocellular carcinoma (HCC) seen during the last 4 years was analyzed prospectively on the basis of disease stage and nuclear DNA content.

METHODS

Ploidy was measured by flow cytometry (FCM). Cells for cytologic diagnosis and FCM were collected by ultrasound-guided fine needle aspiration.

RESULTS

DNA aneuploidy, which was detected in 62% of the patients, did not correlate with clinicopathologic features, except in the sonographic aspect (P = 0.03). However, ploidy correlated significantly with survival; the survival times for patients with an aneuploid DNA index were significantly shorter than for those with a diploid index (P = 0.02). In a Cox multivariate analysis, DNA content was prognostically significant, as were the grade of cirrhosis severity and the echographic aspect.

CONCLUSIONS

In addition to the clinicopathologic features observed, FCM DNA analysis of ultrasound-guided fine needle aspirates from HCC is a simple and valid method for estimating a prognosis of these patients.

An evaluation of the flow cytometric nuclear DNA analysis of intrahepatic multinodular hepatocellular carcinoma for a diagnosis of their multicentricity

This study aims to evaluate the clinical significance of the nuclear DNA index (DI) for identification of multicentrically occurring (MC) hepatocellular carcinoma (HCC). In 14 multinodular HCC patients, the DI of 30 HCC specimens and 14 non-cancerous liver tissues were analyzed by flow cytometry. Histological studies of the 30 HCCs revealed MC in 6 cases and intrahepatic metastasis (IM) in 7 cases except for a histologically undetermined case who was found to be a hepatitis B virus (HBV) carrier, and the MC of this case was determined by a clonal study using the HBV integration pattern. In four of the seven specimens with MC HCC, the DI of all the intrahepatic tumors was 1.0 (diploid pattern), while the remaining three were different. On the other hand, five of the seven IM cases were identical (3 diploid and 2 aneuploid), one similar level (DI = 1.17-1.18) and one different (1.0 and 1.24). Moreover, in one IM case, the possibility of an alteration of the DI during the course of HCC development was investigated. Although the DI of the recurrent main tumor (DI = 1.17) of this case, which was identified as metastasis of the primary tumor by a clonal study, was also similar to that of subsequent metastatic lesions (DI = 1.18), the DI of the primary tumor was 1.0. These results indicate that DI analysis was not enough to make a differential diagnosis of the multicentric occurrence of HCC.

Establishment of two distinct human hepatocellular carcinoma cell lines from a single nodule showing clonal dedifferentiation of cancer cells

Hepatocellular carcinomas often contain tumor cells of more than one histological grade. The clonal relationship and biological behavior of hepatocellular carcinoma cells in histologically heterogeneous areas have not been fully explored. We established two distinct human hepatocellular carcinoma cell lines (HAK-1A and 1B) from a single nodule showing a three-layered structure with a different histological grade in each layer. Morphologically, HAK-1A and 1B resembled well-differentiated hepatocellular carcinoma cells in the outer layer of the original tumor and poorly differentiated ones in the inner layer, respectively. HAK-1B appeared less differentiated morphologically and more aggressive biologically than HAK-1A; HAK-1B had a shorter doubling time, higher tumorigenicity and an aneuploid DNA index. Chromosome analysis revealed many different abnormalities in the two cell lines, in which, however, two identical structural abnormalities (2q+ and 17p+) were identified. Moreover, sequence analysis of the p53 gene showed identical mutations at codon 242 in both cell lines. These findings suggest that the two cell lines are of clonal origin and that hepatocellular carcinomas consisting of cancerous tissues of more than one histological grade may reflect clonal dedifferentiation in the tumor. Furthermore, we predict that a clonal, morphologically less differentiated subpopulation such as HAK-1B is more aggressive in proliferation and may be closely related to subsequent tumor progression in hepatocellular carcinoma.

Risk factors linked to tumor recurrence of human hepatocellular carcinoma after hepatic resection

A total of 238 patients who received curative hepatic resections during the last 10 yr were observed to search for the risk factors linked to early tumor recurrence of human hepatocellular carcinoma after hepatectomy. The results revealed that tumor size, tumor appearance and DNA ploidy were the factors in predicting tumor recurrence after resection for hepatocellular carcinoma. Patients with a tumor size less than or equal to 5 cm or a tumor appearance of the solitary type had better disease-free survival than did those with a tumor size greater than 5 cm or a tumor appearance of multiple/daughter nodule types (p < 0.05). Although patients with pattern III (aneuploid with > or = 2 G0/G1 peaks) hepatoma had fewer statistically significant differences (p = 0.19) than did those with pattern I (diploid) or pattern II (aneuploid with single G0/G1 peak) tumors in predicting tumor recurrence, they did have poorer results in terms of the overall survival rate (p < 0.05). We conclude that patients with hepatocellular carcinoma having the aforementioned risk factors should be observed closely.

Flow cytometric analysis of the nuclear DNA content of hepatoblastoma

The nuclear DNA content of 15 hepatoblastoma cases was determined in paraffin-embedded tissues by flow cytometry. The DNA index (DI) was calculated, and the ploidy pattern of nuclear DNA was estimated. The correlation between the ploidy pattern and clinicopathologic findings was studied, and the prognostic significance of the ploidy pattern was investigated. An aneuploid pattern was seen in 50% of the lesions with histologic embryonal and anaplastic types. It was not seen in the fetal type. In the tumors with combined epithelial components, the fetal-type component had a diploid pattern in all five cases. The embryonal-type component was associated with aneuploidy in two of five cases. In aneuploid tumors, vascular invasion (tumor emboli in the vessels) was observed more frequently. The prognosis of the patients with an aneuploid tumor was significantly poorer. These results indicate that nuclear DNA ploidy pattern analysis might be useful in investigating the prognosis of hepatoblastoma.

A case report of hepatocellular carcinoma within adenomatous hyperplasia: is adenomatous hyperplasia a precancerous lesion or not?

It is controversial whether adenomatous hyperplasia (AH) of the liver progresses to hepatocellular carcinoma. We experienced two hepatic lesions in a patient (73-yr-old male) with cirrhotic liver. One was diagnosed as HCC and the other was AH including a small HCC histologically. To investigate cell kinetics and the ploidy pattern of these lesions, Feulgen DNA-cytofluorometry analysis was performed. The result of this analysis suggested that AH developed into extremely well-differentiated HCC composed of mononuclear diploid cells at first and then was further transformed into clear cell type HCC composed of mononuclear tetraploid cells. The development of human HCC, at least in cirrhotic liver, may therefore be a multi-step process.

Flow cytometric DNA analysis of hepatocellular carcinoma

The prognostic value of nuclear DNA content was studied retrospectively using flow cytometry in 203 cases of resected hepatocellular carcinoma. The occurrence of DNA aneuploidy, which was detected in 50% of patients, correlated significantly with tumor size and the presence of vascular invasion or intrahepatic metastasis. Overall, patients with DNA aneuploid tumors had a significantly worse prognosis than those with DNA diploid tumors (P less than 0.001) and, also in subdivided groups by tumor size (P less than 0.01). Among DNA aneuploid patients, the survival times were significantly shorter for patients with a low DNA index (less than 1.5) than for those with a high DNA index (greater than or equal to 1.5) (P less than 0.05). In a Cox multivariate analysis, nuclear DNA content provided significant prognostic value (P = 0.008), as did vascular invasion (P = 0.001) and intrahepatic metastasis (P = 0.005). These results indicated that nuclear DNA content has an important prognostic value in hepatocellular carcinoma.