Correlation of chromosome counts with histological appearances and prognosis in transitional-cell carcinoma of bladder

Speciation Theory of Carcinogenesis Explains Karyotypic Individuality and Long Latencies of Cancers

It has been known for over 100 years that cancers have individual karyotypes and arise only years to decades after initiating carcinogens. However, there is still no coherent theory to explain these definitive characteristics of cancer. The prevailing mutation theory holds that cancers are late because the primary cell must accumulate 3–8 causative mutations to become carcinogenic and that mutations, which induce chromosomal instability (CIN), generate the individual karyotypes of cancers. However, since there is still no proven set of mutations that transforms a normal to a cancer cell, we have recently advanced the theory that carcinogenesis is a form of speciation. This theory predicts carcinogens initiate cancer by inducing aneuploidy, which automatically unbalances thousands of genes and thus catalyzes chain-reactions of progressive aneuploidizations. Over time, these aneuploidizations have two endpoints, either non-viable karyotypes or very rarely karyotypes of new autonomous and immortal cancers. Cancer karyotypes are immortalized despite destabilizing congenital aneuploidy by clonal selections for autonomy—similar to those of conventional species. This theory predicts that the very low probability of converting the karyotype of a normal cell to that of a new autonomous cancer species by random aneuploidizations is the reason for the karyotypic individuality of new cancers and for the long latencies from carcinogens to cancers. In testing this theory, we observed: (1) Addition of mutagenic and non-mutagenic carcinogens to normal human and rat cells generated progressive aneuploidizations months before neoplastic transformation. (2) Sub-cloning of a neoplastic rat clone revealed heritable individual karyotypes, rather than the non-heritable karyotypes predicted by the CIN theory. (3) Analyses of neoplastic and preneoplastic karyotypes unexpectedly identified karyotypes with sets of 3–12 new marker chromosomes without detectable intermediates, consistent with single-step origins. We conclude that the speciation theory explains logically the long latencies from carcinogen exposure and the individuality of cancers. In addition, the theory supports the single-step origins of cancers, because karyotypic autonomy is all-or-nothing. Accordingly, we propose that preneoplastic aneuploidy and clonal neoplastic karyotypes provide more reliable therapeutic indications than current analyses of thousands of mutations.

Alteration of the LRP1B gene region is associated with high grade of urothelial cancer

We have delineated regions of interest at chromosome 2q21.2, 2q36.3, and 2q37.1 by deletion mapping of 114 urothelial cancers (UC). Altogether, 17%, 18%, and 63% of the G1, G2, and G3 tumors displayed loss of heterozygosity at chromosome 2q, respectively, The region at 2q21.2 was narrowed down to the LRP1B gene (NT_005129.6). Hemi- and homozygous deletion at the LRP1B gene region was seen in 31 of 114 UCs. Only 8% of the UCs with G1 and none with G2 tumors showed loss of heterozygosity at the LRP1B gene, whereas 49% of the G3 UCs had allelic loss at this region. RT-PCR analysis of the LRP1B gene showed the lack of expression of several exons in 2 of 9 cases analyzed. Our analysis suggests that the LRP1B gene is a candidate tumor suppressor gene in UCs.

La citogenetica e la genetica molecolare nella prognosi del carcinoma della vescica: Cytogenetics and molecular genetics in bladder carcinoma prognosis

The use of cytogenetics in the characterization of bladder tumours has made it possible to demonstrate that chromosomal alterations are correlated with stage and grade of the tumour and have a predictive value as regards both tumour recurrences and progression. In the last decade the chromosomes involved in the main aberrations have been identified, and a negative prognostic significance has been suggested for some chromosomal aberrations. The knowledge of cytogenetics has been deepened by the sophisticated methods of molecular genetics, that have discovered many oncogenes and suppressor genes probably involved in the development of bladder tumours. The most characteristic molecular alterations of these tumours are losses of genetic information on chromosomes 9, 11 and 17, as a consequence of deletions and/or mutations. Such alterations probably cause the loss and/or the inactivation of suppressor genes (partly hypothetic still) and could represent important predictive factors of tumour progression.

Cytogenetic findings in pituitary adenoma: results of a pilot study

Pituitary adenomas are the most common tumors of the sellar region and are, with rare exception, benign neoplasms. The natural history of these lesions is only poorly understood and, although histologic, immunocytologic, and ultrastructural characteristics have been well established, predicting the natural history of individual tumors is, at best, unreliable. In an effort to better characterize pituitary adenomas, we have analyzed the karyotypes of 18 surgical specimens and attempted to correlate with the morphologic appearance and the clinical data, for example, endocrinologic subtypes, histology, and tumor invasiveness. Most hormonal subtypes were studied including seven growth hormone-prolactin (GH-PRL), two Prolactin (PRL), two Adrenocorticotrophin (ACTH), seven nonsecretory (NULL). No correlations with morphology or invasiveness could be made. Of 7 null cell adenomas, five (71%) had normal karyotypes, whereas of 11 hormone-secreting adenomas three (28%) were normal. Of seven tumors with mixed GH-PRL activity, six had abnormal karyotypes. At least three chromosomes harbored abnormalities shared by more than two tumors. The results demonstrate that chromosome abnormalities are also found in benign tumors. These findings, however, suggest that hormone-secreting adenomas may be more likely to be associated with karyotypic abnormalities especially those of the GH-PRL variety. Genetic abnormalities associated with chromosomes 1, 4, 7, and 19 were common and warrant further investigation.

Binding of wheat and peanut lectins to human transitional cell carcinomas. Correlation with histopathologic grade, invasion, and DNA ploidy

The binding of peanut (PNA) and wheat germ (WGA) lectins to tissue sections was examined in biopsy specimens from normal urothelium (ten patients) and from tumor tissue of noninvasive (17 patients) and invasive bladder (31 patients) carcinomas. The results were correlated to DNA content, histopathologic grade, and the presence or absence of invasion. Significant alterations in lectin binding associated with the development of cancer were found. A gradual loss of both PNA and WGA binding was found to correlate with higher grades of atypia (P less than 0.001). The loss of WGA binding was significantly correlated with both tumor aneuploidy (P less than 0.001) and the presence of invasion (P less than 0.05), whereas no significant correlation was found between loss of PNA binding and these variables. We concluded that the loss of WGA binding structures associated with bladder cancer shows a better correlation with known risk factors (aneuploidy and invasion) than the loss of PNA binding does.

Comparison of quantitative and classic prognosticators in urinary bladder carcinoma. A multivariate analysis of DNA flow cytometric, nuclear morphometric and clinicopathological features

The prognostic value of nuclear morphometry and DNA flow cytometry of paraffin embedded material of 58 patients with primary and untreated transitional cell carcinoma of the bladder was compared with that of histological grade (WHO-system), tumour stage (TNM-classification), tumour size, multiplicity and ulceration. Small nuclear size (mean nuclear area less than or equal to 95 microns2) (n = 25) and DNA diploidy (n = 28) indicated a favourable outcome (5-year survival 95.8% and 92.2%); large nuclei (mean nuclear area greater than 95 microns2) (n = 33) and DNA aneuploidy (n = 30) indicated a worse prognosis (5-year survival 61.4% and 62.5%) (Mantel-Cox; p = 0.002 and p = 0.007). The quantitative techniques had the advantage over subjective histological grading that distinguishment of an intermediate patient group (WHO-system: grade 2; n = 32) with heterogeneous outcome (5-year survival 78%) was avoided. Multivariate analysis showed tumour stage as the most important prognosticator of survival. Neither the quantitative techniques, nor the other classic features added significantly to the prediction. The additional value of the quantitative techniques was however shown in superficial carcinoma (TNM-classification: stage Ta and T1; n = 37); large nuclei (mean nuclear area greater than 95 microns2) (n = 15) and aneuploid DNA peaks (n = 13) were associated with progressive recurrent tumour (n = 7) (Mantel-Cox: p = 0.03 and p = 0.0004). The quantitative methods thus indicate which patients are at risk for progression and may enable more appropriate treatment at an earlier stage of disease.

The importance of marker chromosomes in superficial transitional cell carcinoma of the bladder: 50 patients followed up to 17 years

Several tenets based on cytogenetic analysis have been developed for noninvasive and submucosal invasive carcinoma of the bladder. In noninvasive carcinoma absence of marker chromosomes (abnormal morphological forms) forecasts a 90 per cent post-resection cure. In submucosal invasive carcinoma marker chromosomes are valuable prognostic aids. Original marker chromosomes are neither replaced nor supplemented by a different marker in recurrences. To test these tenets the cytogenetics of 50 selected carcinomas of the bladder (37 noninvasive and 13 submucosal invasive) from patients followed for up to 17 years from 1968 through 1985 were tabulated. In noninvasive carcinoma absence of markers, prognostic of long-term remission, does not rule out ultimate recurrence. In submucosal invasive carcinoma the markers, commonly present, only confirm the prognosis inherent in histopathology. In recurrences the original marker chromosomes are commonly repeated but they may be added to or replaced.

Dual-parameter flow cytometry of transitional cell carcinomas. Quantitation of DNA content and binding of carbohydrate ligands in cellular subpopulations

Quantitative DNA measurements and estimates of blood group-related carbohydrate antigen expression have been used as predictive parameters in transitional cell carcinomas (Ca). To obtain an accurate quantitative characterization of cellular subpopulations on the basis of these parameters, the authors developed a dual-parameter flow cytometric method using a fluorescence-activated cell sorter. With this method single-cell suspensions from 26 transitional cell carcinomas were analyzed by means of propidium iodide (red fluorescence) as DNA ligand, and peanut agglutinin (PNA), wheat germ agglutinin (WGA), and anti-blood group A antibody (aBGA) as carbohydrate ligands. The latter ligands were visualized directly or indirectly by FITC (green fluorescence). The carbohydrate ligand binding was correlated to the DNA content of cell populations in the way that aneuploid populations showed a higher PNA binding (P less than 0.0002) and a lower WGA (P less than 0.01) and aBGA (P less than 0.04) binding than did diploid cell populations. The binding of PNA to aneuploid populations could be further increased (P less than 0.004) by neuraminidase treatments. Thus, aneuploid cells express both neuraminic acid substituted and unsubstituted PNA receptors. The carbohydrate ligand binding was cell cycle-dependent, as it was reduced (less than 0.008) in the G2-M phase. A low WGA (P less than 0.004) or aBGA (P less than 0.02) binding was correlated to tissue invasion. Immunohistochemistry with the carbohydrate ligands showed a good correlation between aBGA (P less than 0.0005) and PNA (P less than 0.004) binding to tumor cells and flow cytometric assay of these, as well as a correlation (P less than 0.003) between cellular location of WGA receptors and flow cytometric assay of these. It seems that dual-parameter flow cytometry represents an important tool in the characterization of bladder tumors.

Grading in superficial bladder cancer. (2). Cytogenetic classification

Cytogenic analysis was performed in 92 newly diagnosed transitional cell bladder carcinomas and the results were correlated with the clinical course in superficial tumours. Low grade tumours appeared to have hypodiploid or peridiploid chromosomal numbers. Intermediate grade tumours were characterised by chromosomal counts up to the hyperdiploid range but could have a peridiploid modal number. In high grade tumours the modal number was hyperdiploid. The range in chromosomal counts appeared to be more reliable than the modal number as a predictor of the course of superficial tumours. The significant difference in chromosome numbers between low, intermediate and high grade tumours indicates that grading reflects major cytogenetic changes in the tumour cells.

Retrospective study of prognostic importance of DNA flow cytometry of urinary bladder carcinoma

Cellular DNA content was determined by flow cytometry on routinely processed paraffin sections of 61 primary and untreated transitional cell carcinomas of the urinary bladder, and correlated with tumour grade and stage and clinical follow up. All 16 (25%) grade 1 carcinomas were diploid and all 11 (20%) grade 3 tumours were aneuploid. The 34 (55%) grade 2 carcinomas comprised 13 (40%) diploid and 21 (60%) aneuploid cases. Among the 37 superficial carcinomas (stage Ta and T1), 25 (65%) were diploid; 20 (85%) of the 24 advanced tumours (stage T2 to T4) had aneuploid tracings. Ploidy was a significant prognostic indicator (p: 0.006) of five year survival. The initial presence of aneuploidy in superficial bladder carcinoma (stage Ta and T1) is a strong argument for more aggressive treatment than is customary.

Tissue-specific markers in flow cytometry of urological cancers. III. Comparing chromosomal and flow cytometric DNA analysis of bladder tumors

Thirty-seven transitional-cell carcinomas (TCC) of the urinary bladder were analyzed by DNA flow cytometry (FCM). After labelling of the cell suspensions with antibodies to cytokeratin, the cytokeratin-positive cells and the non-epithelial cytokeratin-negative cells could be analyzed separately. After estimation of S- and G2M phase, 3/17 cases (18%) with a normal DNA index showed elevated proliferative levels, among cytokeratin-labelled suspensions only. Of these 17 cases, 14 showed chromosomal abnormalities. The remaining 20 cases were abnormal, irrespective of the technique used. Although immuno-labeling of tumor cells for cytokeratin in FCM increases the sensitivity of this method in detecting aneuploid tumors or tumors with high proliferation fractions, the discriminating power of chromosomal analysis of TCC is greater than FCM.

Cytogenetic analysis in urothelial cell carcinoma

Tissue specimens from 96 patients with urothelial cell carcinoma were subjected to cytogenetic examination to determine whether there is a correlation between chromosomal abnormalities and tumor behavior. Recognizable metaphases were found in 43 patients (45 per cent). The range in chromosomal counts appeared to be a better reflection of invasion than the modal number. Noninvasive tumors nearly always were hypodiploid or diploid. All invasive tumors showed hyperploid cells. Cytogenetically, there was no difference between invasive grade 2 and grade 3 tumors. During our limited followup tumor progression was found only in tumors with hyperploid cells. With a direct technique we found no difference in the frequency of marker chromosomes according to tumor stage and grade.

Chromosome changes in bladder cancer: clinical and other correlations

The chromosome changes in bladder cancer are reviewed with particular emphasis on the application of recent advances in techniques for cytogenetic analyses of bladder cancer and the establishment of nonrandom (specific) karyotypic changes characterizing a significant number of bladder cancers. At present, these groups are characterized by one of the following cytogenetic changes: i(5p), +7, or -9. The results are discussed in relation to the significance of these changes and possible involvement of some oncogenes and other gene loci.

Heterogeneity index score (HIS). New computerized method for classification of human bladder carcinomas using flow cytometry

The rationale for studying nuclear DNA may be its direct relationship to the aggressiveness of cancer. Recent flow cytometric studies (FCM) of cancer cells show the limitation of the current methods for the accurate determination of the degree of aneuploidy or proliferative characteristics of a tumor cell. Here we report a new methodology for a computerized determination which is well correlated with relative mean DNA content in cell populations analyzed by FCM (heterogeneity index, HI). A total of seventy-six tissue samples were examined. Twenty-two specimens were benign tissue while fifty-four were histologically malignant bladder tumors. Forty tumors were grade (G)I-II, ten G-III, and four carcinoma in situ. The samples were mechanically minced into a single cell suspension and stained with propidium iodide. An Ortho system 50-H multiparameter flow cytometer equipped with an Ortho 2150 computer was used to determine DNA content and cell number. HI was calculated using the following formulas: (formula; see text) The mean HIS of twenty-two normal and benign tissues was 9.805 +/- 5.6. The forty G-II tumors had a mean HIS of 23.576 +/- 26.519. Statistical differences were observed between benign tissue and G-I-II tumors (P = 0.0196). G-III tumors had a marked increase in HIS of 160.965 +/- 63.404. The limited study of four carcinoma in situ tumors showed a mean HIS of 45.4 +/- 9.5. Our computer extrapolation of flow cytometric DNA analysis quantifies an objective description of FCM characteristics and histochemical index which may distinguish the degree of tumor malignancy.

Chromosomal analysis of bladder cancer: technical aspects

Of 77 patients with bladder carcinoma, 99 tissue specimens--including tissues of patients with recurrent tumors taken after radiotherapy or cytostatics--were subjected to chromosomal analysis. In 42 specimens, recognizable metaphases could be obtained after conventional Giemsa staining and in a smaller number after C- and/or G-banding. All except one had abnormalities of the chromosomes. Short-term cultures for 24-48 hr in RPMI 1640 plus 15% fetal calf serum plus penicillin-streptomycin gave better results than a direct technique (30 min in 0.075 M KCl + 0.1 microgram colcemid/ml at 37 degrees C, followed by fixation). In low stage/grade tumors the number of recognizable metaphases obtained after short-term cultures is lower than in higher stage/grade tissue specimens.

Analysis of DNA ploidy patterns of gastric carcinomas of Japanese

Ploidy patterns of gastric carcinomas of 54 Japanese patients, ranging in age from 28 to 82 years, were determined by cytofluorometry. The gastric cancers were divided into four basic ploidy patterns; the first pattern was a diploid mode, the second was a heteroploid mode, the third was a mosaic pattern of a diploid and a heteroploid mode, and the fourth was a mosaic of two or more different heteroploid modes. The incidence was 68.4%, 14.8%, 12.9%, and 3.7% in the first, second, third, and fourth patterns, respectively. All the cancers contained polyploid populations, whereas the early cancers tended to contain a lesser amount of polyploid cells than the advanced ones. Diffuse-type cancers and well-differentiated, intestinal-type adenocarcinomas were mostly unimodal cancers of the diploidy or heteroploidy, whereas poorly differentiated adenocarcinomas were often mosaic cancers of several different ploidies. There was no correlation between ploidy patterns and ages and sexes of patients. For 11 cases, labeling indices with 3H-thymidine were determined. Labeling indices of the intestinal-type and diffuse-type cancers were 12% to 27% and 7% to 19%, respectively.

Clinical and biological significance of aneuploidy in human tumours

Aneuploidy is a well recognised feature of human tumours, but the investigation of its biological and clinical significance has been hampered by technological constraints. Quantitative DNA analysis reflects the total chromosomal content of tumour cells and can now be determined rapidly and reliably using flow cytometry; this has resulted in renewed interest in its potential clinical applications. This article reviews the accumulating evidence that tumour ploidy reflects the biological behaviour of a large number of tumour types and that diploid tumours in particular have a relatively good prognosis. The measurement of tumour ploidy is likely to become a valuable adjunct to the clinical and histopathological assessment of cancers.

Chromosomal and DNA patterns in transitional cell bladder carcinoma. A comparative cytogenetic and flow-cytofluorometric DNA study

Biopsy tissue from 71 bladder tumors in 57 patients was studied by chromosome analysis and flow cytofluorometry. Chromosome analysis was hampered by preparation difficulties and was successful in only 53% of the analyzed tumors. DNA analysis failed to reveal near-diploid deviations, while the grossly aneuploid tumors generally had DNA values 10% to 15% above the numerical chromosome counts. Noninvasive tumors were diploid-near-diploid with occasional markers. Superficially invasive tumors were both diploid-near-diploid and near-tetraploid, but with a chromosome count of only 80 in the latter cases. Deeply invasive tumors tended to be triploid on DNA analysis, and had chromosome counts in the vicinity of 60. In addition to single chromosome abnormalities, increased malignancy apparently is also associated with an increased total number of chromosomes. A tetraploid DNA level seems to represent a more stable genome, although chromosomes show gross abnormalities including markers.

Cytogenetic analysis of 62 transitional cell bladder carcinomas

Chromosome analysis of biopsy material obtained after vinblastine pretreatment was carried out in 108 specimens from 89 patients with transitional cell carcinoma of the urinary bladder. Analyzable metaphases were obtained in 62 tumors, but only in nine tumors could karyotypes be analyzed by banding; a conventional technique was used in all others. Ploidy and occurrence of markers corresponded with tumor morphology and invasion and sometimes aided in the clinical evaluation; chromosome anomalies specific for bladder cancer were not revealed. In noninvasive tumors of WHO grade 1 and 2, near-diploid karyotypes with occasional marker chromosomes dominated. Grade 3 tumors showed a variety of grossly aneuploid karyotypes, with an almost constant occurrence of different markers. Superficially invasive G2 tumors had moderately pronounced aberrations with more deviations than non-invasive tumors but without the great variety of G3 tumors.

Invasiveness of transformed bladder epithelial cells

The invasiveness of bladder tumors has been studied in man, experimental animals, and in tissue culture by numerous authors. The prognostic importance of cellular markers for invasiveness is stressed, and the usefulness of histopathological and cytologic grading, cytogenetic studies, antigenic investigations, and enzymatic characterization is discussed. The invasiveness of bladder cells has frequently been examined in transplantation and explantation experiments. In human urothelial cell cultures three grades of transformation are defined, and a correlation has been established between the invasiveness of these cell lines in a three-dimensional in vitro model and their tumorigenicity in nude mice. The mechanism of tumor invasion is discussed, and it is recommended in future research to make a distinction between invasion en bloc and cellular infiltration.

Morphometric grading of bladder tumors in comparison with histologic grading by pathologists

The authors describe the results of the grading of bladder tumors using morphometry and then compare these with results of histologic grading of the same tumors by different pathologists. Nuclear sizes of cells obtained from superficial and deep cell layers of each carcinoma and from giant cells were measured in 27 cases in which histologic tumor grading by different pathologists was unequivocal. In cells from all three areas, nuclear area increased with higher tumor grade. However, tumors of grades I and II showed significant differences in the size only of the large cells. It is concluded that morphometry is a valuable tool in the objective grading of bladder tumors, with the exception of carcinoma in situ lining the bladder lumen.

Improved application of impulse cytophotometry for the diagnosis of urinary bladder carcinoma

Using pulse cytophotometry, almost quantitative separation of the leucocyte fraction from DNA histograms was possible by means of an anticoincidence discrimination device, This modified technique was employed for biparametric DNA/protein measurements of voided urine samples, bladder washings, and tumour tissues. The results show a high degree of correlation between these samples so that, for tumour diagnosis from DNA histograms, voided urine specimens can be used rather than bladder washings. The criteria for the bladder tumour diagnosis are derived from DNA measurements of 32 controls and 35 tumour patients. The diagnostic sensitivity of this method is 0.91 and the specificity 0.75.

The significance of ploidy and proliferation in the clinical and biological evaluation of bladder tumours: a study of 100 untreated cases

Cell material from 100 cases of newly diagnosed bladder tumours was studied with rapid flow cytofluorometric DNA analysis. The degree of ploidy and the percentage of cells in the S-phase characterising the proliferation pattern of the tumours were determined from DNA histograms. The results were related to the tumour categories and to the histopathological grading of the tumours. Approximately 40% of T1 tumours showed aneuploid DNA patterns, while in the other categories aneuploidy was found in almost all cases. With few exceptions, tumours of Grade 1 were found to be diploid and tumours of Grade 3 aneuploid. In tumours of Grade 2, two-thirds were found to be diploid and one-third aneuploid. In the group of aneuploid tumours the tetraploid cases exhibited the least malignant characteristics as judged by histological grades and tumour categories. The aneuploid non-tetraploid tumours increased in malignancy the more they deviated from tetraploidy. This might be explained by our observations of a positive correlation between the degree of ploidy and the degree of proliferation. The proliferation increased from 10% in tetraploid tumours to 20% in triploid and pentaploid tumours.

The prognostic value of DNA analysis in primary carcinoma in situ of the urinary bladder

20 patients with primary carcinoma in situ of the urinary bladder were studied by flow cytofluorometric DNA analysis (FCM). Aneuploidy, i.e. abnormal DNA pattern, was found in all cases. As a rule the aneuploid cell populations were found in the tri-tetraploid region, corresponding to 70--92 chromosomes in the tumour cell nuclei. In seven cases more than one aneuploid cell line was found. All these seven cases showed progression in the tumour disease within 2 years. By FCM it was also possible to determine the proliferation rate of the tumours and the relative number of aneuploid cells in each tumour cell sample. In progressive cases high values of these two variables were found.

Clinico-pathological significance of the DNA histogram patterns in cancer cell nuclei of the stomach and the esophagus

Cytofluorometric analysis of nuclear DNA content was performed in carcinoma cells of the stomach and the esophagus and the exclusive four types of the DNA histogram patterns were established. In 33 patients with carcinoma of the stomach 7 (87.5%) out of 8 with Type I and 3 (50%) out of 6 with Type II in the DNA histogram pattern were the superficial types of carcinomas. Eighteen (81.8%) out of 22 patients with advanced gastric carcinoma belonged to Type III or IV in the DNA histogram pattern and there was only one of the superficial spreading carcinoma seen in these Types. The superficial spreading carcinoma (Stout 10) is generally reported to take more favorable clinical course than the usual advanced ones and the above data were supported that the DNA histogram pattern was associated with prognostic important property of invasive growth. In 34 patients with carcinoma of the esophagus 4 out of 7 with Type I in the DNA histogram pattern have been living more than 3 years following surgery with poor lymphatic permeation (14.3%) around the tumor. While, 6 out of 9 with Type IV had an early recurrence of cancer causing postoperative death within a year after surgery with high incidence of lymphatic permeation (77.8%) around the tumor. Thus, the DNA histogram pattern in the cytofluorometric DNA analysis of the tumor cells seems to give valuable information about the malignancy degree of the individual tumor, which is not possible to obtain only from the cytomorphological features.

Chromosomal analysis as prognostic tool in transitional cell carcinoma: preliminary report

Twelve patients with transitional cell carcinomas were studied for chromosomal abnormalities correlated with cystoscopic and histologic findings. The tumors with abnormal chromosome "markers" or numbers (aneuploidy or polyploidy) appeared to be more aggressive or recurred more frequently than those with normal chromosome patterns.

Ploidy and proliferation in human bladder tumors as measured by flow-cytofluorometric DNA-analysis and its relations to histopathology and cytology

Biopsies from bladder tumors of 41 patients were investigated by flow-cytofluorometric DNA analysis and compared with exfoliated cells. The degrees of ploidy and proliferation were determined. Good agreement was found between the degrees of ploidy and proliferation in the biopsies and the exfoliated cell material. Tumors Grade I-II were either euploid or aneuploid. All Grade III tumors were aneuploid. The S-phase fractions were about 6% in the diploid tumors and 17% with large variations in the aneuploid tumors. The histological grading was well correlated to the number of S-phase cells and the occurrence of aneuploidy. When the Grade II tumors were divided into two groups having lesser and more pronounced atypia, the two groups differed significantly with regard to their degrees of proliferation. In addition to aneuploidy as an important criterium for malignancy, the degree of proliferation appears to be of major biological significance.

Tumor cell karyotypes in malignant melanoma

Fifteen malignant melanomas were subjected to chromosomal analysis, in order to determine whether the number of chromosomes in a tumor cell could be correlated to a clinical prognosis. The protocol involved a direct technique which utilized a Colcemid blockade of spindle formation in mitosis to allow study of metaphase chromosomes. The direct method was chosen to reveal chromosome changes in the tumor cell in situ rather than changes in the cultured cell. Two tumors yielded chromosome spreads which could be counted and correlated with a clinical prognosis. Failure to obtain other adequate chromosome spreads were accounted for by the presence of tissue necrosis and the absence of viable tumor cells.

Prognosis in early carcinoma of the bladder based on chromosomal analysis

In 53 cases of non-invasive or submucosal invasive well differentiated carcinoma of the bladder observed for 4 to 101 months cytogenetic analysis by the direct technique (non-culture) has been performed repeatedly. Markers, abnormal chromosomes, have been found in 33 patients and recurrence has developed in 32 of these 33 patients, resulting in 9 deaths. All but 1 of the 20 patients without markers have been observed for up to 8 years and have remained free of recurrence. In this 1 recurrence, 8 months post-diagnosis, the mode changed from 69 to 92, evidence of dedifferentiation and development of a new tumor in a bladder prone to neoplasia. Based on our over-all cytogenetic experience with 165 patients with carcinoma of the bladder a simplified classification is presented. This classification, built on measurable characteristics of early carcinoma, including the presence or absence of marker chromosomes, allows accurate prognostication and, thus, provides the foundation for development of standard therapy.

A cytochemical method of grading the malignancy of salivary gland tumours preoperatively

Aspiration biopsy is an accurate but still a somewhat controversial method of diagnosing salivary gland tumours preoperatively. During the last few years this method has been more and more accepted dependent on its increasing reliability in diagnosing the different types of tumours, but for an adequate treatment it is also important to know the malignancy degree of the individual tumour. Since invasiveness is the most significant morphological criterion in evaluating the prognosis of a salivary gland tumour it has, however, been difficult to grade the malignancy morphologically on a cytological basis. Thus the diagnostic value of the aspiration biopsy method would increase, if beside the morphological determination of the tumour type it was possible to find a cellular criterion which reflects the grade of malignancy. In the present investigation we have studied the nuclear DNA content in non-invasive tumours and invasive tumours. In general, invasive tumours were characterized by a higher degree of abnormality with respect to the DNA content than the non-invasive tumours. In two tumour types especially studied-mucoepidermoid carcinoma and acinic cell carcinoma-the property of non-invasive growth was found to be associated with a diploid or near-diploid DNA content, whereas invasive growth was associated with a triploid or near-triploid DNA content. These data suggest that the nuclear DNA Content may be related to the morphological differentiation and particularly to the invasive properties of the salivary gland tumours. Thus, cytophotometric DNA analysis of DNA content in the smears from aspirates might be valuable in grading the malignancy of the tumours preoperatively by aspiration biopsy.

Antigenic deletion and prognosis of patients with stage A transitional cell bladder carcinoma

The mixed cell agglutination reaction was studied in 22 patients with stage A transitional cell bladder tumors. The absence of antigens on the original tumor was found to correlate with development of invasive cancer on followup. The presence of antigens on the original tumor correlated with failure to develop stage B or greater disease within 5 to 14 years of followup.

The relationship between the nuclear DNA content in smears of aspirates and the prognosis of mucoepidermoid carcinoma

Cytophometric analysis of nuclear DNA content was performed in a series of mucoepidermoid carcinomas with an extreme difference in the clinical course, which was observed during a follow-up period of 6-13 years. The prerequisite for such a study was the development of a method, which made it possible to study the nuclear DNA content in tumour cells obtained at the time of diagnosis, i.e. 6-13 years ago in the present material. A special cytochemical procedure with destaining of the original Giemsa stain, refixation and subsequent Feulgen staining of the smears of aspirates in the original cytological material was developed. The cytophotometric nuclear DNA analysis of tumour cells in smears of aspirate from mucoepidermoid carcinomas showed that higher ploidy tumours (near-triploid) had a worse prognosis when compared with near-diploid tumours. These data are supported by our previous findings that a shift from a near-diploid to a near-triploid DNA content of the tumour cell nuclei was associated with the prognostic important property of invasive growth. Thus, the cytophotometric nuclear DNA analysis of aspirated tumour cells seems to give valuable information about the malignancy degree of the individual tumour, which is not possible to obtain only from the cytomorphological features.