A Study on the Role of Compensatory Hyperplasia in Renal Carcinogenesis with Dimethylnitrosamine in the Rat

Two experiments of renal carcinogenesis with dimethylnitrosamine (DMN) are described. In experiment I, the carcinogenicity of a single neonatal injection of DMN was compared in 34 intact rats and in 38 rats right-nephrectomized at 8–10 weeks of age. A total of 37 tumor-bearing kidneys were seen: both tubular and anaplastic; tumor incidence and time of observation showed no significant differences between intact and nephrectomized animals. Liver tumors were seen in 38 of 72 rats. In experiment II, 64 adult rats were given DMN in the drinking water for 2 weeks at a concentration corresponding to half an effective dose: 20 rats were used as non-nephrectomized controls; the others were right nephrectomized either on the 7th - 8th day of treatment with DMN or 15 days prior to the beginning of the treatment with the carcinogen. In no case did unilateral nephrectomy have a modifying effect upon carcinogenesis. In nephrectomized rats nonneoplastic nephritic changes were more severe than in intact animals. The design of the present experiments is compared with that of previous studies on the role of either partial hepatectomy or unilateral nephrectomy in carcinogenesis.

[Flow cytometry in prostate cancer. Evaluation of its feasibility for biopsy specimens and correlation with grading]

BACKGROUND

Pathologic staging and grading are the most important prognostic factors in prostatic cancer. Unfortunately, pathologic staging needs to be evaluated by surgical procedures; moreover, the proposed grading systems are largely based upon subjective histopathologic evaluations. In recent years, these problems have been approached with flow cytometry (FCM). The present study evaluates the significance of DNA ploidy of prostatic carcinoma assessed by FCM.

MATERIALS AND METHODS

Microscopic slides from 132 core needle biopsies and 22 surgical specimens of prostatic carcinoma were reviewed and classified according to Gleason's score modified by Epstein et al. Formalin-fixed, paraffin-embedded tissue samples were prepared for FCM evaluation using standard techniques. Adequate histograms were obtained from 113 biopsies (85.6%) and from all the surgical specimens (100%).

RESULTS

Among the 113 biopsy specimens, a statistically significant correlation was found between DNA ploidy and Epstein's grading, since high-grade neoplasms accounted for 40.38% of non-diploid cases and only for 21.33% of diploid cases (chi square = 5.8; p = 0.05). Moreover, tetraploid tumors were defined as a separate FCM category with an absolute prevalence (65.52%) of non-high grade neoplasms (chi square = 5.9; p = 0.05). Although not submitted to statistical analysis, data collected from surgical specimens showed similar distribution.

CONCLUSIONS

DNA ploidy assessment by FCM is a viable procedure in the majority of needle biopsy tissue samples of prostatic carcinoma; it may produce prognostic parameters with greater objectivity than conventional histologic grading.

Flow cytometric DNA analysis of cirrhotic liver cells in patients with hepatocellular carcinoma can provide a new prognostic factor

BACKGROUND

DNA flow cytometry of hepatocellular carcinoma (HCC) cells has been investigated in many studies, but, to the best of our knowledge, there are no data on DNA analysis of cirrhotic parenchyma around the HCC. In this study, cell kinetics and ploidy of parenchymal cells around HCC were performed to ascertain if this would predict the possibility of recurrence in the cirrhotic areas.

METHODS

The DNA content of 93 cases of HCC and of cirrhotic liver around the tumor nodules was analyzed by flow cytometry. Ploidy and proliferative index of HCC and cirrhotic liver were compared with macroscopic, histologic, and clinical features of each case and linked with the behavior of these tumors. Survival curves were assessed according to the Kaplan-Meier method. A multivariate analysis based on Cox proportional hazards regression model was performed on cases of diploid cirrhosis cells in which the S-phase fraction was evaluable.

RESULTS

The univariate analysis of survival suggested significant roles for age, number of intrahepatic nodules, Edmondson-Steiner's classification, portal invasion, vascular invasion, presence of necrosis, hepatitis B surface antigen, alpha-feto-protein, Child's score, ploidy, and S-phase fraction of HCC cells. The DNA analysis of the cirrhotic cells showed that polyploidy was dramatically reduced in patients with HCC, compared with normal hepatocytes, and aneuploid clones were present among diploid cells. High S-phase fraction of cirrhotic cells and Child-Pugh classification were the strongest independent parameters affecting the tumor behavior in this study.

CONCLUSIONS

The results of this study suggest that S-phase fraction of cirrhotic liver parenchyma may be employed as a new parameter in the prognostic evaluation of HCC patients.

Flow cytometric DNA analysis of cirrhotic liver cells in patients with hepatocellular carcinoma can provide a new prognostic factor

BACKGROUND

DNA flow cytometry of hepatocellular carcinoma (HCC) cells has been investigated in many studies, but, to the best of our knowledge, there are no data on DNA analysis of cirrhotic parenchyma around the HCC. In this study, cell kinetics and ploidy of parenchymal cells around HCC were performed to ascertain if this would predict the possibility of recurrence in the cirrhotic areas.

METHODS

The DNA content of 93 cases of HCC and of cirrhotic liver around the tumor nodules was analyzed by flow cytometry. Ploidy and proliferative index of HCC and cirrhotic liver were compared with macroscopic, histologic, and clinical features of each case and linked with the behavior of these tumors. Survival curves were assessed according to the Kaplan-Meier method. A multivariate analysis based on Cox proportional hazards regression model was performed on cases of diploid cirrhosis cells in which the S-phase fraction was evaluable.

RESULTS

The univariate analysis of survival suggested significant roles for age, number of intrahepatic nodules, Edmondson-Steiner's classification, portal invasion, vascular invasion, presence of necrosis, hepatitis B surface antigen, alpha-feto-protein, Child's score, ploidy, and S-phase fraction of HCC cells. The DNA analysis of the cirrhotic cells showed that polyploidy was dramatically reduced in patients with HCC, compared with normal hepatocytes, and aneuploid clones were present among diploid cells. High S-phase fraction of cirrhotic cells and Child-Pugh classification were the strongest independent parameters affecting the tumor behavior in this study.

CONCLUSIONS

The results of this study suggest that S-phase fraction of cirrhotic liver parenchyma may be employed as a new parameter in the prognostic evaluation of HCC patients.

[Prognostic factors in neuroblastoma. Usefulness of DNA analysis using flow cytometry on paraffin-embedded material]

Nuclear DNA content was determined on paraffin blocks of 28 neuroblastic tumors retrieved from Surgical Pathology files. In 26 cases cytofluorimetric analysis for DNA content was satisfactory. 8 tumor were diploid, 12 were aneuploid and 6 tetraploid. All but one of the children with diploid neuroblastoma (NB) died after a survival ranging from 14 to 32 months. The only surviving child had a Stage I thoracic ganglioneuroblastoma (GNB) and was alive after 27 months. Conversely 11 of 12 patients with aneuploid tumors were alive with prolonged follow-up. Two children are alive after a period exceeding 146 months. The only exception in this group of aneuploid tumors was a child with Stage IV neuroblastoma of the adrenal gland with pleuro pulmonary metastasis who died after 6 months. In the group with tetraploid tumors 3 patients died (2 children with Stage III and IV died early while the third, with thoracic Stage II GNB, survived for 72 months). Two patients with tetraploid GNB Stage II and III are alive 65 and 72 months after diagnosis respectively. Another child with Stage IV adrenal NB is alive after 14 months but with metastatic spread to bones, bone marrow and lymph nodes. Cox analysis of the cases demonstrated ploidy as an independent prognostic factor. These results are in agreement with other molecular analysis linking near-ploidy of Neuroblastic tumors to poor prognosis. Ploidy, as detected by flow cytometry for nuclear DNA content, may represent an important prognostic factor in Neuroblastic tumors. The advantage of flow cytometry over other techniques of molecular analysis is represented by the simple methodology suitable for fixed and paraffin embedded tissue, even on retrieval material.

[Utility and limitations of flow cytometry DNA content analysis in neoplastic cells]

A review of the literature concerning the analysis of nuclear DNA content by flow cytometry is made and it is compared with own experience. The advantages and the limits of this technique are examined. The practical problems in the interpretation of the histograms and the value of the measurements are discussed. The importance of this analysis in diagnosis and in staging of many tumors and the clinical involvements are emphasized. In many tumors DNA ploidy represents a new independent prognostic variable that is useful to separate the cases with a potential worse behaviour in an early stage, when other classic parameter are not available. It is also stressed the importance of flow cytometric DNA analysis of tumor cells. This is made on the same tissues that pathologists use for histopathological diagnosis and the results are important in many cases for a diagnostic accuracy.

Polyclonal lymphadenopathy presenting as plasma cell leukemia with reversible renal insufficiency

A case is reported of an elderly patient with generalized lymphadenopathy who, at presentation, showed a blood and bone marrow picture suggestive of plasma cell leukemia, polyclonal hypergammaglobulinemia restricted almost exclusively to IgA, and severe renal insufficiency. Treatment with melphalan and prednisone produced a complete remission that lasted only 1 month. A second partial remission was obtained, but the patient eventually died of heart failure. The pathological picture of the lymph nodes and spleen was intermediate between that of angioimmunoblastic lymphadenopathy (AIL) and of the plasma cell type of giant lymph node hyperplasia (Castleman's disease). The hypothesis is presented that AIL, Castleman's disease and many other polyclonal lymphadenopathies recently described in immunodeficient or elderly patients, including the present case, represent a continuous spectrum of lymphoproliferative disorders due to abnormal responses to various stimuli.