Image analysis of Ag-NOR proteins in transitional cell bladder cancer

Proliferative activity is the most significant predictor of recurrence in noninvasive papillary urothelial neoplasms of low malignant potential and grade 1 papillary carcinomas of the bladder

BACKGROUND

Recurrence of transitional cell carcinoma of the bladder cannot be predicted accurately by traditional criteria alone. This study examined the value of cell proliferative activity, morphometry, and expression of p53, c-erbB-2, and bcl-2 oncogenes in predicting recurrence of superficial papillary urothelial neoplasms of low malignant potential (LMP) and Grade 1 (G1) papillary carcinomas of the bladder.

METHODS

Sixty-two patients (mean age, 62 years) with newly diagnosed superficial pTa bladder tumors (19 LMP, and 43 G1) were analyzed retrospectively. All patients underwent transurethral resection (TUR). Median follow-up was 69 months. Serial sections from formalin-fixed, paraffin-embedded material at initial TUR were stained with monoclonal antibodies (MoAbs) DO7, CB11, and bcl-2-124. Cell proliferation was assessed by MIB-1 MoAb, the quantity of argyrophilic nucleolar organizer region-associated proteins (AgNORs), and mitotic count.

RESULTS

Of the 62 patients, 42 (67.7%) had one or more recurrences. Recurrence rates were higher in MIB-1 (P < 0.0001) and p53 immunopositive cases (P = 0.02), when the mitotic count was greater than 5 (P = 0.004), and in G1 carcinomas (P = 0.04). In univariate analysis, the disease-free period was shorter for MIB-1 (P < 0.0001) and p53 immunopositive (P = 0.0001) cases, for cases with high AgNOR quantity (P = 0.04), mitotic count greater than 5 (P = 0.01), and in G1 carcinomas (P = 0.002). In multivariate analysis, only MIB-1 immunoreactivity retained independent prognostic significance.

CONCLUSIONS

Despite the small cohort, the results confirm the prognostic value of cell proliferation and p53 expression in patients with bladder neoplasms. The results also indicate that MIB-1 immunopositivity is the most significant predictor of recurrence and disease-free survival in superficial LMP and G1 papillary bladder carcinomas.

Gallbladder carcinoma: a video image analysis of AgNOR distribution and its relation to tumour stage and grade

The amount and distribution of interphase argyrophilic nucleolar organizer regions (AgNORs) was studied in 51 gallbladder surgical specimens including 32 primary carcinomas, 10 adenomas and 9 cases of chronic cholecystitis with calculi. The mean nuclear AgNOR area (NORA) and the AgNOR distribution score (NORDS), i.e. the percentage of cells carrying nucleolar aggregates with more than 6 distinct silver dots, were evaluated in 200 epithelial nuclei per specimen by means of automated image analysis and direct counting respectively. Statistical analysis (variance analysis and Student-Neuman-Keuls' test) performed on the pooled mean AgNOR values showed a significant difference (p < 0.001) between carcinomas and non-carcinomatous lesions. Both NORA and NORDS highly discriminated carcinomas with histopathological grade 4 versus cases with grade 1, 2 or 3 (p < 0.001); a less statistically significative p value (< 0.05) was encountered when NORDS values of well differentiated grade 1 carcinomas and adenomas were compared. The NORA parameter permitted the discrimination of stage IV versus stage I carcinomas (p < 0.001), while carcinomas in stage IV and those in stage II were distinguished with a p < 0.05; the NORDS parameter allowed also to distinguish stage IV from both stage I or II tumours (p < 0.001). Our results indicate that the above-mentioned AgNOR parameters may be utilized as additional, more objective quantitative criteria in the clinical-pathological assessment of the outcome of gallbladder carcinomas.

Argyrophilic nucleolar organizer region (AgNOR) area per nucleus as a prognostic factor in breast cancer

Whether argyrophilic nucleolar organizer region (AgNOR) is a predictor of prognosis in breast cancer is controversial. The semiquantitative procedure used to calculate interphasic argyrophilic dots optically is neither reliable nor reproducible. We measured the mean area of AgNOR dots, the mean AgNOR area per nucleus (MA), and the mean AgNOR number per nucleus (MN) by automated image analysis in specimens from 131 patients with breast cancer. Higher MA (> 7.41 microns2), detected in 22 (16.8%) of 131 patients, did not correlate with clinicobiologic variables, except for DNA ploidy status. Overall survival was significantly better in patients with lower MA than in those with higher MA. On multivariate analysis, MA was a significant independent factor, followed by nodal status. These findings indicate that expression of AgNOR should be evaluated in terms of area occupied and that the mean area of AgNOR per nucleus (MA) is an important prognostic factor in the overall survival of breast cancer patients.

Correlation of Ag-NOR protein measurements with prognosis in canine transmissible venereal tumour

Ten canine transmissible venereal tumour (TVT) cases were studied by digital image analysis quantification on sections stained with silver to demonstrate nucleolar organizer regions (Ag-NORs). In each animal, 100 neoplastic cells were randomly selected for evaluation. The following parameters were measured or calculated: area of nucleus, area of Ag-NOR dot, the mean number of Ag-NOR dots per nucleus, the mean area of Ag-NOR dots per nucleus and the ratio of mean nuclear dot area to nuclear area. All 10 cases were treated with vincristine at a dose of 0.6 mg/m2 intravenously once a week. Two, which showed malignant characteristics (i.e. uncontrolled growth, local invasion or metastasis), did not respond to multiple (12) treatments and had a fatal outcome. Of the remaining eight cases, seven responded to two to six treatments and one required 12 treatments. The average number of Ag-NORs per nucleus and the area of Ag-NORs per nucleus were lower in the seven cases that responded to two to six treatments than in the other three cases, but the difference was not significant. However, there was a significant difference in the ratios of Ag-NOR area to nuclear area between the two groups of cases. Thus, poor prognosis was (1) possibly correlated with an increase in the mean number of Ag-NORs per nucleus and an increase in the mean area of Ag-NORs per nucleus, and (2) definitely correlated with an increase in the mean ratio of Ag-NOR area to nuclear area.

Espressione di oncogeni di proliferazione e morte cellulare nel carcinoma superficiale della vescica: Expression of oncogenes in relation to cell proliferation and death in superficial bladder carcinoma

Although superficial bladder cancer may be considered “benign”, it is still today a many-sided neoplasm with a prognosis that cannot be well-defined with known traditional parameters. Proliferation indices Ki67 and AgNOR associated with the expression of some oncogenes (p53, Rb, c-myc, BCL2, c-erbB-2) in relation to traditional parameters could help in the prognosis definition of individual patients. 111 patients with superficial bladder cancer were studied for this purpose, relating the grade, stage, follow-up and morphotype to the proliferation indices. Significant correlations were found with AgNOR, but only for grade with Ki67. The study of the oncoproteins and their different expression showed that those alterations typical of infiltration are already present in the superficial forms, with a significant correlation between oncogenic alterations and grade and stage of disease (p53, Rb) on the one hand, and above all of disease-free interval and progression (c-erbB-2) on the other. Lastly, assessment of the oncoproteins c-myc and BCL2, oncogenes connected with the programmed cell death mechanism (apoptosis), showed important correlations with the neoplastic progression of disease in relation to the p53 expression and proliferative activity.

Argyrophilic nucleolar organizer regions may help the differential diagnostic distinction between chronic pancreatitis and pancreatic ductal adenocarcinoma

BACKGROUND

The aim of this study was to determine whether the number of argyrophilic nucleolar organizer regions (AgNORs) could be of diagnostic significance in differentiating between chronic pancreatitis and pancreatic ductal adenocarcinoma.

METHODS

The number of AgNORs was enumerated in biopsy specimens of normal pancreas, chronic pancreatitis, and pancreatic ductal adenocarcinoma.

RESULTS

The number of AgNORs was lower in patients with normal pancreas than in patients with chronic pancreatitis or pancreatic adenocarcinoma. In addition, the number of AgNORs was significantly lower in chronic pancreatitis than in pancreatic ductal adenocarcinoma (p < 0.001).

CONCLUSIONS

The diagnosis of pancreatic adenocarcinoma is usually clear. Difficulties can be encountered, however, in cases of chronic pancreatitis, specially when biopsy material is small. Our results suggest that the number of AgNORs may help in distinguishing between chronic pancreatitis and pancreatic ductal adenocarcinoma, especially in diagnostically difficult specimens.