Nucleolar organizer regions in patients with precancerous and cancerous lesions of the uterine cervix

Nucleolar organizer regions (AgNOR) and subepithelial vascularization as field cancerization markers in oral mucosa biopsies of alcoholic and smoking patients

OBJECTIVE

The aim of this study was to show that variations in nucleolar organizer regions (AgNOR) and the increase in subepithelial vascularization could reveal changes related to markers of field cancerization in alcoholic and smoking patients who have not yet expressed clinical or histological malignant lesions.

STUDY DESIGN

Quantitative variations in epithelial AgNOR and in the vascularization of the underlying connective tissue were assessed by image analysis in histologically normal biopsy specimens from alcohol drinkers and smoking patients (DS). AgNORs were evidenced by silver staining and vessel walls were labeled by immunohistochemical demonstration of the CD34 antigen. Samples of oral mucosa of nonalcoholic, nonsmoking patients (NDS) obtained during surgical procedures served as controls. Eight parameters related to number, volume, and shape of nuclei and AgNORs, and 4 parameters related to number and diameter of vascular sections were evaluated. Differences between DS and NDS groups were statistically evaluated by means of ANOVA test and posterior Bonferroni comparisons.

RESULTS

The morphometric analysis revealed more irregular-shaped AgNORs in the superficial and suprabasal layers of the oral mucosa of DS patients. The suprabasal layers also exhibited a significantly larger number of AgNORs. The normal oral mucosa of DS patients exhibited a greater vascular density, with predominance of small-caliber blood vessels underlying the basement membrane.

CONCLUSION

The variations in AgNOR and epithelial vascularization would be practical biomarkers to evaluate changes underlying the augmented risk of cancerization in oral mucosa.

Ag-NOR staining and satellite association in lymphoproliferative disorders

The nucleolar organizer regions (NORs) activity and the frequency of satellite associations (SA) in peripheral blood lymphocytes from patients with two chronic lymphoproliferative disorders were studied: 10 cases with B-cell chronic lymphocytic leukemia (B-CLL) and 10 with mycosis fungoides (MF). Thirteen healthy individuals formed the MF control group, and the oldest 7 constituted the B-CLL control group. The mean of Ag-NORs per metaphase was increased in B-CLL patients (8.80 +/- 0.63) compared with their controls (7.99 +/- 0.90) (P less than 0.025), meanwhile MF patients' value did not differ from their controls. In both disorders, the frequency of Ag-NORs in the G chromosomes was increased. The analysis of SA in B-CLL patients only revealed an increase in the frequency of cells with more than 4 ASPs (association pairs). Meanwhile, a significant higher mean of ASPs per cell in MF patients (1.74 +/- 0.41) compared to controls (1.40 +/- 0.24) (P less than 0.05) was observed. Furthermore, a close correlation between cells with complexes of 3 or more chromosomes and the mean of ASPs per cell was also found in MF. In conclusion, an increase of the Ag-NORs expression in B-CLL patients and a modification in the degree of SA in MF patients were found.

AgNOR are sensitive markers of radiation lesions in squamous epithelia

The possibility of detection of incipient cellular alterations is central to early diagnosis and to clinician's capacity to discriminate between samples that appear similar on routine preparations. We examined the value of silver-stained nucleolar organizer regions (AgNOR) in detecting radio-induced alterations in a model of squamous epithelium biologically similar to oral mucosa. Morphometry of AgNOR has been proven to be of value in the detection of incipient cellular alterations. This method allows for the quantitative evaluation of lesions induced by high doses of radiation long before they become apparent in routine preparations. We herein examine the capacity of AgNOR to reveal the response to low doses of radiation, closer to the therapeutic or accidental dose to which the epithelium of oral mucosa may be exposed.

Nucleolar organizer regions in parosteal and central osteosarcomas

Silver stained nucleolar organizer regions (AgNOR) have revealed differences in the biological behavior of certain entities. This study involves a morphometric analysis of AgNOR in 6 central, classic osteosarcomas and 6 parosteal osteosarcomas. There was a statistically significant difference in the number of AgNOR per nucleus between central and parosteal osteosarcomas. Single AgNOR volume was smaller in central osteosarcomas as compared to parosteal osteosarcomas. However, this difference did not reach statistical significance. The parameter AgNOR number per nucleus revealed a cut off value such that 100% of central osteosarcoma cases lay above this value and 100% of parosteal osteosarcoma cases lay below this value. AgNOR demonstration involves a simple technique which can be performed on formalin fixed, paraffin embedded file material. Thus, it may be prudent to routinely assess AgNOR as a contributor to the determination of the pathophysiology of osteosarcomas.

AgNOR mark epithelial foci in malignant transformation in hamster cheek pouch carcinogenesis

Hamster cheek pouch mucosa is an accepted model of oral carcinogenesis. We herein examined the value of morphometric evaluation of silver-stained nucleolar organizer regions (AgNOR) in the detection of epithelial foci in malignant transformation following dimethyl-1,2-benzanthracene-induced carcinogenesis of hamster cheek pouch. AgNOR-related parameters were analyzed at different stages of the process of carcinogenesis (control epithelium, epithelium with no unusual microscopic features, "dysplastic" epithelium, exophytic and endophytic carcinomas). Morphometric evaluation of AgNOR revealed incipient cellular alterations which were not evident in routine preparations and contributed to the characterization of different stages of carcinogenesis in this model.

Prognostic evaluation of HPV-associated precancerous and microinvasive carcinoma of the oral cavity: combined use of nucleolar organiser regions (AgNOR) and proliferating cell nuclear antigen (PCNA)

Nucleolar Organiser Regions (NORs) and Proliferating Cell Nuclear Antigen (PCNA) were investigated on routine paraffin embedded histologic sections of 30 oral biopsy specimens (six cases of leukoplakia with low-degree of dysplasia, nine cases of leukoplakia with moderate-degree of dysplasia, nine cases of leukoplakia with severe-degree of dysplasia, six cases of squamous microinvasive carcinomas), tested for HPV-DNA by in situ hybridisation (ISH). The absolute number of NORs per nucleus and the percentage of nuclear positivity for PCNA were found to be different in each group of pathology, with further diversity due to the presence or absence of HPV-DNA. In the major part of HPV-positive lesions, the AgNOR number and percentage of cells positive for PCNA were found to be generally lower than in corresponding negative forms. Conversely, a few cases of HPV+ lesions showed significantly higher values both of AgNOR and PCNA, if compared to the other cases of HPV+ and HPV- lesions. These data suggested that high values of AgNOR and PCNA, in moderate and high grade oral dysplasia, could represent an "alarm signal" of a worse prognosis, and then a possible indication for a strict clinical management and/or a stronger treatment of some HPV-associated preneoplastic lesions.

Nucleolar organizer regions as a marker of incipient transformation in a model of experimental carcinogenesis

Nucleolar organizer regions stained selectively with a silver colloid technique (AgNOR) were evaluated during the process of tumour promotion in the skin of mice. Tumour promotion and control skin samples were processed for identification of AgNOR by light microscopy and submitted to a morphometric study of the following AgNOR-related variables: nuclear area (V.NUC); AgNOR number per nucleus (N.NOR); single AgNOR area (V.NOR); total AgNOR area per nucleus (TV.NOR) and proportion of nucleus occupied by AgNOR (TV.NOR/V.NUC). N.NOR exhibited significant differences between control and tumour tissue, but in the promotion period, N.NOR did not exhibit a significant rise until week 24. V.NOR and TV.NOR rose significantly as early as 2 weeks after the onset of promotion when the cells fail to exhibit unusual microscopic features. The significant increase in AgNOR material at the beginning of the promotion period reveals the potential value of the variables assessed in the early quantitative evaluation of cellular alterations which could be linked to the probability of tumour development. Rise in AgNOR material would indicate transcriptional activation leading to an increase in protein synthesis and, ultimately, to the expression of an altered phenotype.

Nucleolar organizer regions in lining epithelium adjacent to squamous cell carcinoma of human oral mucosa

BACKGROUND

The value of silver staining of nucleolar organizer regions (AgNOR) counts as a diagnostic aid has been reported for several neoplastic entities. Previous studies have proved the value of the morphometric evaluation of AgNOR in the detection of incipient cellular alterations.

METHODS

A morphometric analysis of AgNORs was performed in oral mucosa epithelium adjacent to squamous cell carcinoma compared with normal mucosa epithelium and the carcinomatous parenchyma.

RESULTS

Highly statistically significant differences in all 5 AgNOR-related parameters assessed were found between normal mucosa and mucosa adjacent to cancer. Conversely, the corresponding nuclear parameters failed to exhibit significant differences. The parameter AgNOR contour index plotted for individual cases affords a cutoff value that could prove useful in identifying epithelia at early stages of transformation.

CONCLUSIONS

AgNOR evidenced significant variations in epithelium adjacent to oral squamous cell carcinoma, which did not exhibit morphologic signs of atypia. Based on this study, AgNOR would be a quantitative, discriminative aid, easy to monitor in a pathology laboratory, in detecting incipient cellular alterations. These findings contribute to the issue of early diagnosis and to the knowledge of tumoral growth.

Nucleolar organizer regions as markers of incipient cellular alterations in squamous epithelium

Transcriptionally active nucleolar organizer regions identified by silver staining (AgNOR) vary in number with cellular activity and/or malignant transformation and have been used as a diagnostic tool. A morphometric study of AgNORs was performed in an experimental model of irradiated squamous epithelium (Wistar rat sole skin) 4, 8, and 14 hours and 1, 2, 5, and 7 days post-irradiation with 50 Gy of x-rays. A statistically significant and progressive rise in AgNOR average volume of up to 238% and reduction in AgNOR number/nucleus of up to 40% were detected as a function of post-irradiation time. A statistically significant 46% increase in AgNOR volume was detected as early as 8 h post-irradiation, when no histological changes were observable in routine preparations. These results suggest that AgNORs may be useful as a quantitative marker of incipient changes in cellular activity and caution against the indiscriminate use of AgNORs in the follow-up of lesions which may have been exposed to radiotherapy. Furthermore, this study suggests the possibility of using AgNORs as a sensitive biological dosimeter in cases of uncontrolled exposure to radiation.

A correlation of argyrophilic nucleolar organizer regions with stages of hepatocellular carcinoma

BACKGROUND

Recently, the number and morphologic features of argyrophilic nucleolar organizer regions (AgNOR), silver-stained nucleolar organizer regions, were thought to reflect the cellular proliferative activity and the grade of malignancy. In liver diseases, it has been reported that AgNOR scores for hepatocellular carcinomas (HCC) were significantly higher than those for benign and borderline lesions; the scores increased with histologic tumor grade.

METHODS

Using the colloid silver staining technique to reveal AgNOR, 64 liver biopsy specimens with HCC were examined of which 14 had Stage I disease, 20 had Stage II, 14 had Stage III, 10 had Stage IVA, and 6 had Stage IVB (by International Union Against Cancer criteria).

RESULTS

AgNOR in nuclei were divided into two types. Type 1 (T1-NOR) contained large and medium-sized brown dots with well-defined margins. Nucleoli were included in this type. Type 2 (T2-NOR) had fine black single dots and clusters without well-defined margins outside T1-NOR, but within the nucleus. The size and irregularity of T1-NOR changed with the progress of cancerous stages. The increase in the number of T2-NOR contributed preponderantly to the overall increase in Ag-NOR scores.

CONCLUSIONS

These results suggest that HCC with smaller and/or irregular T1-NOR in combination with high T2-NOR scores have a more aggressive potential. AgNOR may be useful indicators for evaluating the progress of HCC.

Morphometric study of nucleolar organizer regions in human oral normal mucosa, papilloma and squamous cell carcinoma

A morphometric study of nucleolar organizer regions (NOR) was performed to analyze their distribution, volume, number and shape in the different strata of human normal oral mucosa epithelium and papilloma and in squamous cell carcinoma employing microphotographs of silver-stained paraffin sections. The different NOR-related parameters evidenced significant differences between normal mucosa, papilloma and squamous cell carcinoma. The functional polarity of normal mucosa epithelium and of papilloma is also evidenced in terms of NOR-related parameters. The discriminative value of certain NOR parameters was demonstrated.

Chromosome fragility in lymphocytes of women with cervical uterine lesions produced by human papillomavirus

We studied 30 women with cervical lesions that showed human papillomavirus infection (HPV). Cervical HPV infection was diagnosed by cytology, histology, immunohistochemistry, and electron microscopy, as well as by DNA viral hybridization in situ with 6, 11, 16, and 18 HPV types. Three groups of patients were studied: 15 women infected by HPV of 6 and 11 types with koilocytic lesions and benign evolution, 15 women infected by HPV of 16 and 18 types with koilocytic lesions and malignant evolution, and 15 normal women without cervical lesions who served as controls. For each group, chromosome fragility was studied in peripheral blood lymphocytes. Aphidicolin (AP) was used as a clastogenic agent at a concentration of 0.12 microM. There were significant differences (p less than 0.001) between the control population and the patients affected by HPV. There were also significant differences (p less than 0.001) between the two groups infected with HPV. Our findings support the concept that chromosome fragility could serve as a cytogenetic marker to measure evolution, prognosis, and treatment of cervical lesion associated with HPV.

Nucleolar organizer regions in Spitz nevi and malignant melanomas

Nucleolar organizer regions (NOR) are loops of DNA that transcribe ribosomal RNA; they can be easily identified in formalin fixed paraffin embedded tissue using a silver (Ag) method. It has been suggested that the number of AgNOR per cell can differentiate between benign and malignant melanocytic lesions of skin. We have studied 29 Spitz nevi (SN) and 39 invasive malignant melanomas (MM) by the same silver method. SN showed between 1.0 and 1.6 AgNOR per cell with a mean of 1.2. MM counts ranged from 1.2 to 4.2 with a mean of 2.0. It is concluded that the AgNOR method cannot reliably differentiate SN from MM; however, a count of more than 2.0 AgNOR per cell would favor a diagnosis of MM rather than SN.

Effect of differentiating agents on nucleolar organizer region activity in human melanoma cells

A human cell line established from a metastatic melanoma had both multiple numerical and structural chromosome aberrations including one to two copies of a submetacentric marker chromosome with an insertion of an active nucleolar organizer region (NOR). Treatment of this cell line with retinoic acid (RA) induced morphologic differentiation and reduced the cellular saturation density concomitant with a significant decrease in Ag-NOR activity. RA-treated cells grown in the absence of this differentiating agent, however, displayed a return to normal Ag-NOR activity, indicating the effect of this chemical on ribosomal genes is reversible.