The relevance of the DNA index and proliferation rate in the grading of benign and malignant soft tissue tumors

Article Abstract:

An important job of the pathologist is to distinguish between benign and malignant tumors. However, pathologists also gain additional knowledge from tissue specimens that aids them in the classification of tumors, as well as in predicting clinical prognosis. In the case of soft tissue tumors, histopathological characteristics, such as tumor necrosis (cell death), mitotic score, or the number of cells in mitosis (a phase of cell division) on any microscopic field, and cellular differentiation, have all been shown to have significant prognostic value. Researchers investigating a variety of other tumors have demonstrated that cellular DNA content, an indicator of chromosome content, is also a significant prognostic factor. Soft tissue tumor specimens obtained from 8 benign and 46 malignant growths were investigated to determine the prognostic value of DNA content, cell cycle analysis, and cell proliferation. DNA content was measured by obtaining single-cell suspensions from tissue, staining with ethidium bromide, and analyzing with a flow cytometer. Cell cycle data was based on analysis of the flow cytometric data. A monoclonal antibody called Ki-67, which stains a protein associated with cell proliferation, was used to acquire data on that parameter. The results indicated that benign tumors were least likely to have increased quantities of DNA, and the probability that a growth would have increased DNA increased with the tumor grade. Benign tumors tended to have normal DNA, a high proportion of cells in the G1 phase of the cell cycle, and low staining with Ki-67. Low grade tumors had parameters similar to benign tumors, whereas high grade tumors had abnormal DNA quantities, a low proportion of cells in G1, and high staining with Ki-67. Somewhat surprisingly, although Ki-67 is associated with cell proliferation, it did not correlate with the number of observed mitoses in tissue sections. The evidence suggests that the parameters of DNA content, G1 cell cycle phase, and Ki-67 staining are independent and useful additions to classic tumor grading systems, and the authors propose a supplementary grading system for that purpose. (Consumer Summary produced by Reliance Medical Information, Inc.)

Identification and classification, Tumors

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Diffuse sclerosing variant of papillary carcinoma of the thyroid: clinical importance, surgical treatment, and follow-up study

Article Abstract:

Diffuse sclerosing (excessive fibrous tissue growth) variant of papillary carcinoma of the thyroid is uncommon among papillary carcinomas (characterized by small raised protrusions), although the variant is not rare when only young women are considered. Since the prognosis for this variant is excellent, it is imperative that the condition be promptly and accurately diagnosed. The authors discuss the characteristics of the diffuse sclerosing variant as seen in 14 women, all less than 29 years of age. Autoantibodies against thyroglobulin are common among such patients, and 7 of 10 tested in the present series were positive. It is possible to misdiagnose the condition as Hashimoto's thyroiditis, which was the case in four patients. Another patient had been misdiagnosed with Grave's disease. One of the features of the diffuse sclerosing variant is the presence of psammoma bodies, which may be seen both radiologically and on biopsy. Psammoma bodies are layered calcium concretions which build up around cells. These grainy pathological features get their name from the Greek word for sand. Treatment of diffuse sclerosing papillary carcinoma requires the surgical removal of the entire thyroid; it may be possible to prevent chronic hypoparathyroidism by removing the parathyroid glands from the affected thyroid and reimplanting at least two. Unfortunately, the tumor may invade the laryngeal nerve in the later stages and damage to this nerve is unavoidable if surgery is not carried out prior to the invasion of the nerve. In the present series, all 14 patients are alive and well at an average follow-up of 16 years. These results suggest that conservative surgery should be attempted to preserve function and cosmetic appearance as far as possible; such conservative surgery requires that the diagnosis be made early and that the condition is not mistaken for other thyroid disorders. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Case studies, Diagnosis, Thyroid gland, Diagnosis, Differential, Differential diagnosis, Thyroid cancer, Psammoma bodies

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Flow cytometric DNA analysis of parathyroid tumors with special reference to its diagnostic and prognostic value in parathyroid carcinoma

Article Abstract:

Conventional histopathological classification is difficult for parathyroid cancer. It would be helpful to have more discriminating criteria. DNA ploidy (the number of chromosome sets in a cell) would have several advantages if found to be suitable. The technique for assessing DNA ploidy is fairly objective, as it uses a flow cytometer, an automated instrument, to determine if a cell's chromosome complement is the normal 23 pairs, diploid, or aneuploid, an abnormal number. In addition, DNA ploidy may serve as a useful prognostic indicator. To examine the use of the flow cytometer in the classification of parathyroid tumors, tissue from 49 patients was analyzed. Eleven patients had carcinomas, 28 had adenomas, and 5 patients had type 1 multiple endocrine neoplasia. The hyperplastic tissues from the multiple endocrine neoplasia patients all had normal DNA patterns. Only one adenoma had an abnormal DNA ploidy. Five of 16 carcinoma patients had an aneuploid DNA pattern. Four of these five developed metastatic disease; of the 11 carcinoma patients with diploid patterns, four developed recurrence or metastatic disease. In addition, three of the five carcinoma patients with an aneuploid pattern were hypercalcemic, despite the surgical removal of malignant parathyroid tissue. It appears that an aneuploid chromosome complement is associated with increasing malignant behavior of parathyroid carcinoma and an unfavorable prognosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

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