Image cytometry DNA ploidy correlates with histological subtypes in endometrial carcinomas

Abstract

Image cytometric DNA ploidy analysis of endometrial carcinomas was performed to determine whether ploidy status and ploidy-related parameters like DNA index, percentage of cells exceeding 5c and 9c, correlate with histologic subtype. This is a prospective study of 391 patients with stage I endometrial carcinoma which included 331 (85%) endometrioid adenocarcinoma, 22 (6%) serous adenocarcinoma, 7 (2%) clear cell adenocarcinoma, 2 (0.5%) small cell carcinoma, 1 (0.3%) undifferentiated carcinoma, and 28 (7%) unclassifiable adenocarcinoma. Twenty-five percent of endometrioid adenocarcinomas were non-diploid. In contrast, all clear cell adenocarcinomas and 21/22 (95%) of serous adenocarcinomas were non-diploid. Hyperdiploidy (25 cases) was found only in endometrioid adenocarcinomas. Mean DNA index of the stemline in serous adenocarcinoma (1.72) and clear cell adenocarcinoma (1.81) was higher than in endometrioid adenocarcinoma (1.1). The difference in ploidy-related parameters between endometrioid adenocarcinoma and serous adenocarcinoma was highly significant (Po0.001). In addition, Grade 3 endometrioid adenocarcinoma showed significant difference in all ploidy-related parameters compared with grade 1 and grade 2 tumors (Po0.001). Our results show that DNA ploidy-related parameters may be valuable in subtyping histologically difficult cases of endometrial carcinomas.

DNA Ploidy Heterogeneity in Endometrial Carcinoma

“…Histologic subtyping and grading were performed according to the World Health Organization (WHO) classification of tumors (20). Tumors showing morphologic features of adenocarcinoma, which could not be classified according to the WHO criteria, were diagnosed as ''adenocarcinoma, unclassifiable'' (21). A case was categorized as histologically heterogeneous if the histologic subtyping differed between the curettage and hysterectomy specimen or when the histologic grade differed by 2 levels between the 2 specimens.…”

“…The technique has been described earlier (21). In brief, 1 or more 50 mm sections were processed to prepare a monolayer of cell nuclei on poly-L-lysine coated glass slides.…”

“…The system consists of a Zeiss Axioplan microscope, a 546 nm green filter, and a black-and-white high-resolution digital camera (21). Images of at least 1000 nuclei were automatically photographed.…”

Molecular Biology of Endometrial Carcinoma

“…The percentage of disease free survival for tumours in stage I, which is 94%, versus 64% in aneuploid tumours shows a clear difference. The important fact remains that in the vast majority of studies the ploidity is mentioned as independent prognostic factor (Pradhan et al, 2006, Suehiro et al, 2008.…”

Changes in Chromatin Structure in Curettage Specimens Identifies High-Risk Patients in Endometrial Cancer

“…Depending on the curettage tissue depth, one or two 1-mm cylinders were punched out using a custom-made precision instrument (Beecher Instruments). Monolayers of cell nuclei were prepared from one or more 50-mm sections cut from the cylinder(s) and stained with Feulgen-Schiff according to the established protocols (21). Automated image-based DNA cytometry was carried out using Ploidy Work Station (PWS, Room 4 Ltd.) together with a Zeiss AxioPlan light microscope with a 546-nm green filter and a black and white digital camera (AxioCam MRm, Zeiss).…”