An improved method of releasing cell nuclei from paraffin-embedded highly keratinized squamous cell carcinomas by pretreatment with 85% formic acid-0.3% H,O, followed by enzymatic treatment with subtilisin Carlsberg is described. After DAPI staining the resulting suspensions of cell nuclei were analyzed by DNA flow cytometry, in addition to microscopy. The total yield of released cell nuclei was improved and the proportion of tumor cell nuclei in the suspensions increased from 12% to 53% using this method compared to the conventional preparation technique. Cytoplasmic residue disappeared nearly completely. Thus, the finding of false aneuploid cell populations representing diploid cells with autofluorescent cytoplasm could be avoided. In addition, even small true aneuploid cell populations could be detected due to the increased proportion of released tumor cell nuclei and the lower proportion of background in the >2C region. 0 1993 Wiley-Liss, Inc.Key terms: DNA flow cytometry, keratinized tissues, archival material, formic acid-H202In 1983 Hedley et al. (4) introduced a technique for preparation of cell nuclei from paraffin-embedded tissues for flow cytometric DNA measurement. This method has been widely used for retrospective analyses of the cellular DNA content in various types of malignancies. The original Hedley method has recently been modified using subtilisin Carlsberg (Sigma, protease XXIV) instead of pepsin and avoiding all centrifugation steps. By this means, cell loss and clumping of the cell nuclei or the debris were minimized, also resulting in a better estimate of the proportion of cells in various parts of the cell cycle (5). This improved method, in our hands, gave good results in archival material from various tumors: adenocarcinomas of the prostate, colonrectum, and urinary bladder; transitional cell carcinomas of the bladder; carcinomas of the testis and ovary, and myosarcomas of the uterus. However, we failed to adapt this method in verrucous squamous cell carcinoma of the Bilharzial bladder. The problem was the low yield of cell nuclei from the tumors and remaining fluorescent cytoplasm. This problem has also been observed by others in melanotic lesions of the skin (7). In order to increase the release of bare cell nuclei from the tissue sections by proteolytic treatment, the tissue pieces were, prior to this treatment, incubated with formic acid and HzOz, which dissolves disulfide bonds of keratins. The results obtained by this procedure were compared with the results obtained by the conventional method, which omits cleavage of disulfide bonds.
MATERIAL AND METHODSCell Material Tissue samples from 23 patients who underwent radical cystectomy for invasive verrucous carcinomas of the bladder at the Urology and Neuphrology Center of Mansoura, Egypt were studied. All tumors were well differentiated and typical for verrucous squamous cell carcinoma of the bladder (2). Four of the tumors were of stage 1 or 2, and 19 tumors were of stage 3 or 4 according to the classification of the UICC (6). Area...