DNA ploidy analysis of neoplasms is most frequently performed by flow cytometry of single nuclear suspensions or image analysis of Feulgen-stained cytologic specimens. To assess the prognostic significance of ploidy in renal adenomas (less than 3 cm in diameter), nuclear DNA content of 21 renal cortical neoplasms was analyzed by image cytometry (CAS 200, Cell Analysis Systems, Inc., Elmhurst, IL) on Feulgen-stained 5-pm fixed embedded tissue sections. Five (36%) of 14 small neoplasms (so-called renal adenomas; (mean diameter, 7.2 mm; range, 2-24 mm) were in the aneuploid range. Four (57%) of seven carcinomas (mean diameter, 6.3 cm; range, 3.5-10 cm) were aneuploid, a frequency not significantly different from that in the adenomas ( P = 0.4). Mean DNA index (1.38) for aneuploid adenomas and carcinomas was identical. Diploid renal adenomas (mean diameter, 5.9 mm) were smaller, although not significantly so ( P > 0.051, than the aneuploid ones (mean, 9.7 mm). Size of diploid (mean, 6.7 cm) and aneuploid (mean, 6.1 cm) renal carcinomas was similar. Clinical follow-up studies to evaluate utility of DNA ploidy and proliferative activity in prognosis and management of small renal cortical neoplasms are indicated. c 1994 Why-Liss, Inc.Key terms: Image cytometry, image analysis, DNA ploidy, renal adenoma, renal carcinoma Renal cortical neoplasms have historically been classified on the basis of size. Traditionally. those less than 3 cm in diameter were felt to have a benign behavior (socalled renal adenomas), while those greater than 3 cm in diameter were thought to have the potential to metastasize (8). The presence of metastases with some lesions less than 2 cm and their absence in others greater than 10 cm have clouded this criterion (X,9). Based on similar epidemiology (9,4 1 ), often indistinguishable morphology at the light and electron microscopic level (9.26,29,4 1 ), and similar imniunohistologic panels indicating proximal and distal tubular markers in both renal adenomas (16,17,44,46) and carcinomas ( I5.25,27.46), they are increasingly becoming regarded as a spectrum of renal cortical neoplasms, with those smaller than 3 cm being renal carcinomas of low malignant potential. Results of DNA cytometric studies (6.10.23) tend to support this supposition.Flow and image cytometry have detected aneuploidy in up to -1% of renal carcinomas (-i,5.7,1-i,30,32-34,57). with aneuploidy being shown in most studies to be a poor prognostic factor. Aneuploidy has also been shown to correlate with tumor size (4.7.14,30,33.34,37), renal tumors less than 2 cm being diploid. and those more than 5 cm frequently being aneuploid and DNA heterogenous (6). It is suggested that a progressive alteration in DNA Q 1994 Wiley-Liss, Inc. might herald aggressive tumor behavior, with neoplasms in the 2-5 cni size range being in a transition zone in which changes in DNA content start to occur ( 6 ) .DNA analysis by image cytometry of paraffin-embedded formalin-fixed sections offers advantages both over flow cytometry and image cytometry of c...
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