FLOW-CYTOMETRIC ANALYSIS OF NUCLEAR-DNA CONTENT IN ENDOMETRIAL ADENOCARCINOMA - ATYPICAL MITOSES ARE ASSOCIATED WITH DNA ANEUPLOIDY

Flow-cytometric studies have demonstrated that DNA aneuploidy and prol iferative activity are independent prognostic factors in endometrial c arcinoma. The authors performed flow-cytometric analysis of the nuclea r DNA content of 46 fresh endometrial adenocarcinomas to investigate t umor DNA ploidy end cell-cycle kinetics in relation to histologic feat ures with known prognostic significance, mitotic activity (assessed qu antitatively), and clinical features suggestive of hyperestrogenism. T hirty-five tumors (76%) were DNA-diploid, and 11 (24%) were DNA-aneupl oid. DNA aneuploidy correlated significantly with two histologic featu res: high cytologic grade (P < .027) and five or more atypical mitoses per 50 high-power fields (P < .001). The presence of one or more atyp ical mitosis per 50 high-power fields, evaluated independent of DNA pl oidy, was associated with stage III or IV tumors (P < .015). A low pro liferative index correlated with tumors with grade 1 architecture (P < .006) and grade 1 or 2 cytology (P < .017); a high proliferative inde x: correlated with vascular invasion by tumor (P < .027). DNA ploidy a nd proliferative activity did not correlate with any feature indicativ e of estrogenic status including age, parity, menopausal status, obesi ty, hypertension, diabetes, exogenous estrogen use, or endometrial hyp erplasia. Therefore, in endometrial adenocarcinoma, estrogenic status does not correlate with DNA ploidy or proliferative activity; prolifer ative activity correlates with tumor grade; and atypical mitoses appea r to be highly associated with both DNA aneuploidy and advanced tumor stage, and as such, may identify tumors with a poor prognosis.