الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
This study aims first at evaluation of AgNORs, CD34 and MMP-2
in normal and NSCLC.Second, to compare and to correlate the findings
with other clinicopathological variants such as age, sex, tumor grade and
stage, LNs metastases and distant metastases. Statistical analysis and
correlations were made for all these variants.
This retrospective study was carried upon 40 Egyptian patients with
non small cell lung cancer and ten cases of non neoplastic lung lesions
that were taken as a control. The patients. were admitted to Benha
University Hospital, National Cancer Institute and Nasser Institute.
These cases included 15 cases of squamous cell carcinoma, 9 cases
of Adenocarcinoma, and 16 cases of undifferentiated large cell
carcinoma. 10 cases of non-neoplastic lung diseases (2· cases of cystic
lung disease- 6 cases of emphysema adjacent to bronchiactesis and 2
cases of pneumonia adjacent to lung abscess) were taken as control. The
mean age of cancer patients was 55.6 Ys. The incidence of non small cell
lung carcinoma was more common in males (28 cases) than females (12
cases).
\w§) Non small cell lung carcinomas were graded into 3 cases of well
differentiated tumors, 11 cases ofMD tumors, 10 cases ofPD tumors, and
16 cases of UDLCC. TNM staging system was applied for each tumor
case. Lymph node metastases and distant metastases were evaluated for
every case.
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Summary
As regarding 1NMstaging system, there were 12 cases at stage I, 8
cases at stage II, 5 cases at stage III, and 15 cases at stage IV. Among the
40 cases of non small cell lung carcinoma, 10 cases had no lymph node
metastases (NO), 15 cases categorized as Nl, 10 cases categorized as N2,
and 5 cases categorized as N3. There were 24 cases without evident
distant metastasis (MO)and 16 cases with distant metastases (Ml).
The mean AgNORs count for control and malignant cases was
detected by counting the number of dots in nuclei of 100 cells in high
power fields (xl 000). For control cases, the mean AgNORs was 1.5
dots/nucleus, and for NSCLC cases, it was 7.2 dots/nucleus. The mean
AgNOR count was higher in Sq.C.C cases (7.4 dots/nucleus) than in
Adenocarcinoma (6.5 dots/nucleus).About distribution of dots in nuclei,
they are arranged at the periphery of nucleoli in some cases, but in other
cases, they are dispersed in the nucleoplasm.
Mean AgNORs count was significantly correlated with
histopathological grade of non small cell lung cancer.
CD34 was detected by immunohistochemical staining technique in
all control and NSCLC cases. CD34 was detected as brown membranous
staining of blood vessels. The expression was hypervascular ~O blood
”-. vessels) in 6 control cases, but hypovascular ~ 30 blood vessels) in the
other 4 control cases.
For Sq.C.C cases, 10 cases (66.7%) were hypovascular, and the
other 5 cases (33.3%) were hypervascular Among 9 adenocarcinoma
cases, 6 cases (66.7%) were hypervascular, and the other 3 cases (33.3%)
were hypovascular.For UDLCC cases, 11 cases (68.7%) were
hypervascular, while the other 5 cases (31.3%) were hypovascular,.
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Summary
There was significant positive correlation between extent of CD34
expression and state of distant metastases and stage of non small cell lung
cancer (according toTNM staging system) as among 12 cases at stage 1,2
cases were hypervascular and the other 10 Cases were hypovascular.
Among 8 cases at stage II, 3 cases were hypervascular, and the other 5
cases were hypovascular. Among 5 cases at stage III, 3 cases were
hypervascular and 2 cases were hypovascular. Among the 15 cases at
stage IV 14 cases were hypervascular and only one case was
hypovascular.
MMP-2 was detected by immunohistochemical staining technique.
It appeared as fine cytoplasmic granules in tumor cells. Also endothelial
cells and fibroblasts were positively stained for M1\1P-2.in all control
cases, the normal bronchial epithelial cells were negatively stained for
M1\1P-2.
among 15 cases of Sq.C.C 4 cases showed (-ve) expression, 6
cases showed (+ 1) expression (less than 10% of malignant cells were
positively stained), 2 cases showed (+2) expression (10-40% of malignant
cells were positively stained), and the other 3 cases showed (+3)
expreSSIOn (more than 40% of malignant cells were positively
stained).Among 9 cases of Adenocarcinoma, 2 cases showed (-ve)
expression, 2 cases showed (+1) expression, 4 cases showed (+2)
expression, and one case showed (+3) expression of M1\1P-2.A!nong 16
cases of UDLCC cases, 3 cases showed (-ve) expression, 3 cases showed
(+ I) expression, 7 cases showed (+2) expression, and 3 cases showed (+3)
expression ofMMP-2.
- InO.
Summary
There was significant positive correlation between extent ofMMP.
2 expression and state of distant metastases, as among 24 cases without
distant metastases 9 cases shOWed(-ve) expression, II cases showed (+ I)
expression, and 4 cases showed (+2) expression of MMP-2. Among 16
cases with distant metastases, 9 cases shOWed(+2) expression, and the
other 7 cases showed (+3) expression ofMMP-Z.
Also, there was significant positive COrrelationbetween extent of
MMP-2 and stage of non small cell lung cancer, as out of 12 cases at
stage I, 6 cases showed (-ve) expression, 4 cases shOWed(+ I) expression,
and the other 2 cases showed (+2) expression ofMMP-2. Among 8 cases
at stage II, 6 cases showed (+ I) expression, and the other 2 cases showed
(+2) expression ofMMP-2.Among 5 cases at stage III, 3 cases showed (_
ve) expression, one case showed (+ I) expression, and the last case
showed (+2) expression ofMMP-2. Among 15 cases at stage IV, 8 cases
showed (+2) expression, and the other 7 cases showed (+3) expression of
MMP-Z.
There was significant positive Correlation between extent ofCD34
expression and extent ofMMP-2 expression, as among 22 hypervascular
cases, 3 cases showed (+ I) expression, 12 cases showed (+2) eXPression
and the other 7 cases showed (+3) expression ofMMP-2, however among
18 hypovascular cases, 9 cases showed (-ve) expression, 8 cases showed
(+1) expression and one case showed (+2) expression ofMMP-2.
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Conclusion-Recommendation
CD34 and l\1MP-2 can be used to detect the liability ofNSCLC to
give distant metastasis. lYlMP-2 but not CD34 may be used to
differentiate between non-neoplastic and neoplastic lung tissues. The
extent of angiogenesis (assessed by extent of CD34 expression) and
extent of l\1MP-2 expression may detect the tumor of aggressive behavior
as their extent of expression increased with tumors of advanced stages.
Simultaneous determination of CD34 and l\1MP-2 is more
serviceable than either alone for the precise prediction of metastasis in
NSCLC.
CD34 expression IS higher in Adenocarcinoma cases than
squamous cell carcinoma.
Silver colloidal staining for AgNORs may be used to differentiate
between non-neoplastic and neoplastic lung lesions and also could be
used to detect the grade and histopathological type ofNSCLC.
Mean AgNORs count/nucleus is higher in adenocarcinoma is lower
than in Sq.C.C cases. The poorer the grade of tumor differentiation, the
higher the mean AgNORs count per nucleus.
Cancer registry programs should be developed and applied in all
institutions dealing with cancer cases. This would allow data transfer and
comparison of research results between different studies.