Nucleolar Organizer Region Expression in Hepatocellular Carcinoma and Liver Cirrhosis Among Patients in Khartoum .State

Abstract

This descriptive retrospective study was performed in Khartoum to assess the expression of NORs in hepatocellular carcinoma as compared to liver cirrhosis in Sudanese patients, to find out whether there is statistically significance differences in mAgNORs between the two cases as well as in different grades of hepatocellular carcinoma.39 paraffin blocks representing the cases of hepatocellular carcinoma ,were taken from hospital records in three different governmental centers in Khartoum, as well as 16 cases of liver cirrhosis. A minimum of three sections (3μ) were taken from each liver tissue, one section was stained routinely by haematoxylin and eosin to high- light tissue architecture and determine the tumor grade, other histological section was stained by silver-NOR mthod. Staining was performed on formalin-fixed, paraffin- embedded tissue sections NOR dots were counted in 100 randomly selected hepatocytes at ×100 oil immersion objective, and the mean count per cell was calculated for each case. Statistical analysis was done by using the Student T-test for unpaired data and Spearman's correlation tests. AgNOR count results were later compared with the histologic diagnosis. The mean AgNORs count was 2.94 and 6.54 dots per cell in liver cirrhosis and HCC respectively and the difference was statistically significant (P. value less than 0.01). The study revealed increasing mean AgNOR counts from cirrhosis to hepatocellular carcinoma. The hepatocellular carcinomas were graded according to the Edmondson-Steiner histological grading system. Among the study population 23 of HCC cases was well differentiated hepatocellular carcinoma (constituting about 58.9% of HCC cases), 13 cases were moderately differentiated carcinoma (constituting about 33.3% of HCC cases) and 3 cases were poorly differentiated hepatocellular carcinoma (constituting about 7.7% of HCC cases. The mAgNOR in grade I, grade II and grade III HCC was 4.36± 1.5, 8.34±2.02 and 10.82±2.40 respectively.There was statistically significant correlation between mAgNORS count and hitological tumor grade (P.value less than 0.05). The AgNOR score increases with the increasing tumor grade.