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Ploidy studies in adenomatous polyps of colon.

I read the paper by Whitehead et al with great interest as their findings parallel some results, which Dr George Sledge and I have obtained with germ cell neoplasms of the testis. The conclusion that, "Dukes's (sic) A tumours which have invaded no farther than the bowel wall, if they are aneuploid, exhibit the less severe form (type 3) re-emphasises the importance of early recognition and removal of both adenomatous polyps and carcinomas of the colon" is misleading and not supported by the data in table 1.1 It is inconsistent to construe that the difference between zero instances of type 4 histograms in stage A carcinomas, two instances in stage B, and one in stage C is meaningful and at the same time draw no conclusion from the observation that 11 of the 14 instances of type 1 histogram occurred in the tumours that had behaved most agressively. Thus from the data one might better conclude that aneuploidy does not correlate well with neoplastic progression and aggressiveness in colonic epithelial neoplasia. It seems to occur only in malignant neoplasms, but it could be argued that the data would support a concept that it is merely a side effect of the fundamental disorder of growth, and perhaps even one which gets in the way. The same arguments apply to their conclusions in the last paragraph that, "the findings in this study also support the view that the malignant process in cancer of the colon is a stepwise process." Their conclusion, "There is clearly a case for ploidy studies on all adenocarcinomas of the colon, especially with the technique used in this study, which is simple and cost effective...," is also questionable as the technique entails much special equipment and software not available in most hospital pathology laboratories and as their data do not show a correlation between ploidy and prognosis in colonic adenocarcinoma. Lastly, although the authors state in the discussion that "25 of the 41 carcinomas examined were diploid" and (referring to textual citations of 15 cases of type 1 histogram, 10 cases of type 2, 13 cases of type 3, and 3 cases of type 4) that "Tables 1 and 2 summarise these results," table I tabulates only 36 carcinomas altogether and shows only 24 of them as diploid. The two tables also show 27 instances of type 1 histogram (14 carcinomas, 13 adenomas), 13 instances of type 2 (10 carcinomas, 3 adenomas), nine instances of type 3 (all carcinoma), and three instances of type 4 (all carcinoma). Thus the text and the tables disagree on the number of carcinomas, the number of diploid carcinomas, and the numbers of types I and 2 cases.