Nucleolar organizer regions (NORs). Basic concepts and practical application in tumor pathology.

The purpose of this investigation is to give an introduction to a novel method in tumor pathology, namely the Ag-NOR technique. The basis of this method is the argyrophilic staining of intranucleolar, non-histone proteins which are specifically associated with transcriptionally active sites of ribosomal DNA. They can therefore be considered as a marker for the protein synthesis and thus the proliferation rate of a given cell. The morphologic basis of the argyrophilic reaction is presented by metaphasic and interphasic tissue culture cells. The applicability of Ag-NOR technique to tumor pathology is exemplified by main results of three studies dealing with tissue sections of 65 meningiomas, whole organ sections of 50 renal carcinomas, and cytospin preparations of 30 urinary washout specimens. These studies document the considerable value of the Ag-NOR content for both, malignancy diagnosis and tumor grading. With the help of image analysis it can be shown that besides the mean number of Ag-NORs the mean area per Ag-NOR dot is of diagnostic significance. In conclusion the Ag-NOR technique is a simple inexpensive and accurate method which can be applied both to formalin fixed, paraffin-embedded tissue and cytologic specimens. As a marker of malignancy it is an invaluable new tool for the diagnostic pathologist.