Immunohistochemical evaluation of novel and traditional markers associated with urothelial differentiation in a spectrum of variants of urothelial carcinoma of the urinary bladder

Introduction: Non-neoplastic urinary bladder lesions are not life threatening, but are an important source to cause clinical symptoms and signs. However, neoplasms of the bladder are a source of morbidity, mortality, and exhibit more clinical challenges. Cystoscopy provides overall information about an anatomical/pathological condition of the urinary bladder which will be helpful for patients' management. A cystoscopic biopsy is a primary diagnostic tool for diagnosing urinary bladder cancer. Objectives: The objective of the study was to find the frequency and histomorphological characteristics of urinary bladder lesions in Dhulikhel Hospital, to find the clinical presentation of urinary bladder lesions and to grade the urothelial tumors based on the World Health Organization (WHO)/ International Society of Urological Pathology (ISUP) classification 2004. Methodology: This was a retrospective, cross-sectional, observational study carried out in the Department of Pathology, Dhulikhel Hospital-Kathmandu University Hospital. Convenient sampling was done. All cystoscopy biopsies received from January 2014 to December 2018 were studied. All tissue blocks were retrieved, cut, and stained with Hematoxylin and Eosin. The stained slides were examined under a light microscope by the primary investigator. Result: A total of 70 cystoscopic biopsies were analyzed. The majority of patients 20 (28.6%) were in the age group between 60 and 69 years and males were predominant 43 (61.4%). The neoplastic lesions constituted 40 (57.1%) of all bladder lesions, among them urothelial carcinoma accounted for 38 (54.2%). Similarly, chronic cystitis 27(38.6%) was the most common non-neoplastic lesion. Conclusion: The study found that the neoplastic lesions were commonly encountered in urinary bladder lesions. Among them, lowgrade urothelial carcinoma was the most common bladder tumor. However, most of the non-neoplastic lesions were inflammatory in origin. Cystoscopy combined with histomorphological examination helps in the early detection of bladder lesions.

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Cytokeratin 7 and Cytokeratin 20 in Primary Urinary Bladder Carcinoma and Matched Lymph Node Metastasis

Archives of Pathology & Laboratory Medicine ◽

10.5858/2001-125-0921-cacipu ◽

2001 ◽

Vol 125 (7) ◽

pp. 921-923 ◽

Cited By ~ 4

Author(s):

Jiazhong Jiang ◽

Thomas M. Ulbright ◽

Cheryl Younger ◽

Katya Sanchez ◽

David G. Bostwick ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Metastasis ◽

Urinary Bladder ◽

Urothelial Carcinoma ◽

Lymph Node Metastases ◽

Primary Tumor ◽

Cytokeratin 20 ◽

Cytokeratin 7 ◽

Node Metastasis ◽

Node Metastases

Abstract Background.—Cytokeratin 7 (CK7) and cytokeratin 20 (CK20) are 2 types of intermediate filament protein. Expression of CK7 is seen in the majority of primary urinary bladder carcinomas. CK20 is restricted to superficial and occasional intermediate cells of the normal urothelium of the bladder. Aberrant CK20 expression has been documented in urothelial carcinoma and has proved useful as an ancillary diagnostic aid for urinary bladder tumor. Our hypothesis is that the pattern of CK7 and CK20 expression in metastatic urothelial carcinoma duplicates the expression of the same markers in the primary tumors. Therefore, immunohistochemical staining of metastatic tumors for these 2 markers may be helpful for differential diagnosis in ambiguous metastatic tumor deposits. Objective.—To determine the concordance of CK7 and CK20 expression in primary bladder urothelial carcinoma and the matched lymph node metastasis. Design.—We studied 26 patients with lymph node metastases who underwent radical cystectomy and bilateral lymphadenectomy for bladder carcinoma. Immunohistochemical staining for CK7 and CK20 was performed on formalin-fixed paraffin-embedded tissues containing primary cancers and lymph node metastases. Results.—In all cases, there was a concordant expression of CK20 in the primary cancer and its matched lymph node metastasis. Twelve cases (46%) showed positive CK20 immunoreactivity in the primary tumor and its matched lymph node metastases, whereas 14 cases (54%) were negative for CK20 in both the primary tumor and lymph node metastasis. All cases showed positive CK7 immunoreactivity in the primary cancers and matched lymph node metastases. Conclusions.—CK20 immunoreactivity is reliably observed in metastases from bladder cancer when the primary tumor expresses CK20.

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