Abstract :
Background: Urothelial carcinoma is the 7th most common cancer worldwide. More than 50% of patients with non-invasive tumors have recurrences and 10-15% of these will progress to invasive cancer. Hence there is a need to assess the biological behavior of tumors with newer modalities.
CK 20 is generally expressed only in the umbrella cells of the non-neoplastic urothelium, whereas their abnormal expression predicts malignant potential in low grade TCC. Micro vessel Density (MVD) as elsewhere is a predictive prognostic marker in TCC also. Hence CK 20 and MVD together can aid the clinician in defining specific targeted therapies.
Objectives: To assess the clinical utility of CK 20 and MVD in urothelial neoplasms as diagnostic and prognostic factors.
Methods: Study was conducted on 30 TURBT specimens diagnosed as malignant urothelial neoplasms according to WHO/ISUP 2004 classification. Immunochemical staining for CK 20 and CD 34 were done and interpreted.
RESULTS: Out of 30 Urothelial neoplasms 2 were Papillary Urothelial Neoplasms of Low Malignant Potential (PUNLMP), 10 were Low Grade Papillary Urothelial Neoplasm(LGPUN), 13 were High Grade Papillary Urothelial Neoplasm (HGPUN), and 5 were Invasive urothelial Neoplasm(IUN).
Abnormal expression of CK 20 was seen in 100% (2/2) of PUNLMP, 80% (8/10) of LGPUN, 46% (6/13) of HGPUN and 40% (2/5) IUN (P = 0.048).
Average MVD was 6.75 in PUNLMP, 19.36 in LGPUN, 28.18 in HGPUN and 44 in IUN (P=0.019).
Conclusion: CK 20 and MVD are useful in predicting benign versus malignant behavior and defining treatment strategies.
Keyword :
Urothelial neoplasms, CK 20, Micro vessel Density