Importance of red patches diagnosed in cystoscopy for haematuria and lower urinary tract symptoms

Fernando, Herman; Thota, Sreenivasa S; Burtt, Glyn; Waterfall, N B; Husain, Imtiaz

doi:10.1136/pgmj.2006.050112

“…In patients less than 60 years old in this study, biopsies of red patches were negative for neoplasia [125]. Fernando et al found a similar age range (60-70 years) for positive biopsies and found that red patch biopsies were positive for CIS in four out of 25 patients [126]. Prudent cystoscopic examination, therefore, should include sampling of areas with erythema, elevation or erosion, as well as diverse random sampling of grossly normal bladder mucosa in a high-risk patient.…”

Section: Fluorescence Cystoscopysupporting

confidence: 70%

The origins of urothelial carcinoma

Liu

¹

,

Davidson²,

MacLennan

³

et al. 2010

Expert Review of Anticancer Therapy

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It is now widely believed that there are two major pathways for urothelial carcinogenesis. One pathway usually involves mutation of FGF receptor 3 and gives rise to low-grade papillary tumors that frequently recur but seldom invade. By contrast, high-grade urothelial malignancies, including high-grade papillary urothelial carcinoma and urothelial carcinoma in situ (CIS) usually exhibit deletions or mutations of TP53. Urothelial CIS is the most likely precursor of high-grade invasive bladder cancer. It is a 'flat lesion' that may be relatively inconspicuous at cystoscopy, or even endoscopically undetectable. The clinical hazards associated with this elusive and biologically dangerous neoplasm have been increasingly well documented since the original studies by Melicow in 1952. Primary or secondary urothelial dysplasia is even more challenging to detect and diagnose than CIS. It is theorized that dysplasia may antedate the onset of CIS, but support for the putative progression of dysplasia to CIS is found in fewer than 20% of cases. Since many benign urothelial changes may resemble CIS at cystoscopy, in biopsies and even with molecular profiling, care must be exercised when making a diagnosis of CIS. For patients whose screening tests are worrisome for the presence of premalignant urothelial disease, newer bladder imaging modalities, including Raman spectral imaging and optical coherence tomography, may enable improved biopsy site selection. In this article, we discuss the above-noted topics, as well as other related issues, such as the possible role of papillary urothelial hyperplasia as a preneoplastic lesion and the roles of cancer stem cells and field cancerization in urothelial carcinogenesis.

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“…There is also a significant association between age >70 and the presence of flat lesions(dysplasia/CIS) in association with carcinoma This goes with previous studies by Cheng et al (21) , Demir et al (22) , Fernando et al (23) , Garbar et al (24) and Takenaka et al (9) . In the present study, the majority of the studied cases of flat lesions including CIS were males (88.3%).…”

Section: Significance Of Flat Epithelial Lesions Of the ………supporting

confidence: 85%

Significance of Flat Epithelial Lesions of the Urinary Bladder in Early Detection of Bladder Cancer: Histopathological and Immunohistochemical Study

Ramadan

¹

,

Omar

²

,

Abdel-Wahed

³

et al. 2013

Zagazig University Medical Journal

1

0

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Background: Urothelial carcinoma of the urinary bladder is the second most common malignancy of the genitourinary system, after prostate cancer. The flat lesions are classified into flat lesions without cytological atypia (Flat hyperplasia) and flat lesions with cytological atypia; reactive atypia, atypia of unknown significance, urothelial dysplasia and urothelial carcinoma in situ). The immunohistochemical markers such as cytokeratin 20,CD 44 and Ki 67 may be useful in differentiating CIS from reactive changes in difficult biopsy cases. Aim: This study was conducted to determine the role of cytokeratin 20, CD 44 and Ki 67 in the diagnosis of dysplasia and other flat lesions of the urinary bladder. Methods: Sixty representative cases for flat urothelial lesions of urinary bladder were examined immunohistochemically using antibodies against CD44, cytokeratin 20 and Ki-67. Results: CD 44 were positive in 100%of cases of reactive urothelial atypia, but flat Hyperplasia and CIS cases were negative. However CD 44 were positive in 42.9% of atypia of unknown significance and 14.3% of Dysplasia. CK 20 were positive in (95.5%) of Dysplasia. Non of Flat Hyperplasia were positive for CK 20. However CK 20 was positive in 88.2% of CIS, 57.1 % of atypia of unknown significance and 7.1% of reactive urothelial atypia. ki 67 index were high in 82.4% of cases of CIS, non of flat hyperplasia expressed high ki 67 index. However ki 67 index were high in 57.1% of atypia of unknown significance, 52.4% of dysplasia and 14.3% of reactive urothelial atypia. Conclusion. CD 44 is the most constant marker in the reactive urothelium. CK20 is the most commonly detected marker in the dysplastic urothelium. Nevertheless, the most accurate is application of an immunohistochemical panel composed of the three antibodies (standard CD 44, CK20 and Ki-67) together with correlation with morphology. This is very useful for confirming the presence of dysplastic changes in the urothelium and differentiating reactive urothelium from dysplastic urothelium (dysplasia/CIS).

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“…In our present a statistically significant relationship was observed between age <50 and the presence of isolated flat lesions. There is also a significant association between age >70 and the presence of flat lesions(dysplasia/CIS) in association with carcinoma This goes with previous studies by Cheng et al (21) , Demir et al (22) , Fernando et al (23) , Garbar et al (24) and Takenaka et al (9) . In the present study, the majority of the studied cases of flat lesions including CIS were males (88.3%).…”

Section: Significance Of Flat Epithelial Lesions Of the ………supporting

confidence: 85%

Significance of Flat Epithelial Lesions of the Urinary Bladder in Early Detection of Bladder Cancer: Histopathological and Immunohistochemical Study

Ramadan

¹

,

Omar

²

,

Abdel-Wahed

³

et al. 2013

Zagazig University Medical Journal

0

View full text Add to dashboard Cite

Background: Urothelial carcinoma of the urinary bladder is the second most common malignancy of the genitourinary system, after prostate cancer. The flat lesions are classified into flat lesions without cytological atypia (Flat hyperplasia) and flat lesions with cytological atypia; reactive atypia, atypia of unknown significance, urothelial dysplasia and urothelial carcinoma in situ). The immunohistochemical markers such as cytokeratin 20,CD 44 and Ki 67 may be useful in differentiating CIS from reactive changes in difficult biopsy cases. Aim: This study was conducted to determine the role of cytokeratin 20, CD 44 and Ki 67 in the diagnosis of dysplasia and other flat lesions of the urinary bladder. Methods: Sixty representative cases for flat urothelial lesions of urinary bladder were examined immunohistochemically using antibodies against CD44, cytokeratin 20 and Ki-67. Results: CD 44 were positive in 100%of cases of reactive urothelial atypia, but flat Hyperplasia and CIS cases were negative. However CD 44 were positive in 42.9% of atypia of unknown significance and 14.3% of Dysplasia. CK 20 were positive in (95.5%) of Dysplasia. Non of Flat Hyperplasia were positive for CK 20. However CK 20 was positive in 88.2% of CIS, 57.1 % of atypia of unknown significance and 7.1% of reactive urothelial atypia. ki 67 index were high in 82.4% of cases of CIS, non of flat hyperplasia expressed high ki 67 index. However ki 67 index were high in 57.1% of atypia of unknown significance, 52.4% of dysplasia and 14.3% of reactive urothelial atypia. Conclusion. CD 44 is the most constant marker in the reactive urothelium. CK20 is the most commonly detected marker in the dysplastic urothelium. Nevertheless, the most accurate is application of an immunohistochemical panel composed of the three antibodies (standard CD 44, CK20 and Ki-67) together with correlation with morphology. This is very useful for confirming the presence of dysplastic changes in the urothelium and differentiating reactive urothelium from dysplastic urothelium (dysplasia/CIS).

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Importance of red patches diagnosed in cystoscopy for haematuria and lower urinary tract symptoms

Cited by 9 publications

References 8 publications

The origins of urothelial carcinoma

The origins of urothelial carcinoma

Significance of Flat Epithelial Lesions of the Urinary Bladder in Early Detection of Bladder Cancer: Histopathological and Immunohistochemical Study

Significance of Flat Epithelial Lesions of the Urinary Bladder in Early Detection of Bladder Cancer: Histopathological and Immunohistochemical Study

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