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).

Background: The gold standards for detection of urothelial carcinoma are cystoscopy and biopsy. Both are invasive and expensive, therefore cytology is the first approach to investigate urothelial neoplasm, being safe and cost-effective. Aim of the study:To evaluate the role of Minichromosome maintenance protein 2 in differentiation between benign and malignant urothelial lesions and the role of Fascin in detection of invasion in malignant tumors using urine cytology Materials and Methods: A prospective study has been held from January 2016 to December 2018. Eighty cases divided into: group A included a definitive cytological diagnosis either benign or malignant and group B included a cytological diagnosis of atypia and suspicious. An immune-cytochemistry technique was done using minichromosome maintenance protein-2 and Fascin on urine cytology specimens for diagnosing bladder cancer. Results: In group A the sensitivity of Minichromosome maintenance protein 2 and cytology were 90% and100% respectively, while the specificity was 100% and 70% respectively. In group B the sensitivity of MCM2 and cytology were 81% and 100% respectively, while specificity was 94.4% and 0.0% respectively. In both groups the sensitivity and specificity of Fascin were 86.5% and100% respectively. Conclusions: Minichromosome maintenance protein 2 differentiates between benign and malignant tumors of the urinary bladder, also Fascin detect invasion by examination of urine cytology.

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).