Comparison between cell kinetical and immunohistochemical studies on carcinoma and atypia/dysplasia of urinary bladder mucosa

Abstract

Results of cell kinetic analyses on transurethrally obtained material from urinary bladder are compared with parallel immunohistochemical tests on carcinoembryonic antigen (CEA) and tissue polypeptide antigen (TPA), performed on the same material. Labelling index increases from 1.4% in slight to 20% in marked urothelial atypia. CEA reaction in slight atypia is slight or moderate, slight, moderate or distinct in atypia, and moderate to distinct in carcinoma in situ. TPA always shows moderate to distinct reactions. Cell kinetically, urothelial carcinomas yield similar gradations. They were positive for CEA in 70% and for TPA in 100%. In GO and GI carcinomas, negative and slightly positive reactions predominate, poorly differentiated lesions yield predominantly distinct reactions. In all grades, TPA ranges from slight to distinctly positive. As in cell kinetic analyses, there is a relationship between differentiation grade and stage for CEA expression. This does not apply for TPA. The results permit us to draw conclusions on the different biological and histogenetical behavior of urothelial carcinomas. There are undoubtedly differences in the behavior of papillary-exophytical and solid invasive carcinomas in terms of both cell kinetics and immunohistochemistry.

Behavior of Epithelial Differentiation Antigens (Carcinoembryonic Antigen, Epithelial Membrane Antigen, Keratin and Cytokeratin) in Transitional Cell Carcinomas of the Bladder

“…These did not differ morphologically from nor mal CEA-negative urothelium. An increase in staining for CEA in carcinoma in situ has also been reported by others [3,20,21], confirming the fitness of this antigen for detecting preneoplastic changes of the urothelium. In transitional cell carcinomas, results of staining for CEA are variable [3,22], The progressive increase in the num ber of positive tumors with higher grade and stage ob served by others [23][24][25] was also detected in our study, but did not reach statistical significance.…”

“…An increase in staining for CEA in carcinoma in situ has also been reported by others [3,20,21], confirming the fitness of this antigen for detecting preneoplastic changes of the urothelium. In transitional cell carcinomas, results of staining for CEA are variable [3,22], The progressive increase in the num ber of positive tumors with higher grade and stage ob served by others [23][24][25] was also detected in our study, but did not reach statistical significance. Elevated urinary levels of CEA have been reported in patients with bladder cancer [26], However, a definitive correlation between urinary CEA levels and tumor immunostaining for CEA is lacking [21], K polyclonal antibody stained uniformly the entire urothelial thickness, without significant changes in dysplastic urothelium and carcinoma in situ, as reported by other authors [27][28][29], Monoclonal CK antibody (molec ular weight 52 kilodaltons) shows a specific staining pat- tern for the basal layer of normal and dysplastic urothelium.…”

“…Two important objectives in the diagnosis of bladder cancer are to delimit clearly the different tumor grades and to recognize the cytological abnormalities of fiat uro thelium which are prone to progress to invasion [1][2][3]. Both questions are important from clinical and pathologi cal points of view [4][5][6].…”

Grading and Prognostic Significance of Urologic Carcinomas

“…55, 72.65 and 100%, respectively [85]. The DNA synthesis times that can be measured in vitro by double labelling are long in low malignant urothelial neoplasias and short in highly malignant tumors [86][87][88][89][90], Comparable results can be obtained immunohistochemically by the use of anlibromodeoxyuridine antibodies. The labelling index is 3 times higher than that in normal urothelium (5 vs. 13%).…”

“…In highly malig nant carcinomas, the cytokeratins 7, 8, 18 and 19 predom inate. Cytokcratin 13. however, is reduced [92], The expression of TPA and of carcinocmbryonic antigen (CEA) is membrane-associated in papillary urothelial car cinomas of low malignancy without or with superficial stromal invasion, whereas the invasive urothelial carcino mas are predominantly characterized by a diffuse cyto plasmic expression [87,93], Well-differentiated G I carcinomas arc often difficult to recognize cytologicaliy due to their scant atypias and exclusively diploid DNA values. Immunocytologic analy ses using a newly developed monoclonal antibody, 486p3/12.…”