Diagnostic utility of p53 and CK20 immunohistochemical expression grading urothelial malignancies

Abstract

IntroductionCurrent grading system in application by WHO/ISUP divides urothelial malignancies in low and high grade by morphologic criteria while strict segregation may become cumbersome in limited tissue specimens. As grading these carcinomas are of utmost prognostic significance after depth of invasion, therefore we evaluated the role of immunohistochemical expression of p53 and cytokeratin 20 as an adjuctive tool in grading urothelial carcinoma.MethodsThe study was conducted in Aga khan university hospital, Histopathology section from December 2010 till June 2011 for duration of six months. It involved 95 cases of urothelial carcinomas diagnosed on trans-uretheral resection specimens of bladder growth. Immunohistochemical expression of p53 and cytokeratin 20 was performed according to standard protocols and correlated with grade and depth of invasion.ResultsThere were 48 cases (50.5%) of low grade and 47 cases (49.5%) of high grade urothelial carcinoma included in the study. Male to female ratio was 4.3:1. Majority of patients (80%) were seen in 45 to 90 years age group. Diffuse positive expression of cytokerain 20 was noted in 33 cases (68.8%) of high grade and 19 (40.4%) low grade tumors. Strong positive expression of p53 was seen in 35 cases (72.9%) of high grade while only 17 cases (36.2%) of low grade tumors showed strong p53 expression.ConclusionSignificant difference in expression of Cytokeratin 20 and p53 was found between low and high grade urothelial carcinoma. Therefore we suggest combined use of these markers may be helpful in assigning grade to urothelial carcinoma especially when histologic features are borderline.

Altered expression of CKs 14/20 is an early event in a rat model of multistep bladder carcinogenesis

“…The present results may also support the use of CK20 for distinguishing neoplastic and preneoplastic foci from some reactive lesions, as previously proposed (Edgecombe et al 2012;Amin et al 2014). However, similar expression patterns for both markers were observed in lgpc and hgpc, contrasting with previous findings from clinical studies (Mumtaz et al 2014).…”

“…However, similar expression patterns for both markers were observed in lgpc and hgpc, contrasting with previous findings from clinical studies (Mumtaz et al . ).…”

Evaluation of double immunocytochemical staining for CK20 and P53 as a potential adjunct to cytology for urothelial cancer diagnosis

“…Cytokeratin 20 is normally expressed in umbrella cells only. Therefore, its abnormal expression beyond superficial layers has been used as a marker for the diagnosis of transitional cell carcinoma on biopsies and cytology. It seems that dysregulation of CK20 is an early event in carcinogenesis of papillary non‐invasive bladder carcinoma associated with grade and stage, whereas its predictive value is under investigation …”

p53 immunohistochemistry in high‐grade urothelial carcinoma of the bladder is prognostically significant

“…The mean percentage of the triplicate core results was recorded for each case. Cases were categorized as ‘positive’ or ‘negative’ by the use of 10% and 40% cut‐offs, as previously described . Cases were then alternatively classified as ‘abnormal’ or ‘wild type’.…”

“…Cases were categorized as 'positive' or 'negative' by the use of 10% and 40% cut-offs, as previously described. 19,22,27,[29][30][31] Cases were then alternatively classified as 'abnormal' or 'wild type'. Abnormal cases were those that showed a null phenotype (complete lack of staining) and those that stained at or above a variety of cut-offs (20%, 40%, 50%, 60%, 70%, and 90%).…”