HistopathoIogical and immunohistochemical study of non-invasive papillary urothelial tumors

Non-invasive, papillary urothelial tumors are those restricted to the level of bladder mucosa. The stage and grade are the classic prognostic variables that permit evaluating recurrence or progression of the disease. However. immunohistochcmistry is still of limited use in predicting the progress of non-invasive urothelial tumors. The present work was done to study the immuno-expression of different biologic markers in non-invasive papillary urothelial tumors graded according to WHO/ISUP classification and to evaluate their use as predictive factors for the recurrence and progression of the tumor. A total of 50 non-invasive papillary urothelial tumors constituted the material of this work; 2 papillomas, 12 papillary urothelial neoplasms of low malignant potential [PUNLMP], 2216w grade carcinomas [LGC] and 14 high grade carcinomas [HGC]. All cases were re-stained with conventional H and E, for confirming diagnosis, and with different immunostains [CK20, E-cadherin, Ki67 and p53]. Thirty six out of the 50 included cases [72%] showed abnormal CK20 immunostaining [either focal or diffuse]; mostly seen in low and high grade carcinomas. Thirty one cases [62%] showed abnormal E-cadherin immunostaini ng [heterogeneous or negative]; also seen in low and high grade carcinomas. The indices of Ki67 and p53 immunostaining were seen to be correlated with the grade of the tumor. Statistically, it was found that all the studied markers were significantly associated with tumor grade. Also, there was a significant difference between immunostaining of PUNLMP and LGC. Recurrence was seen in 16 cases [2 PUNLMP 5 LGC and 9 HGC]. However, progression to higher stage was seen in 7cases [2 LGC and 5 HGC]. From this work, we can conclude that mixed immunohistochemical staining [CK20, E-cadherin, Ki-67 and p53] of non-invasive papillary urothelial bladder tumors can help in separating PUNLMP from LGC as well as predicting recurrence and identifying potentially invasive lesions before they become actually muscle-invasive

Peritumoral lymphatic microvessel density as a prognostic parameter in endometrial carcinoma

Lymphatic invasion and nodal metastasis play a major role in the spread and prognosis of endometrial adenocarcinoma [EC]. In this study, we investigated tumor lymph-angiogenesis, detected by D2-40, as a predictive marker for the risk of lymph node [LN] metastasis and its relation to other prognostic parameters in EC. Fifty-five cases of EC treated with total hysterectomy and pelvic LN dissection were reviewed. All cases were immunostained for D2-40. Positively stained microvessels [MV] were counted in densely lymphovascular foci [hotspots] at X400 field [0.17 mm[2]]. Lymphovascular invasion was detected in 20/55 patients by D2-40 and 14/55 by routine hematoxylin and eosin. Peritumoral lymphatic vessel [LV] count was significantly higher than intratumoral LV count [17+7 versus 5+4/0.17 mm[2], P< 0.01]. Peritumoral D2-40 lymphovascular count correlated significantly with FIGO grade [P <0.001], lymphovascular invasion [P=0.001] and lymph node [LN] metastases [P=0.005]. However it showed non-significant correlation with peritoneal wash positivity [P=0.830] and stage of the disease [P=0.341]. Lymphovascular invasion detected by D2-40 showed significant correlation with LN metastases [P<0.01]. Our study showed that assessing LVD with D2-40 in the endometrial carcinoma might be a valuable parameter for predicting patients having an increased risk of developing metastatic disease. In addition, D2-40 increases the frequency of detection of lymphatic invasion relative to routine hematoxylin and eosin stain