Bladder cancer is the most common malignancy involving the urinary system and the ninth most common malignancy worldwide. In Egypt ,it is the leading cancers in Egyptian patients representing 12% of cancers.
Many clinicopathological variables including age, clinical stage, tumor grade, tumor size, and histology remain the most common prognostic predictors in the clinical decision making for urinary bladder carcinoma patients.
Several genetic and biological alterations have been implicated in urinary bladder carcinoma development and progression.They include anti-apoptotic genes, cell cycle regulators, various immune, nuclear, proliferative markers, cellular growth factors & cell surface adhesion molecules. Molecular markers are potential tool for detection of bladder cancer ,predeliction of tumor recurrence and progression and for development of metastasis.
This retrospective study was carried upon 60 cases of surgically removed urinary bladder carcinoma,10 cases of non neoplastic and non granulomatous urinary bladder lesions were used as control. The age of the patients in this study was ranged from 31-70 with mean age 60.4 years. These cases were 42 males (70%) and 18 females ( 30%) with male to female ratio 2.3: 1. They were classified into 20 cases squamous cell carcinoma , 20 cases transitional cell carcinoma and 20 cases of adenocarcinoma. 30 cases (50%) were associated with bilharziasis . Grading of the studied cases was 2 cases(3.3%) grade 1 ,28 cases(46.7%) grade 2 and 30 cases(50%) grade 3. According to tumor size 20 cases(33.3%) were transitional cell carcinoma (50%) >adenocarcinoma (20%) .
Squamous cell carcinoma, showed the highest CD44 expression. Metaplastic squamous epithelium showed high CD44 expression as invasive squamous cell carcinoma. Transitional cell carcinoma showed higher level of CD44 expression in invasive tumors than normal and preneoplastic epithelium.This may suggests a possible role for CD44 in pathogenesis of urinary bladder carcinomas.
There was a statistically significant correlation between high CD44 expression and grade, tumor size , depth of invasion ,lymph node metastasis ,lymph vascular invasion , TNM stage and 3 year survival . Denoting that CD44 molecule may have a role in cancer progression, invasion, lymph node metastasis and poor prognosis.
Traditional light microscopic (H&E) evaluation of diagnostic bladder biopsy specimens is often sufficient for evaluation of the depth of invasion and hence staging of urothelial carcinoma.The assessment of muscularis propria (MP) invasion can usually be made on routine H&E-stained microscopic slides; however, there are several circumstances in which accurate determination of MP invasion may be difficult . In an attempt to avoid this dilemma and define by objective criteria the muscularis mucosa (MM) and MP, Many immunohistochemical markers for smooth muscle differentiaon have been employed .
Smoothelin is a smooth muscle-specific marker expressed only in terminally differentiated smooth muscle cells as part of its contractile cytoskeleton.
Smoothelin was demonstrated in 53 cases of urinary bladder carcinoma , while 7 cases were negative .The muscularis propria displayed diffuse Smoothelin expression in 50% of cases, patchy expression in 20% and focal expression in 18.4% of cases while 11.6% were negative .The muscularis mucosa didn't show Smoothelin expression. The (7) cases negative for Smoothelin expression showed muscle fragmentation and intense desmoplastic reaction .Indicating that Smoothelin can be used in the accurate recognition of muscularis propria from either muscularis mucosae or desmoplastic reactions.
There was a statistically significant correlation between diffuse Smoothelin expression and depth of invasion , TNM stage and 3 year survival suggesting its role in facilitating appropriate pathologic stage designation of bladder carcinoma.
There was a statistically significant correlation between 3 year survival and sex , age , tumor size , grade ,depth of invasion ,Lymph node metastasis ,Lympho vascular invasion ,distant Youtubemetastasis , TNM stage , CD44 expression & Smoothelin expression. Pointing to a prognostic role of CD44 and Smoothelin in urinary bladder carcinoma. |
