Diagnostic utility of CK20, p53 and KI67 to differentiate between Papillomas/Non-Invasive papillary urothelial Neoplasm of low malignant potential/non-invasive papillary urothelial carcinoma, low grade
Dr. Dipti Gajjar, Dr. Mansi Faujdar, Dr. Rohit Jain and Dr. Shubha Gupta
Background: Urinary Bladder cancer is the 7th most common cancer worldwide, with an estimated 260,000 new cases occurring each year in men and 76,000 in women. It is estimated that approximately 70-80% of patients with newly diagnosed bladder cancer present with non-invasive or early invasive. The problem arise mostly in distinguishing urothelial papilloma from non-invasive PUNLMP & papillary carcinoma especially low grade noninvasive ones. It is very important to distinguish these entities to design the therapeutic and monitoring strategies for these patients and it is difficult on the basis of histological features alone.
Aim & Objectives: To study histomorphological spectrum of urothelial tumors according to WHO/ISUP consensus (2004) and to study pattern of expression of CK20, p53 LI & Ki67 LI to differentiate between Papillomas/PUNLMP/PUCLG.
Material & Method: In this study 300 consecutive cases were taken from March 2016 to May 2017. Cases were histomorphologically classified according to WHO/ISUP (2004) classification & investigated the role of IHC panel of CK20, p53 & Ki67 to evaluate their utility for the diagnosis & to differentiate between Papilloma/PUNLMP/PUCLG.
Results: Out of 300 cases, 48 cases were required IHC (CK20, p53, Ki67) for final diagnosis. Out of 48 cases, 16 were diagnosed as PUCLG, 10 were diagnosed as PUNLMP. Urothelial papilloma and Inverted urothelial papilloma were diagnosed in 13 and 9 cases respectively.
Conclusion: The WHO/ISUP (2004) classification for bladder tumor enables to diagnose urothelial tumors into clinically and prognostically relevant entities. IHC panel of CK20, p53 & Ki67 may be a useful diagnostic marker in Papillary urothelial neoplasms, especially Non-invasive urothelial neoplasias at the lower end of the spectrum & help to differentiate papilloma/PUNLMP/PUCLG with borderline histological features.