McKnight Ryan, Cohen Cynthia, Siddiqui Momin T
Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia 30322, USA.
Diagn Cytopathol. 2011 Sep;39(9):635-40. doi: 10.1002/dc.21429. Epub 2010 Oct 14.
The evaluation of invasion in urothelial carcinomas of the urinary bladder cannot be determined on cytology and can be particularly challenging in biopsy cases with limited sampling. Recent studies of bladder resection specimens suggest that fascin overexpression may be a marker of aggressive urothelial carcinomas and can help facilitate the assessment of invasion. In this study, we evaluated urine cytology and corresponding biopsy specimens with proven invasive urothelial carcinoma for fascin expression by immunohistochemistry. Thirty-five patients diagnosed with positive urine cytology and biopsy-proven invasive urothelial carcinoma between January 2003 and February 2009 were identified. We found increased fascin expression in 100% (35/35) of SurePath™ urine cytology preparations as well as 100% (35/35) of corresponding biopsy cases with invasive urothelial carcinoma. On urine cytology, cytoplasmic fascin staining was moderate to intense in malignant tumor cell clusters and single cells and not observed in benign urothelial cells. Staining in biopsy cases was generally intense and cytoplasmic and present in both the invasive (100%) and noninvasive (31%) components of the lesion. These findings uphold the association of increased fascin expression in invasive urothelial carcinomas of the urinary bladder. We furthermore demonstrate that fascin staining can be performed successfully on SurePath™ urine cytology preparations in which increased fascin expression correlates with invasion on biopsy. While not a definitive marker of invasion, as it is observed in in situ carcinoma, we conclude that the utilization of fascin immunohistochemistry on urine cytology might serve as a useful adjunct in predicting invasiveness in subsequent biopsies.
膀胱尿路上皮癌浸润情况无法通过细胞学检查确定，对于取材有限的活检病例而言尤其具有挑战性。近期对膀胱切除标本的研究表明，fascin过表达可能是侵袭性尿路上皮癌的一个标志物，有助于评估浸润情况。在本研究中，我们通过免疫组织化学评估了经证实为浸润性尿路上皮癌的尿液细胞学标本及相应活检标本中的fascin表达情况。我们纳入了2003年1月至2009年2月间35例尿液细胞学检查阳性且活检证实为浸润性尿路上皮癌的患者。我们发现，SurePath™尿液细胞学标本中100%（35/35）以及相应的浸润性尿路上皮癌活检病例中100%（35/35）的fascin表达均增加。在尿液细胞学检查中，恶性肿瘤细胞簇和单个细胞的胞质fascin染色呈中度至强阳性，良性尿路上皮细胞中未观察到染色。活检病例中的染色通常较强且为胞质染色，存在于病变的浸润性成分（100%）和非浸润性成分（31%）中。这些发现支持了膀胱浸润性尿路上皮癌中fascin表达增加的相关性。我们还证明，SurePath™尿液细胞学标本上可以成功进行fascin染色，其中fascin表达增加与活检时的浸润相关。虽然它不是浸润的确定性标志物，因为原位癌中也可观察到，但我们得出结论，尿液细胞学检查中使用fascin免疫组织化学可能作为预测后续活检中浸润性的有用辅助手段。
