Pathology Department, Massachusetts General Hospital, Boston, MA 02118, USA.
Hum Pathol. 2013 May;44(5):860-6. doi: 10.1016/j.humpath.2012.08.011. Epub 2012 Nov 27.
Muscle invasive urothelial carcinoma has been treated with cystectomy ± adjuvant therapy. Recently, a bladder-sparing protocol has been offered to selected patients closely followed with surveillance biopsies. In this setting, radiation-induced changes (RAD-Ch) may be very difficult to distinguish from carcinoma in situ, and failing to recognize them may lead to overtreatment. We ascertained the role of immunohistochemistry using cytokeratin (CK) 20, p53, and CD44s in bladder biopsies from 28 patients with a history of bladder radiation and 17 with carcinoma in situ without radiation. Negative or weak multifocal nuclear p53 staining was seen in 24 of 28 RAD-Ch cases, whereas strong and diffuse nuclear p53 staining was found in 8 of 17 carcinoma in situ cases and moderate and focal to multifocal in 3. CK20 showed strong cytoplasmic staining of only umbrella cells in 22 of 28 RAD-Ch cases. In contrast, 11 of 17 carcinomas in situ showed diffuse and strong CK20 positivity and 5 moderate and focal to multifocal positivity. All carcinomas in situ with weak or no p53 showed significant CK20 staining except 1. CD44s displayed diffuse membranous positivity in 7 of 17 RAD-Ch cases and up to mid-third in 8. Only 1 of 17 carcinomas in situ had diffuse membranous CD44s staining. Diffuse and significant CK20 expression was seen in most carcinomas in situ. Strong and diffuse p53 expression was only seen in carcinoma in situ (~50%), whereas diffuse CD44s staining was typically only seen in RAD-Ch. Our data suggest that a CK20(-) p53(-) CD44a panel proves to be very helpful (CK20 more reliable than p53 or CD44s) in the diagnosis of RAD-Ch.
肌层浸润性尿路上皮癌采用膀胱切除术加辅助治疗。最近，为密切随访监测活检的选定患者提供了保留膀胱的方案。在这种情况下，放射诱导的变化（RAD-Ch）可能非常难以与原位癌区分，如果未能识别它们，可能会导致过度治疗。我们使用细胞角蛋白（CK）20、p53 和 CD44s 在 28 例有膀胱放疗史和 17 例无放疗原位癌的膀胱活检中确定了免疫组织化学的作用。28 例 RAD-Ch 病例中有 24 例出现阴性或弱阳性核 p53 染色，而 17 例原位癌病例中有 8 例出现强而弥漫的核 p53 染色，3 例为中度和局灶性至多灶性。28 例 RAD-Ch 病例中只有 22 例显示伞细胞的 CK20 强细胞质染色。相比之下，17 例原位癌中有 11 例显示弥漫性和强 CK20 阳性，5 例为中度和局灶性至多灶性阳性。除 1 例外，所有 p53 弱阳性或阴性的原位癌均显示出明显的 CK20 染色。CD44s 在 17 例 RAD-Ch 病例中有 7 例显示弥漫性膜阳性，在 8 例中可达中三分之一。仅有 1 例原位癌显示弥漫性膜 CD44s 染色。大多数原位癌显示弥漫性和明显的 CK20 表达。只有在原位癌（约 50%）中才观察到强而弥漫的 p53 表达，而弥漫性 CD44s 染色通常仅见于 RAD-Ch。我们的数据表明，CK20（-）p53（-）CD44a 组在诊断 RAD-Ch 方面非常有用（CK20 比 p53 或 CD44s 更可靠）。
