Analysis of the peripheral blood lymphocyte subsets in patients with bladder carcinoma (original) (raw)
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Seminars in diagnostic pathology, 2018
Intravesical immunotherapy, chemotherapy, and neoadjuvant systemic chemotherapy are among the most frequent therapeutic procedures to treat malignancies of the urinary bladder. These treatment modalities produce reactive morphologic changes in the urothelium that can mimic urothelial carcinoma in situ, urothelial dysplasia or true invasive urothelial neoplasia. Mitomycin C used after transurethral resection of bladder tumor to reduce recurrences, BCG intravesical immunotherapy to treat high risk non-muscle invasive bladder cancer and urothelial carcinoma in situ, and platinum-based systemic chemotherapy to improve post-cystectomy disease-specific survival some of the causes of therapy related atypia in urinary bladder. In addition, a number of systemic drugs in use to treat other systemic diseases, such as cyclophosphamide used to treat certain auto-immune disorders or hematologic malignancies, or the anesthetics ketamine increasingly used as illegal recreational drug, may produce s...
Best Practices Recommendations in the Application of Immunohistochemistry in the Bladder Lesions
The American Journal of Surgical Pathology, 2014
The bladder working group of the 2013 International Society of Urologic Pathology (ISUP) Conference on Best Practices Recommendation in the Application of Immunohistochemistry (IHC) in Urologic Pathology discussed 5 settings in which IHC is commonly used in clinical practice. With regard to markers for urothelial differentiation, the committee found that there is no ideal marker or established panel to confirm urothelial differentiation. On the basis of the differential diagnostic consideration, positivity for GATA3, CK20, p63, and either high-molecular weight cytokeratin (HMWCK) or cytokeratin (CK)5/6 is of value in proving urothelial differentiation in the appropriate morphologic and clinical context. With regard to the role of IHC in the distinction of reactive atypia from urothelial carcinoma in situ, the committee recommended that morphology remains the gold standard in this differential diagnosis and that, at best, the IHC panel of CK20/p53/CD44(s) has potential utility but is variably used and has limitations. The immunostaining pattern must be interpreted with strict morphologic correlation, because overreliance on IHC may be misleading, particularly in the posttreatment setting. IHC has no role in the distinction of dysplasia versus carcinoma in situ and in the grading of papillary urothelial carcinoma. IHC may have a limited but distinct role in staging of bladder cancer. In a subset of cases, depending on the clinical and histologic context, broad-spectrum cytokeratins (to identify early or obscured invasion) and desmin (distinction of muscle from desmoplasia and to highlight muscle contours for subclassification) may be helpful. Limited experience and conflicting data preclude smoothelin or vimentin to be recommended routinely for subclassifying muscle type at this time. In the workup of a spindled cell proliferation of the bladder and in limited specimens, we recommend an immunohistochemical panel of 6 markers including ALK1, SMA, desmin, cytokeratin (AE1/AE3), and p63 with either of HMWCK or CK5/6. Currently, there are no prognostic immunohistochemical or molecular studies that are recommended to be routinely performed on biopsy or resection specimens.
Cancer Immunology Immunotherapy, 1982
A total of 143 patients with transitional cell carcinoma of the urinary bladder were tested for lymphocyte-mediated cytotoxicity against the bladder carcinoma cell line I24. Some of the patients were also tested against MANO (another cell line of transitional cell bladder carcinoma origin), HCV29 (from bladder epithelium, probably transformed in vitro) and~or HT29 (from a colon adenocarcinoma). The patients were divided into a high-or a low-responder group for each cell line. The patients were followed up and the correlation between a high response in the cytotoxicity tests and survival was evaluated using an adaptation of the Mantel-Haenszel statistics. No significant correlation could be demonstrated.
European Urology, 2002
On behalf of the European Association of Urology (EAU) guidelines for diagnosis, therapy and follow-up of bladder cancer patients were established. Criteria for recommendations were evidence based, and included aspects of cost-effectiveness and clinical feasibility. Method: A systematic literature research using Medline Services was conducted. References were weighted by a panel of experts. Results: TNM, 1997, classification and WHO grading 1998 are recommended. Recommendations are developed for diagnosis for bladder cancer in general, treatment of superficial and infiltrative bladder cancer, and follow-up after different types of treatment modalities, such as intravesical instillations, radical cystectomy, urinary diversions, radiotherapy and chemotherapy. CLASSIFICATION OF BLADDER CANCER The use of the TNM classification 1997 and WHO grading, 1999, is encouraged, as it corresponds best with the clinical outcome of the tumours (1) More than 90% of bladder cancers are transitional cell carcinoma (TCC); the remainder are squamous cell or adenocarcinoma. Bladder tumours are considered superficial (Tis-Ta-T1) or infiltrative (T2-T3-T4) based on cystoscopy, transurethral resection (TUR), imaging studies and histopathological findings. There is also important inter observer variability in classifying stage T1 vs. TA tumours and grading tumours (2). DIAGNOSIS Early detection Early symptom recognition in bladder tumours is a key to better prognosis (6,7). Haematuria is the most common finding in bladder cancer. The degree of haematuria does not correlate with the extent of the disease. Bladder cancer may also present with voiding irritability. Imaging Intravenous pyelography is considered as an important examination to evaluate haematuria but the necessity to perform routinely is now questioned because of the low incidence of important findings obtained (3). Ultrasonography combined with plain abdominal film was found to be as accurate in the diagnosis of the cause of haematuria as IVP. Computed tomography scanning may be part of the evaluation of invasive bladder tumours and the evaluation of pelvic and abdominal lymph node metastasis. Its usefulness in predicting the local extent of the disease is reduced by artefactual abnormalities in the perivesical tissues. The significance of routine bone scans before total cystectomy in infiltrative tumours is questionable. Urinary cytology Examination of a voided urine or bladder barbotage specimen for exfoliated cancer cells is particularly useful when a high-grade malignancy or CIS is present. It remains often negative in low-grade tumours. Cystoscopy and TUR A bimanual examination should be performed first to assess whether or not a mass is palpable in the bladder and, if so, whether it is fixed to the pelvic wall. TUR of the bladder tumour should be done so as to maximize the preservation of architectural detail and the relation of the tumour to the various layers of the bladder wall. The more superficial component of the tumour should be resected separately from its deeper component. Biopsy specimens of the tumour and suspected area should be taken to map the extent of the disease. Random biopsies of normal mucosa are indicated in the presence of positive cytology, * For more extensive information consult the EAU Guidelines presented at the XVIth EAU annual congress, Geneva, Switzerland (ISBN 90-806179-3-9) * EAU Working Group on Oncological Urology (Chairman: Prof.Dr.
Low-grade T a (noninvasive) urothelial carcinoma of the bladder
Urology, 2005
This article discusses the development of international guidelines for the diagnosis, treatment, follow-up, and prevention of low-grade Ta urothelial carcinoma of the bladder. The authors, who are experts in this field from 3 continents and 7 countries, reviewed the English language literature through September 2004. The results of the authors' deliberations are presented here as a consensus document. The objective of this study was to determine the optimal diagnostic workup, treatment, follow-up, and prevention of low-grade, Ta urothelial carcinoma of the bladder. A consensus conference convened by the World Health Organization (WHO) and the Société Internationale d'Urologie (SIU) met to critically review the literature on the diagnosis and treatment of low-grade Ta urothelial carcinoma of the bladder. Research was conducted using Medline; this search engine also was used to identify additional works not detected at the initial search. Evidencebased recommendations for diagnosis and management of the disease were made with reference to a 4-point scale. Low-grade Ta urothelial carcinoma of the bladder is a well-studied subject with many level 1 and 2 evidence references that support clinical practice. Findings from 135 reviewed citations are summarized. Many grade A and B recommendations on the diagnostic workup and management of this disease can be given with level 1 and 2 evidence based on prospective randomized clinical trials of sufficient statistical power. This should improve the quality of the treatment of this disease. UROLOGY 66 (Suppl 6A): [75][76][77][78][79][81][87][88] 2005.
Encyclopedia of Cancer, 2014
Bladder cancer (BlCa) constitutes the 11th most common cancer worldwide, accounting for roughly 3 % of all cancers, with a male predominance (3.5:1). The highest incidence rates are reported in Western Europe, North America, and Australia, thus depicting a higher prevalence of this particular neoplasm in developed countries (a 6-fold increase, comparing with developing countries). Most cases of BlCa have an urothelial (transitional cell) phenotype, and it is estimated that approximately 70-80 % of those newly diagnosed present with noninvasive (i.e., basement membrane limited) or early invasive (i.e., invading the lamina propria) features (Ta, Tis, or T1), so-called superficial BlCa, whereas the remainder are deeply invasive (i.e., infiltrating the muscularis propria and beyond) cancers (T2-T4). The histology of infiltrating urothelial carcinomas is variable, although most of pT1 cancers are papillary and low or high grade, and most of T2-T4 carcinomas are non-papillary and high grade. Characteristics Morphologic Aspects Noninvasive Lesions Flat Lesions Urothelial dysplasiait is characterized by some degree of architectural distortion, accompanied by nuclear irregularity, nucleomegaly, hyperchromasia, and pleomorphism, but insufficient to merit a diagnosis of urothelial carcinoma in situ (CIS). There is evidence, however, that these lesions share some genomic abnormalities with CIS, thus rendering them a putative precursor role. Urothelial carcinoma in situ (CIS)it is characterized by architectural disorder, nuclear hyperchromasia, and pleomorphism (Fig. 1). The full thickness of the epithelium is not required to be occupied by atypical cells, which may show a pagetoid growth pattern or clinging to the basement membrane. CIS is accepted as a direct precursor of invasive urothelial carcinoma. Some authors diagnose CIS with microinvasion when there is invasion into the lamina propria that does not exceed 5 mm in depth nor more than 20 cells in the subepithelial connective tissue.
https://www.ijrrjournal.com/IJRR\_Vol.6\_Issue.10\_Oct2019/Abstract\_IJRR0045.html, 2019
Context (background) & aims-The urinary bladder is a part of lower urinary tract, one of the main portals of the urogenital system. The different bladder lesions constitute a major health problem in developing countries. Carcinoma of this region is the commonest neoplasm in elderly male in our country. Our study was done with the aim of early diagnosis of these lesions in a cost effective manner. Materials & Methods-Total 62 cases were selected having signs and symptoms of lower urinary tract infection and hematuria. The specimens were collected from the Urology department of a tertiary care hospital situated at Kolkata. Thereafter, the tissues were processed routinely for histopathology and immunohistochemistry (p53, ki-67 & 34βE12 cytokeratin).Morphometric analysis of Mean Nuclear Diameter (MND), Mean cytoplasmic diameter (MCD), Mean nuclear area (MNA), Mean Nuclear Perimeter (MNP), Nucleo-cytoplasmic ratio (N: C) etc were done on H & E stained sections with ERMA ocular micrometer and analysed by software AutoCAD 2007. Statistical analysis used-Unpaired Student"s t-Test. Results-Statistically significant difference was found between non-neoplastic and malignant lesions. The diagnosis was confirmed by histopathological findings along with morphometry and proliferative activities as well as invasiveness were assessed with ki-67 and 34βE12 cytokeratin immunolabelling. Conclusion-Morphometry can be an important tool for early diagnosis and determination of therapeutic protocol in the different urinary bladder lesions especially if they are correlated with immunohistochemistry.
Urinary immunocytology—Promise or nonseller? A review with an opinion
Urologic Oncology: Seminars and Original Investigations, 2014
Urine cytology is considered a valid diagnostic method of urological and nephrological diagnosis and follow-up, whereas immunohistochemistry is an indispensable adjunct to histopathology. The combination of both-urinary immunocytology-has, so far, only attained a marginal role. This review gives a state-of-the-art update of urinary markers and relevant epitopes, elucidates some methodological pitfalls, and gives an outlook on the promise of urinary immunocytology today. It suggests that morphological urine cytology should be amended by immunology in a mutual quest of urologists and pathologists to improve the diagnostic power of urine cytology. The cost-effectiveness of the method is considered. This review also sheds light on the age-old dispute among pathologists about the nature of urothelial carcinoma that is reflected in the frequent and controversial reclassifications of the disease. r 2014 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).