الفهرس 
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Abstract
In this study, one hundred cases of urothelial bladder carcinoma which were chosen from the archive of the Department of Pathology, Minia University Hospital in the period from 2010 to 2014. Tumour tissues were obtained from 70 patients who had undergone radical cystectomy and 30 patients had done TUR. Lymph node metastasis was evaluated in radical cystectomy cases. The cases were divided into; grade1 (n=14), grade 2 (n=42), and grade 3 (n=44). It had been found that twenty seven cases (27%) were non-muscle invasive urothelial carcinomas (stage Ta and stage T1), while 73 (73%) cases were muscle-invasive urothelial carcinomas (stages T2, T3, and T4).
On studying HER-2 immunoexpression, positive HER-2 membranous expression (2+ and 3+) was found in 31% of cases studied. HER-2 overexpression (3+) or high positive staining was observed in 20% of the cases, while 11% of the cases showed (2+) or low positive expression. Negative expression was found in 69% of the samples, stratified as; 0 score in 43%, and 1+ score in 26% cases.
There was a significant association between HER-2 immunoexpression and tumour grade. HER-2 overexpression was found more frequently in grade 3 cases (31.82%), than in grade 2 cases (14.29%), while none of grade 1 cases showed HER-2 overexpression. Score 2+ was detected in 21.4% of grade 1, and in 19.05% of grade 2 cases, but was not observed in grade 3 cases. Negative staining was found in 78.6%, 66.66%, and 68.18% of grade 1, 2, and 3 of cases respectively.
None of stage Ta cases showed HER-2 overexpression, and there was an increase in HER-2 overexpression with increase in T stages. The association between HER-2 immunoexpression and different tumour stages was statistically significant. There is a significant association between HER-2 immunoexpression and tumour muscle invasiveness. HER-2 immunoexpression was not significantly correlated with patient’s age, gender, bilharziasis, or lymph node metastasis.
COX-2 expression was found to be positive in 71%, and negative in 29% of cases studied. COX-2 positivity was significantly associated with tumour grade. COX-2 positivity was observed more in grade 3 cases 34/44 (77.27%), than in both grade 2 32/42 (76.19%), and grade 1 5/14 (35.71%) cases. The frequency of COX-2 expression was increased by stage, and this result was statistically significant. There was a significant association between COX-2 immunoexpression and depth of muscle invasion.
COX-2 expression was not significantly associated with patient’s age, gender, bilharziasis, or lymph node metastasis. There was a significant positive correlation between HER-2 immunoexpression and COX-2 immunoexpression (r=0.197, and p=0.050).
from observations in this study, it is suggested that HER-2 and COX-2 can play essential roles in the pathogenesis, aggressiveness, invasion, and progression of urothelial carcinoma. So studying the expression of those key molecules could serve as potential targets for prognosis and treatment of bladder urothelial carcinoma, and may assist in the identification of cases that are at greater risk and may have an unfavorable clinical outcome.