الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Urinary bladder cancer represents a major economic problem as much as it is global and national health problem as it is important cause of morbidity and mortality worldwide. Urothelial carcinoma (UC) is the most common histologic type of bladder cancer. An important feature of UC is the propensity to give variable morphologic variants, the prognosis of which different from the conventional one. UC with squamous differentiation is the commonest histologic variant of UC that could be encountered in 60% of cases of urothelial carcinoma. Squamous differentiation in UC seems to be unfavorable prognostic feature predicting local recurrence after radical cystectomy. Also it may be indicator of poor response to radiation therapy and systemic chemotherapy. Also increased extent of squamous differentiation in UC may be associated with adverse outcome. Squamous differentiation in UC is detected histologically by keratin pearl formation, individual cell keratinization and intercellular bridges which may be difficult to detect in focal or non-keratinizing cases. Desmocollin2 (DSC2) is a calcium-dependent glycoprotein which is a major intercellular adhesive junction in squamous epithelium. Cytokeratin 14 (CK14) is a type I (acidic) of human intermediate filament protein which usually pairs with Cytokeratin 5 type II (basic) cytokeratin that expressed in the basal compartment of all stratified squamous epithelia. This study aimed to evaluate the diagnostic value of CK14 and DSC2 both singly and in combination for squamous differentiation in UC. This retrospective study was conducted on 73 specimens of primary urinary bladder carcinoma, retrieved from the archives of Pathology Departments, Faculty of Medicine, Menoufia University and Cairo University spanning the period between 2014 and 2017. Fifty-seven cases were received as cystectomy specimen and 16 cases as cystoscopic biopsy. Histologic type, grade, stage, squamous metaplasia of surface epithelium, lymphovascular and perineural invasion were all assessed in haematoxylin and eosin (H& E) stained slides. Evidence of squamous differentiation in UC (keratin pearl formation, dyskeratosis and intercellular bridges) was evident in 31 cases. The method used for immunostaining was streptavidin-biotin amplified system using DSC2 and CK14 primary antibodies. A highly significant statistical association was found between positive DSC2 expression and presence of squamous differentiation in UC cases (P=0.001). It showed sensitivity of 90% and specifity of 92%. A highly statistically significant association was also detected between CK14 expression and presence of squamous differentiation in UC cases (P=0.001). It showed sensitivity of 74% and specifity of 81%. Combining both DSC2 and CK14 showed sensitivity of 94% and specifity of 77 Both DSC2 and CK14 positive expression showed significant statistical association with grade of SCC (P= 0.03 and 0.001 respectively) with decreased intensity of expression from grade I to grade III. CK14 expression showed significant statistical association with bad prognostic parameters including increased percentage of squamous differentiation in UC, lymphovascular (LVI) and perineural invasion (PNI) among UC cases (P=0.002, 0.001 and 0.001 respectively). It also showed significant statistical association with advanced pathologic tumor stage in all studied cases (P= 0.057).