Pitfalls in the use of smoothelin to identify muscularis propria invasion by urothelial carcinoma
ABSTRACT Studies predominantly performed on cystectomy specimens have shown that antibodies against smoothelin can distinguish between muscularis mucosae (MM) (negative or weak stain) and muscularis propria (MP) (strong stain). However, studies on diagnostically difficult (transurethral resection) specimens have not been performed. We studied 34 transurethral resection cases where outside pathologists questioned the presence of MP invasion. Upon expert review of the H&E slides, there was no MP invasion in 18 cases. Smoothelin in MM was negative in 8/18 (44%), weakly positive (1+) in 5/18 (28%), moderately positive (2+) in 4/18 (22%), and moderately/strongly (2-3+) positive in 1/18 (6%). Smoothelin in uninvolved MP present in 8 cases was: 2+ in 2/8 (25%) and 3+in 6/8 (75%). Smoothelin expression in MM was weaker than in MP in 7/8 (88%) cases where both were present. Of 16 tumors with MP invasion, smoothelin in involved MP was: 1+ in 1/16 (6%), 2+ in 3/16 (19%), 2 to 3+ in 9/16 (56%), and 3+ in 3/16 (19%). Smoothelin expression in concurrent uninvolved MP was similar. Our data confirm the relatively distinct staining pattern of smoothelin between MM and MP. However, due to the overlap of intensity between MM and MP, caution should be maintained while using smoothelin immunohistochemistry as a diagnostic tool for MP invasion.
- SourceAvailable from: Ellen C Zwarthoff
[Show abstract] [Hide abstract]
- "Despite these difficulties, accurate recognition of MD invasion is crucial for patient treatment according to the current guidelines. Immunohistochemical expression of the cytoskeletal protein Smoothelin is reported to be stronger in MD than in MM [13–15]. Therefore, additional immunohistochemistry using Smoothelin can be useful in differentiating both muscle layers. "
ABSTRACT: Urothelial cell carcinoma (UCC) with musculus detrusor (MD) invasion is treated by cystectomy. Subsequent pathologic evaluation of cystectomies does not reveal MD invasion (<pT2) in a subgroup of patients. Our objective was to identify features at diagnostic transurethral resection (TUR) predicting down-staging (<pT2) at cystectomy. Patients with pathologically confirmed MD invasion at TUR followed by cystectomy for UCC without (neo-) adjuvant therapy were included (N = 106). Slides of both TUR and cystectomy specimens were reviewed, and survival analyses were performed. In total, 27/106 (26 %) tumors were down-staged at cystectomy, of which 13 (12 %) had no residual tumor (pT0). There was no significant difference in age, gender, time interval between TUR and operation, number of slides sampled, and presence of TUR scar between down-staged (<pT2) and pT2 UCC. At review of TUR specimens (N = 52) with UCC initially diagnosed as pT2, MD invasion was not confirmed in eight cases (15 %). One case showed extensive histiocytic reaction misinterpreted as UCC; in four cases, muscularis mucosae had been considered MD, and in three cases, desmoplastic reaction mimicked MD. No histologic parameter at TUR was significantly associated with down-staging at cystectomy. Overall and disease-specific survival was not statistically different in down-staged and pT2 UCC. In conclusion, down-staging of UCC (<pT2) at cystectomy occurred in 26 %. At review of diagnostic TURs, MD invasion was not confirmed in 15 %. No clinical or pathologic parameter was predictive for down-staging at cystectomy. There was no difference in survival between down-staged and pT2-staged UCC.Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin 07/2012; 461(2):149-56. DOI:10.1007/s00428-012-1277-0 · 2.56 Impact Factor
Conference Paper: MotorMaster+ 2.0: Energy management for the pulp and paper industry[Show abstract] [Hide abstract]
ABSTRACT: MotorMaster+ 2.0 is designed to support energy management functions at medium and large sized industrial facilities. Version 2.0 contains many new design features and modifications that have been proposed by industrial users. This paper highlights the software enhancements that should be of interest to those in the pulp and paper industry and illustrates how MotorMaster+ is successfully being used by a large forest products companyPulp and Paper Industry Technical Conference, 1998. Conference Record of 1998 Annual; 07/1998
- [Show abstract] [Hide abstract]
ABSTRACT: Thin muscle fibers on transurethral resection of the bladder (TURB) can represent either muscularis propria destroyed or splayed by urothelial carcinoma or muscularis mucosae, which can be hyperplastic. The data from 94 patients with invasive bladder cancer seen at our institution (1986-2008) with a mean of 25.4 months of follow-up, who had had an uncertain pathologic diagnosis, were analyzed (72 men and 22 women, mean age 69.4 years). Subsequent restaging TURB or a definitive therapeutic procedure performed ≤3 months after the original TURB in 57 patients revealed that 22 patients (38.6%) had nonmuscle-invasive disease and 32 (56.1%) had Stage pT2 or greater disease. The staging for 3 patients remained ambiguous. Of the 94 patients, 37 did not undergo a restaging/therapeutic procedure within 3 months of their original TURB. Restaging TURB is critical when the initial TURB findings are equivocal for muscularis propria invasion. Although this might seem intuitive, 37 of 94 patients did not undergo repeat staging/therapeutic procedures within 3 months of their initial TURB.Urology 09/2010; 76(3):600-2. DOI:10.1016/j.urology.2009.12.080 · 2.13 Impact Factor