Urothelial Carcinoma With an Inverted Growth Pattern Can be Distinguished From Inverted Papilloma by Fluorescence In Situ Hybridization, Immunohistochemistry, and Morphologic Analysis

Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
American Journal of Surgical Pathology (Impact Factor: 5.15). 01/2008; 31(12):1861-7. DOI: 10.1097/PAS.0b013e318060cb9d
Source: PubMed


Inverted papilloma of the urinary bladder and urothelial carcinoma with an inverted (endophytic) growth pattern may be difficult to distinguish histologically, especially in small biopsies. The distinction is important as these lesions have very different biologic behaviors and are treated differently. We examined histologic features and undertook immunohistochemical staining and UroVysion fluorescence in situ hybridization (FISH) to determine whether these methods could aid in making this distinction. We examined histologic sections from 15 inverted papillomas and 29 urothelial carcinomas with an inverted growth pattern. Each tumor was stained with antibodies to Ki-67, p53, and cytokeratin 20. In addition, each tumor was examined with UroVysion FISH for gains of chromosomes 3, 7, and 17 and for loss of chromosome 9p21 signals. None of the inverted papillomas stained positively for Ki-67 or for cytokeratin 20. Only 1 of 15 inverted papillomas stained positively for p53. By contrast, 66%, 59%, and 59% of urothelial carcinomas with an inverted growth pattern stained positively for Ki-67, p53, and cytokeratin 20, respectively. Only 3 of the urothelial carcinomas stained negatively for all 3 immunohistochemical markers. UroVysion FISH produced normal results for all cases of inverted papilloma. By contrast, 21 of 29 cases (72%) of urothelial carcinoma with an inverted growth pattern demonstrated chromosomal abnormalities typical of urothelial cancer and were considered positive by UroVysion FISH criteria. Morphologic features, as well as immunohistochemical stains (including stains for Ki-67, p53, and cytokeratin 20) and/or UroVysion FISH can help to distinguish inverted papilloma from urothelial carcinoma with an inverted growth pattern.

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Available from: Shaobo Zhang, Feb 11, 2015
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    • "The author completely agrees with the opinion of Sudo et al [3]. Jones et al [2], who examined 29 cases of UC with an inverted growth pattern and 15 cases of IP, stressed that p53, Ki-67 and cytokeratin 20 can distinguish UC with an inverted growth pattern from IP by morphologic, FISH, and immunohistochemical analysis. In IP, p53, KI67 and cytokeratin 20 were all negative, while, in UC with an inverted growth pattern, their expression was seen in 59% (p53), 66% (Ki-67) and 59% (cytokeratin 20). "
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