Fascin Stain as a Potential Marker of Invasiveness in Carcinomas of the Urinary Bladder: A Retrospective Study with Biopsy and Cytology Specimen Correlation
RM McKnight, C Cohen, W Jiang, MT Siddiqui. Emory University Hospital, Atlanta, GA
Background: The biologic behavior and prognosis of urothelial carcinomas of the urinary bladder are largely dependent on the presence of invasion. Evaluation of invasion cannot be determined on cytology and can be challenging in biopsy cases with limited sampling. Recent studies of bladder resection specimens suggest that Fascin overexpression may be a marker of aggressive urothelial carcinomas and can help facilitate the assessment of invasion.
Design: We selected thirty-five patients with concurrent urine cytology and biopsy proven invasive urothelial carcinoma. Fascin immunohistochemical (IHC) staining on SurePath™ urine samples and biopsy were performed. Fascin staining was also performed on five negative control urine cytology and biopsy cases.
Results: Intense cytoplasmic staining was observed in malignant cells in all thirty-five urines (sensitivity =100%). Intense staining was not detected in benign urothelial cells in which only occasional faint, nonspecific cytoplasmic and nuclear staining was observed. All five negative control urines were also negative for Fascin staining (specificity =100%). All thirty-five (100%) corresponding biopsy cases with invasive urothelial carcinoma were positive for Fascin. Staining was generally intense and cytoplasmic. Weak to moderate staining was noted in the basal layer but was absent in the superficial urothelium of five negative control biopsy cases. In eleven cases (31%), Fascin immunoreactivity was observed in both the invasive and non-invasive components of the lesion examined. Lastly, in six cases (17%) Fascin highlighted isolated invasive tumor cells and was negative in the overlying non-invasive tumor component.
Conclusions: This study is the first to utilize Fascin IHC in cytology with biopsy correlation. Fascin staining can be successfully performed on SurePath™ cytology preparations. Fascin, while not a definitive marker for invasion, is overexpressed in urothelial carcinomas of the urinary bladder. Furthermore, intense Fascin staining in urine cytology specimens appears to be highly sensitive and specific for urothelial carcinoma and correlates with invasion on subsequent biopsy. Of particular interest is a subset of biopsy cases in which Fascin highlighted only isolated nests of invasive tumor cells; intense Fascin staining was noted in the concurrent urine cytology. Fascin staining on urine cytology is a useful adjunct to predict invasiveness in subsequent biopsies.
Monday, March 22, 2010 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 51, Monday Morning