[449] Fascin as an Identifier of Metastatic Urothelial Carcinoma: A Retrospective Study of Fine Needle Aspirations.

Adam P Vogt, Cynthia Cohen, Momin T Siddiqui. Emory University School of Medicine, Atlanta, GA

Background: Fascin immunohistochemical (IHC) staining has been shown to be a useful marker to determine invasion of urothelial carcinoma. Currently, thrombomodulin is the preferred marker for determination of primary site of metastatic disease in patients with concurrent or previously diagnosed urothelial carcinoma. Fascin, a marker of invasiveness, has not been correlated with metastatic disease. To enhance diagnostic accuracy and correctly identify primary site for appropriate patient management, fascin may be a useful marker in metastatic urothelial carcinoma.
Design: Twenty five cases with adequate cell block material for IHC staining were identified in surgical pathology and cytopathology files of metastatic urothelial carcinoma with either concurrent or previously resected urothelial carcinoma between 2005 and 2010. Fascin, thrombomodulin, uroplakin, cytokeratin 7, and cytokeratin 20 IHC were performed on paraffin-embedded cell block serial sections. Tissue microarrays with two 1mm cores of each of 26 renal and 46 prostate carcinomas were immunostained for fascin.
Results:

Marker Expression in Metastatic Urothelial Carcinoma

	Positive	Negative	Percent Positive
Fascin	23/25	2/25	92%
Thrombomodulin	20/25	5/25	80%
Uroplakin	0/25	25/25	0%
Cytokeratin 7	23/25	2/25	92%
Cytokeratin 20	7/25	18/25	28%

Fascin IHC Sensitivity and Specificity In GU Malignancies

Sensitivity	92%
Specificity	100%
PPV	100%
NPV	97%

Concordant results were seen in 22 of 25 (88%) cases for both fascin and thrombomodulin. Either fascin and/or thrombomodulin demonstrated positive staining in 25 of 25 (100%) cases. 100% of the 26 and 46 cases of kidney and prostate carcinomas respectively, were negative for fascin expression in the cells of interest.
Conclusions: Fascin is over-expressed in the majority (92%) of metastatic urothelial carcinomas. Previous studies have correlated fascin IHC staining with invasion. In comparing fascin with the traditional markers of urothelial carcinoma, fascin expression is of greater frequency and intensity than thrombomodulin. The combination of fascin and/or thrombomodulin identified all twenty-five (100%) cases of urothelial carcinoma. Fascin IHC staining is equivalent in frequency and intensity to cytokeratin 7. Fascin is an advantageous diagnostic complement to thrombomodulin and/or cytokeratin 7, in the setting of metastatic urothelial carcinoma, and is highly specific and sensitive relative to genitourinary malignancies.
Category: Cytopathology

Wednesday, March 2, 2011 1:00 PM

Poster Session VI # 83, Wednesday Afternoon