Urothelial carcinoma with an inverted growth pattern can be distinguished from inverted papilloma by fluorescence in situ hybridization, immunohistochemistry, and morphologic analysis

Timothy D. Jones, Shaobo Zhang, Antonio Lopez-Beltran, John Eble, Ming Tse Sung, Gregory T. MacLennan, Rodolfo Montironi, Puay Hoon Tan, Suqin Zheng, Lee Ann Baldridge, Liang Cheng

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Abstract

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.

Original languageEnglish
Pages (from-to)1861-1867
Number of pages7
JournalAmerican Journal of Surgical Pathology
Volume31
Issue number12
DOIs
StatePublished - Dec 2007

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Inverted Papilloma
Fluorescence In Situ Hybridization
Keratin-20
Immunohistochemistry
Carcinoma
Growth
Coloring Agents
Neoplasms
Chromosomes, Human, Pair 17
Chromosomes, Human, Pair 3
Chromosomes, Human, Pair 7
Chromosome Aberrations
Urinary Bladder
Chromosomes
Staining and Labeling
Biopsy
Antibodies

Keywords

  • Cytokeratin 20
  • Differential diagnosis
  • Endophytic
  • Fluorescence in situ hybridization
  • Immunohistochemistry
  • Inverted
  • Inverted papilloma
  • Ki-67
  • Neoplasia
  • p53
  • Transitional cell carcinoma
  • Urinary bladder
  • Urothelial carcinoma
  • UroVysion

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine

Cite this

Urothelial carcinoma with an inverted growth pattern can be distinguished from inverted papilloma by fluorescence in situ hybridization, immunohistochemistry, and morphologic analysis. / Jones, Timothy D.; Zhang, Shaobo; Lopez-Beltran, Antonio; Eble, John; Sung, Ming Tse; MacLennan, Gregory T.; Montironi, Rodolfo; Tan, Puay Hoon; Zheng, Suqin; Baldridge, Lee Ann; Cheng, Liang.

In: American Journal of Surgical Pathology, Vol. 31, No. 12, 12.2007, p. 1861-1867.

Research output: Contribution to journalArticle

Jones, Timothy D. ; Zhang, Shaobo ; Lopez-Beltran, Antonio ; Eble, John ; Sung, Ming Tse ; MacLennan, Gregory T. ; Montironi, Rodolfo ; Tan, Puay Hoon ; Zheng, Suqin ; Baldridge, Lee Ann ; Cheng, Liang. / Urothelial carcinoma with an inverted growth pattern can be distinguished from inverted papilloma by fluorescence in situ hybridization, immunohistochemistry, and morphologic analysis. In: American Journal of Surgical Pathology. 2007 ; Vol. 31, No. 12. pp. 1861-1867.
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AU - Eble, John

AU - Sung, Ming Tse

AU - MacLennan, Gregory T.

AU - Montironi, Rodolfo

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AB - 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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KW - UroVysion

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