title: Diagnostic utility of p53 and CK20 immunohistochemical expression grading urothelial malignancies.
abstract: BACKGROUND
  Current grading system in application by WHO/ISUP divides urothelial malignancies in low and high grade by morphologic criteria while strict segregation may become cumbersome in limited tissue specimens. As grading these carcinomas are of utmost prognostic significance after depth of invasion, therefore we evaluated the role of immunohistochemical expression of p53 and cytokeratin 20 as an adjuctive tool in grading urothelial carcinoma.
  
  
  METHODS
  The study was conducted in Aga khan university hospital, Histopathology section from December 2010 till June 2011 for duration of six months. It involved 95 cases of urothelial carcinomas diagnosed on trans-uretheral resection specimens of bladder growth. Immunohistochemical expression of p53 and cytokeratin 20 was performed according to standard protocols and correlated with grade and depth of invasion.
  
  
  RESULTS
  There were 48 cases (50.5%) of low grade and 47 cases (49.5%) of high grade urothelial carcinoma included in the study. Male to female ratio was 4.3:1. Majority of patients (80%) were seen in 45 to 90 years age group. Diffuse positive expression of cytokerain 20 was noted in 33 cases (68.8%) of high grade and 19 (40.4%) low grade tumors. Strong positive expression of p53 was seen in 35 cases (72.9%) of high grade while only 17 cases (36.2%) of low grade tumors showed strong p53 expression.
  
  
  CONCLUSIONS
  Significant difference in expression of Cytokeratin 20 and p53 was found between low and high grade urothelial carcinoma. Therefore we suggest combined use of these markers may be helpful in assigning grade to urothelial carcinoma especially when histologic features are borderline.
authors.affiliation: Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan.
authors.forename: Shazia
authors.initials: S
authors.lastname: Mumtaz
authors.affiliation: Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan.
authors.forename: Atif Ali
authors.initials: AA
authors.lastname: Hashmi
authors.affiliation: Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Sheema H
authors.initials: SH
authors.lastname: Hasan
authors.affiliation: Liaquat National Hospital and Medical College, Karachi, Pakistan.
authors.forename: Muhammad Muzzammil
authors.initials: MM
authors.lastname: Edhi
authors.affiliation: Dhaka Medical College, Dhaka, Bangladesh.
authors.forename: Mehmood
authors.initials: M
authors.lastname: Khan
keywords: Cytokeratin 20; Papillary urothelial carcinoma; p53
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