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Objective: Although most patients with urinary bladder cancer present with noninvasive and low-malignant stages of the disease, about 20% eventually develop life-threatening metastatic tumors. This study was designed to evaluate the potential of matrix-assisted laser desorption/ionization (MALDI) mass spectrometry imaging (MSI) to identify molecular markers predicting the clinical course of bladder cancer., Materials and Methods: We employed MALDI-MSI to a bladder cancer tissue microarray including paraffin-embedded tissue samples from 697 patients with clinical follow-up data to search for prognostically relevant associations., Results: Analysis of our MALDI imaging data revealed 40 signals in the mass spectra (m/z signals) associated with epithelial structures. The presence of numerous m/z signals was statistically related to one or several phenotypical findings including tumor aggressiveness (stage, grade, or nodal status; 30 signals), solid (5 signals) or papillary (3 signals) growth patterns, and increased (6 signals) or decreased (12 signals) cell proliferation, as determined by Ki-67 immunohistochemistry. Two signals were linked with tumor recurrence in noninvasive (pTa category) tumors, of which one was also related to progression from pTa-category to pT1-category disease. The absence of one m/z signal was linked with decreased survival in the subset of 102 muscle-invasive cancers., Conclusion: Our data demonstrate the suitability of combining MSI and large-scale tissue microarrays to simultaneously identify and validate clinically useful molecular markers in urinary bladder cancer., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Aim: Urothelial (transitional cell) tumors account for about 90% of all bladder tumors. Their presentation varies from benign lesions that rarely recur to highly malignant tumors. Inverted (endophytic) growth pattern in urothelial carcinoma is particulary hard to distinguish from inverted papilloma. Morphologic criteria alone are not enough and immunohistochemical assesments must also be done, especially in cases of small size biopsy material or transurethral resections. The aim of this study was to accentuate the importance and ways of differentiation of this variable forms as their treatment and prognosis differ., Patients and Methods: In the period from 01.01.2008. to 30.06.2009. at Department of Pathology, University Hospital "Sestre milosrdnice" four patients were diagnosed with low-grade urothelial carcinoma with an inverted growth pattern. Routine histology and additional immunohistochemistry to p53, Ki-67 and CK 7 and 20 was performed., Results: There were three male patients aging 37, 61 and 69 years and one female aged 46 (mean 53.3 years). Three patients presented with painless hematuria while the last patient had microhaematuria as an Incidental finding. Histologically, tumors formed nests of atypical urothelial cells. Very few or no mitotic figures were observed. Invasion of lamina propria was present in three specimens. Immunohistochemically, positive staining to p53 and CK 20 was observed in all four cases and staining to CK 7 in two. Staining to CK 20 was positive in 80%-100% of tumor cells while the number of p53 positive cells was between 20% and 40% in all four cases. Proliferative activity was assesed using Ki-67 antibody. The percentage of positively stained tumor cells, assesed in hot spots under high magnification (400x), was 5%, 7%, 8% and 12% (mean 8%)., Conclusion: Urothelial carcinoma with inverted growth pattern and inverted papilloma have similar morphologic features but their biological behaviour, treatment and prognosis are different. In order to avoid the urothelial carcinoma to be misdiagnosed as a benign papilloma, we find it very important to make additional investigations beside conventional histology. Immunohistochemical staining for CK 20, p53 and Ki-67, which is positive in most carcinomas, can help us make the right diagnosis.

Micropapillary urothelial carcinoma (MUC) is a rare variant of urinary bladder carcinoma associated with highly aggressive behaviour. The aim of this study was to analyse clinicopathological features of MUC particularly a relationship between pathological stage at presentation and proportion of micropapillary component (MPC) in 10 patients with MUC. In the examined period (January 1st 2004 - June 30th, 2007) there were 610 patients with urinary bladder cancer (M:F = 456:154), while 10 (1.6%) of them were patients with MUC. All MUC were invasive at the time of diagnosis. Stage distribution at presentation was 4 T1(40%) and 6 T2 (60%) and the percentage of MPC correlated with pathological stage: 3 of 4 (75%) tumors staged T1 had less than 10% of MPC and 5 of 6 (83,3%) tumors staged T2 had more than 50% of MPC. MUC is an aggressive tumor, often in advanced stage of disease at the time of diagnosis, in which the pathological stage is related to the proportion of MPC.

409 cases of superficial bladder carcinoma (pTa, pTi, Tis) are reported. They are divided into three groups: 171 patients treated by TUR alone, 124 treated by TUR and local thio-TEPA, and 114 patients treated by TUR and BCG vaccine locally. It was found that the frequency of recurrence fell by 56.7, 41.9 and 26.3%, while the progression of the illness declined correspondingly by 19.8, 16.9 and 11.4%. In other words, in terms of recurrence and progression, the poorest results were found for the group treated by TUR only, and the best results were found with the TUR and BCG group.