Utility of CK 20 and micro vessel density in diagnosis and prognosis of urothelial neoplasms

Urothelial carcinoma is the 7th most common cancer worldwide. More than 50% of patients with non-invasive tumors have recurrences and 10–15% of these will progress to invasive cancer. Hence there is a need to assess the biological behavior of tumors with newer modalities.

CK 20 is generally expressed only in the umbrella cells of the non-neoplastic urothelium, whereas their abnormal expression predicts malignant potential in low grade TCC. Micro vessel Density (MVD) as elsewhere is a predictive prognostic marker in TCC also. Hence CK 20 and MVD together can aid the clinician in defining specific targeted therapies.

To assess the clinical utility of CK 20 and MVD in urothelial neoplasms as diagnostic and prognostic factors.

Study was conducted on 30 TURBT specimens diagnosed as malignant urothelial neoplasms according to WHO/ISUP 2004 classification. Immunochemical staining for CK 20 and CD 34 were done and interpreted.

Out of 30 Urothelial neoplasms 2 were Papillary Urothelial Neoplasms of Low Malignant Potential (PUNLMP), 10 were Low Grade Papillary Urothelial Neoplasm(LGPUN), 13 were High Grade Papillary Urothelial Neoplasm (HGPUN), and 5 were Invasive urothelial Neoplasm(IUN).

Abnormal expression of CK 20 was seen in 100% (2/2) of PUNLMP, 80% (8/10) of LGPUN, 46% (6/13) of HGPUN and 40% (2/5) IUN (P = 0.048).

Average MVD was 6.75 in PUNLMP, 19.36 in LGPUN, 28.18 in HGPUN and 44 in IUN (P=0.019).

CK 20 and MVD are useful in predicting benign versus malignant behavior and defining treatment strategies.