eISSN: 2084-9869
ISSN: 1233-9687
Polish Journal of Pathology
Current issue Archive Manuscripts accepted About the journal Supplements Abstracting and indexing Subscription Contact Instructions for authors
SCImago Journal & Country Rank
vol. 68
Original paper

Immunohistochemical differentiation between muscularis mucosae and muscularis propria for improving the staging of bladder cancer in patients undergoing transurethral resection of bladder tumours

Sławomir Poletajew, Ewa Wolińska, Aleksander Wasiutyński, Bartosz Dybowski, Piotr Radziszewski, Barbara Górnicka

Pol J Pathol 2017; 68 (3): 218-224
Online publish date: 2017/11/30
View full text
Get citation
JabRef, Mendeley
Papers, Reference Manager, RefWorks, Zotero
Microscopic differentiation between muscularis mucosae (MM) and muscularis propria (MP) of the bladder in the material obtained during transurethral resection (TUR) remains difficult. The study was aimed at determination of the usefulness of immunohistochemical staining in this context. Forty-seven TUR specimens were stained with 5 mouse anti-human antibodies: anti-desmin, anti-filamin, anti-type IV collagen, anti-smoothelin, and anti-vimentin. Slides were assessed under light microscopy and the intensity of the immune reaction within MM and MP was evaluated on a four-level visual scale as follows: negative (0) and weakly (1), moderately (2), or strongly (3) positive. MM was identified in 27 patients (57.4%). The modal values of reaction intensity in MM and MP was 0 and 2 for desmin (p > 0.05), 2 and 2 for filamin (p = 0.01), 2 and 2 for type IV collagen (p > 0.05), 1 and 2 for smoothelin (p = 0.03), and 2 and 0 for vimentin (p = 0.02), respectively. Identical intensity within MM and MP was observed in 7.1%, 28.6%, 20%, 30.1%, 5.6%, respectively. Immunohistochemistry can help differentiate between MM and MP in TUR specimens. As of yet, no single marker can reliably differentiate between MM and MP; however, a combination of anti-filamin, anti-smoothelin, and anti-vimentin antibodies may be reasonable for diagnostic purposes.

bladder cancer, microscopic diagnostics, immunohistochemistry, staging, muscularis mucosae

Babjuk M, Böhle A, Burger M, et al. EAU Guidelines on Non-Muscle-invasive Urothelial Carcinoma of the Bladder: Update 2016. Eur Urol 2017; 71: 447-461.
Amin MB, McKenney JK, Paner GP, et al. ICUD-EAU International Consultation on Bladder Cancer 2012: Pathology. Eur Urol 2013; 63: 16-35.
Özyalvaçli G, Özyalvaçli ME, Astarci HM, et al. Evaluation of different p16 immunostaining methods and the prognostic role of p16/Ki-67 combined expression in non-muscle invasive bladder cancers. Pol J Pathol 2015; 66: 57-66.
Amin MB, Trpkov K, Lopez-Beltran A, et al. Best practices recommendations in the application of immunohistochemistry in the bladder lesions: report from the International Society of Urologic Pathology consensus conference. Am J Surg Pathol 2014; 38: e20-34.
Council L, Hameed O. Differential expression of immunohistochemical markers in bladder smooth muscle and myofibroblasts, and the potential utility of desmin, smoothelin, and vimentin in staging of bladder carcinoma. Modern Pathol 2009; 22: 639-650.
Bovio IM, Al-Quran SZ, Rosser CJ, et al. Smoothelin immunohistochemistry is a useful adjunct for assessing muscularis propria invasion in bladder carcinoma. Histopathology 2010; 56: 951-956.
Paner GP, Shen SS, Lapetino S, et al. Diagnostic utility of antibody to smoothelin in the distinction of muscularis propria from muscularis mucosae of the urinary bladder: a potential ancillary tool in the pathologic staging of invasive urothelial carcinoma. Am J Surg Pathol 2009; 33: 91-98.
Paner GP, Brown JG, Lapetino S, et al. Diagnostic use of antibody to smoothelin in the recognition of muscularis propria in transurethral resection of urinary bladder tumor (TURBT) specimens. Am J Surg Pathol 2010; 34: 792-799.
Miyamoto H, Sharma RB, Illei P, et al. Pitfalls in the use of smoothelin to identify muscularis propria invasion by urothelial carcinoma. Am J Surg Pathol 2010; 34: 418-422.
Poletajew S, Wilczek E, Wasiutynski A, et al. Antigenic profile of muscularis mucosae and muscularis propria of the urinary bladder. Iran J Immnuol 2015; 12: 50-63.
Babjuk M. Optimized management in patients with bladder cancer. Cent European J Urol 2015; 68: 15-16.
Bayraktar Z, Gurbuz G, Tasci A, et al. Staging error in the bladder tumor: the correlation between stage of TUR and cystectomy. Int Urol Nephrol 2001; 33: 627-629.
Beukers W, Meijer T, Vissers CJ, et al. Down-staging ( Chang BS, Kim HL, Yang XJ, et al. Correlation between biopsy and radical cystectomy in assessing grade and depth of invasion in bladder urothelial carcinoma. Urology 2001; 57: 1063-1066.
Cheng L, Neumann RM, Weaver AL, et al. Grading and staging of bladder carcinoma in transurethral resection specimens. Correlation with 105 matched cystectomy specimens. Am J Clin Pathol 2000; 113: 275-279.
Lee SE, Jeong IG, Ku JH, et al. Impact of transurethral resection of bladder tumor: analysis of cystectomy specimens to evaluate for residual tumor. Urology 2004; 63: 873-877.
Poletajew S, Fus Ł, Walędziak M, et al. Comparison of pathological staging and grading of urothelial bladder carcinoma in post-transurethral resection and post-radical cystectomy specimens. Pol J Pathol 2014; 65: 305-312.
Fritsche HM, Burger M, Svatek RS, et al. Characteristics and outcomes of patients with clinical T1 grade 3 urothelial carcinoma treated with radical cystectomy: results from an international cohort. Eur Urol 2010; 57: 300-309.
Witjes AJ, Lebret T, Compérat EM, et al. Updated 2016 EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer. Eur Urol 2017; 71: 462-475.
Vakar-Lopez F, Shen SS, Zhang S, et al. Muscularis mucosae of the urinary bladder revisited with emphasis on its hyperplastic patterns: a study of a large series of cystectomy specimens. Ann Diagn Pathol 2007; 11: 395-401.
Poletajew S, Biernacki R, Buraczyński P, et al. Patterns of care in patients with muscle-invasive bladder cancer - a retrospective cohort study. Contemp Oncol (Pozn) 2016; 20: 341-343.
Dixon JS, Gosling JA. Histology and fine structure of the muscularis mucosae of the human urinary bladder. J Anat 1983; 136: 265-271.
Holmang S, Hedelin H, Anderstrom C, et al. The importance of the depth of invasion in stage T1 bladder carcinoma: a prospective cohort study. J Urol 1997; 157: 800-803.
Ro JY, Ayala AG, el-Naggar A. Muscularis mucosa of urinary bladder. Importance for staging and treatment. Am J Surg Pathol 1987; 11: 668-673.
Paner GP, Ro JY, Wojcik EM, et al. Further characterization of the muscle layers and lamina propria of the urinary bladder by systematic histologic mapping: implications for pathologic staging of invasive urothelial carcinoma. Am J Surg Pathol 2007; 31: 1420-1429.
Kulkarni GS, Hakenberg OW, Gschwend JE, et al. An updated critical analysis of the treatment strategy for newly diagnosed high-grade T1 (previously T1G3) bladder cancer. Eur Urol 2010; 57: 60-70.
Malmqvist U, Arner A, Uvelius B. Cytoskeletal and contractile proteins in detrusor smooth muscle from bladders with outlet obstruction – a comparative study in rat and man. Scand J Urol Nephrol 1991; 25: 261-267.
Hansel DE, Paner GP, Nese N, et al. Limited smoothelin expression within the muscularis mucosae: validation in bladder diverticula. Human Pathol 2011; 42: 1770-1776.
Lindh C, Nilsson R, Lindstrom ML, et al. Detection of smoothelin expression in the urinary bladder is strongly dependent on pretreatment conditions: a critical analysis with possible consequences for cancer staging. Virchows Archiv 2011; 458: 665-670.
Lu G, Ding J, Wang Z. Vimentin gene transfection promotes the invasion of bladder cancer SW780 cells. Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi 2014; 30: 713-716.
Zhao J, Dong D, Sun L, et al. Prognostic significance of the epithelial-to-mesenchymal transition markers e-cadherin, vimentin and twist in bladder cancer. Int Braz J Urol 2014; 40: 179-189.
Costa VL, Henrique R, Danielsen SA, et al. Three epigenetic biomarkers, GDF15, TMEFF2, and VIM, accurately predict bladder cancer from DNA-based analyses of urine samples. Clin Cancer Res 2010; 16: 5842-5851.
Reinert T, Borre M, Christiansen A, et al. Diagnosis of bladder cancer recurrence based on urinary levels of EOMES, HOXA9, POU4F2, TWIST1, VIM, and ZNF154 hypermethylation. PloS One 2012; 7: e46297.
Mhawech P, Iselin C, Pelte MF. Value of immunohistochemistry in staging T1 urothelial bladder carcinoma. Eur Urol 2002; 42: 459-463.
Conn IG, Crocker J, Wallace DM, et al. Basement membranes in urothelial carcinoma. Br J Urol 1987; 60: 536-542.
Schapers RF, Pauwels RP, Havenith MG, et al. Prognostic significance of type IV collagen and laminin immunoreactivity in urothelial carcinomas of the bladder. Cancer 1990; 66: 2583-2588.
Quick links
© 2018 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe