Carcinoma in situ of the urinary bladder: Review of clinicopathologic characteristics with an emphasis on aspects related to molecular diagnostic techniques and prognosis

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dc.contributor.authorNese N.
dc.contributor.authorGupta R.
dc.contributor.authorBui M.H.T.
dc.contributor.authorAmin M.B.
dc.date.accessioned2024-07-22T08:22:07Z
dc.date.available2024-07-22T08:22:07Z
dc.date.issued2009
dc.description.abstractCarcinoma in situ (CIS) of the urinary bladder is defined as a flat lesion comprising of cytologically malignant cells which may involve either full or partial thickness of the urothelium. De novo CIS constitutes less than 3% of all urothelial neoplasms; however, CIS detected concurrently or secondarily during follow-up of urothelial carcinoma constitutes 45% and 90%, respectively, of bladder cancer. CIS is noted predominantly in male smokers in the sixth or seventh decade. Patients may present with dysuria, nocturia, and urinary frequency and urgency with microscopic hematuria. Cystoscopic findings may range from unremarkable to erythema or edema. Urine cytology is an important diagnostic tool. Cellular anaplasia, loss of polarity discohesion, nuclear enlargement, hyperchromasia, pleomorphism, and atypical mitoses are the histopathologic hallmarks of CIS. Extensive denudation of the urothelium, monomorphic appearance of the neoplastic cells, inflammatory atypia, radiation induced nuclear smudging, multinucleation, and pagetoid spread of CIS may cause diagnostic difficulties. Together with clinical and morphologic correlation, immunostaining with CK 20, p53 (full thickness), and CD44 (absence of staining) may help accurately diagnose CIS. Fluorescent in situ hybridization analysis of voided urine for amplification of chromosomes 3, 7, and 17 and deletion of 9p has high sensitivity and specificity for diagnosing CIS in surveillance cases. Several other molecular markers, such as NMP 22 and BTA, are under evaluation or used variably in clinical pathology. Intravesical bacillus Calmette-Guerin (BCG) instillation is considered the preferred treatment, with radical cystectomy being offered to refractory cases. Chemotherapy, α-interferon, and photodynamic therapy are other modalities that can be considered in BCG-refractory cases. Multifocality, involvement of prostatic urethra, and response to BCG remain the most important prognostic factors, although newer molecular markers are being evaluated for this entity. Patient outcome varies based on whether it is de novo development or diagnosed secondary to prior or concomitant papillary bladder cancer. From a clinical perspective, the principal determinants of outcome are extent of disease, involvement of prostatic urethra, response to therapy, and time to recurrence. © Journal of the National Comprehensive Cancer Network.
dc.identifier.DOI-ID10.6004/jnccn.2009.0004
dc.identifier.issn15401405
dc.identifier.urihttp://akademikarsiv.cbu.edu.tr:4000/handle/123456789/18940
dc.language.isoEnglish
dc.publisherJones and Bartlett Publishers
dc.rightsAll Open Access; Bronze Open Access
dc.subjectalpha interferon
dc.subjectaminolevulinic acid hexyl ester
dc.subjectBCG vaccine
dc.subjectcyclin dependent kinase inhibitor 2A
dc.subjectcyclophosphamide
dc.subjectdoxorubicin
dc.subjectmitomycin C
dc.subjectnuclear matrix protein 22
dc.subjectprotein p21
dc.subjectprotein p53
dc.subjecttelomerase
dc.subjectuvomorulin
dc.subjectbladder biopsy
dc.subjectbladder carcinoma
dc.subjectcancer cell
dc.subjectcancer chemotherapy
dc.subjectcarcinoma in situ
dc.subjectcell proliferation
dc.subjectclinical feature
dc.subjectcystectomy
dc.subjectcystoscopy
dc.subjectdiagnostic accuracy
dc.subjectdisease free survival
dc.subjectdysuria
dc.subjectfluorescence in situ hybridization
dc.subjectgene amplification
dc.subjectgene deletion
dc.subjectgene expression profiling
dc.subjectgenetic predisposition
dc.subjecthematuria
dc.subjecthistopathology
dc.subjecthuman
dc.subjectimmunohistochemistry
dc.subjectlong term exposure
dc.subjectnocturia
dc.subjectoutcome assessment
dc.subjectphotodynamic therapy
dc.subjectprognosis
dc.subjectreview
dc.subjectrisk factor
dc.subjectsensitivity and specificity
dc.subjectsmoking
dc.subjecturinalysis
dc.subjecturinary frequency
dc.subjecturinary urgency
dc.subjecturine cytology
dc.subjecturothelium
dc.titleCarcinoma in situ of the urinary bladder: Review of clinicopathologic characteristics with an emphasis on aspects related to molecular diagnostic techniques and prognosis
dc.typeReview

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