Utility of a Comprehensive Immunohistochemical Panel in the Differential Diagnosis of Spindle Cell Lesions of the Urinary Bladder

作者：Westfall Danielle E; Folpe Andrew L; Paner Gladell P; Oliva Esther; Goldstein Lynn; Alsabeh Randa; Gown Allen M; Amin Mahul B^*

来源：American Journal of Surgical Pathology, 2009, 33(1): 99-105.

DOI：10.1097/pas.0b013e318180c899

• urinary bladder
• spindle cell
• pseudosarcomatous myofibroblastic proliferation
• sarcomatoid carcinoma
• leiomyosarcoma
• p63
• ALK
• cytokeratin 5/6
• smooth muscle actin
• pankeratin

Spindle cell lesions of the urinary bladder are uncommon, but when encountered in clinical practice, pose a difficult diagnostic challenge as the differential diagnostic considerations ire Vast. Pseudosarcomatous processes significantly overlap with malignant tumors (sarcomatoid urothelial carcinoma and leiomyosarcoma) ill their morphology and published immunohistochemical profile [pancytokeratin pan (CK), smooth Muscle actin (SMA), and desmin]. p63 has been studied rarely and CK 5/6 and CK 34 beta E12 have not been analyzed in the bladder in this diagnostic context. In the current study, 45 typical examples of spindle cell lesions [10 pseudosarcomatous myofibroblastic proliferations (PMP), 22 sarcomatoid urothelial carcinomas, and 13 smooth Muscle tumors] of the urinary bladder were immunostained with a panel containing broad spectrum anticytokeratin antibodies (OSCAR or AE1/ AE3), as well as antibodies to CK 34 beta 3E12, CK 5/6, p63, SMA, and anaplastic lymphoma kinase (ALK). The immunoreactivity was as follows: PMP-CK (OSCAR) 7/10 (70%), CK (AE1/AE3) 7/9 (78%), CK 34 beta E12 0/10 MY.), CK 5/6 0/9 (0%), p63 0/9 (0%,,), SMA 10/10 (100%), ALK 2/10 (20%), sarcomatoid urothelial carcinoma-CK (OSCAR) 15/22 (68%), CK (AE1/AE3) 14/20 (70%) CK 34 beta E12 5/20 (25%), CK5/6 6/22 (27%), p63 11/22 (50%), SMA 16/22 (73%), ALK 0/22 (0%); and smooth muscle tumors-CK (OSCAR) 7/13 (54%), CK (AE1/AE3) 7/12 (58%, ), CK 34 beta E12 0/12 (0%,), CK 5/6 0/12 (0%), p63 3/13 (23%), SMA II/13 (85%), ALK 0/13 (0%,). Positivity for keratin was typically Focal to moderate ill smooth muscle tumors and more commonly moderate to diffuse ill sarcomatoid carcinomas and PMP. Our data indicate that there is significant immunohistochemistry I overlap between the different spindle cell lesions, each of which has unique clinicopathologic, prognostic, and therapeutic ramifications. Within the context of morphology, an immunohistochemical panel composed of broad-spectrum antibodies to cytokeratin as well as antibodies to SMA, ALK, p63, and CK 5/6 will be a useful diagnostic adjunct,: a combination of pankeratin, SMA, and ALK positivity favors PMP; expression of several cytokeratin and especially CK 34 beta E12 and CK 5/6 with p63 favors sarcomatoid carcinoma and SMA positivity with overall absence or other markers favors leiomyosarcoma.

• 出版日期2009-1