الفهرس 
Utility of image analysis and racemase immunohistochemical stain in differentiating urothelial carcinoma in-situ from its mimics
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Abstract
Urothelial CIS represents a neoplastic flat lesion in which the surface epithelium contains cells showing high-grade cytologic atypia. In daily practice, the conventional histologic differentiation between CIS and non-CIS conditions of the urothelial mucosa (dysplasia and reactive atypia) may be challenging. However, pathologic classification is crucial in terms of clinical management and prognosis (McKenney et al., 2001 a and b). It is prognostically and therapeutically significant; it may be very difficult to distinguish it from other lesions with considerable histomorphologic overlap (Aron et al., 2013; Oliva et al., 2013). Each lesion is defined with precise nomenclature and strict morphologic criteria. In many cases, morphologic features alone suffice for diagnosis. Other cases may require a panel of immunohistochemical antibodies consisting of cytokeratin 20 (CK20), CD44, and P53 for diagnosis. Molecular studies have provided further insight into the premalignant potential of these urothelial lesions (Hodges et al., 2010).Several studies have investigated the triple immunohistochemical staining of CK20, CD 44, and P53 in normal urothelium and flat lesions of the transitional epithelium, however, the necessity of extremely high quality staining techniques, the increased expenses and difficulty to interpret the results, remains a big obstacle for this panel to be considered as routine investigation (VandenBoom et al., 2014).A number of tumor markers have been studied for their potential role in the diagnosis and prognosis of these lesions. Nevertheless, there is still a need for more biomarkers that can identify lesions with a high risk of progression (Culhaci et al., 2010)