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Proliferation activity in bladder tumors does not correlate with the pathological grading.

Worldwide, bladder cancer is the seventh most frequent cancer in men and the 17th most frequent cancer in women, respectively. In men, this type of cancer is the second most frequent type of cancer localized in the genitourinary system, after prostate cancer. The incidence of bladder cancer is ever growing and the etiopathogenic factors of bladder cancer are numerous and still not fully understood. Smoking is the most common risk factor incriminated in the onset of urinary tract cancer, the incidence of bladder cancer being directly connected to the smoking duration and the tobacco amount intake. Regarding the histopathological types, more than 90% of bladder cancer is represented by transitional cell carcinomas. Histopathology assessment of bladder cancer is a constant challenge regarding the connection between tumor grading, depth of invasion, extension and clinical prognosis. We evaluated here a number of 32 confirmed bladder tumors and we aimed to find common patterns of expression for markers like cytokeratin 7 (CK7), CK20, vascular endothelial growth factor (VEGF), CD34, matrix metalloproteinases (MMPs) 2, 8 and 9, as well as for the Ki67 proliferation index. Our study showed that both CK7 and CK20 were present in different tumor areas and tumor gradings, MMP9 was more constantly expressed compared to the more variable expression of MMPs 2 and 8, vascular densities did not seem to increase in high-grade invasive tumors compared to low-grade tumors. Interestingly, while high Ki67 proliferating indexes were present especially in high-grade superficially tumors, compared to low-grade papillary tumors; this correlation was inversed for the advancing edges of the tumor. This common feature of invasive urothelial tumors will thus require further studies in order to elucidate the cellular signaling pathways by which these tumors increase their overall invasiveness.