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[Carcinoma in situ of the urinary bladder: clinical experience and preliminary study of Thomsen-Friedenreich antigen].

Clinical experience on thirteen cases of carcinoma in situ (CIS) of urinary bladder were reported. T (Thomsen-Friedenreich) antigen, a precursor of other blood group antigen than ABH, was investigated by the technicque of Avidin-Biotin-Peroxidase Complex (ABC) method primarily in these CIS lesion. We also investigated T antigen expression in ureteropelvic tumor and attempted to correlate its expression with their prognosis. Overall clinical pictures of CIS simulate chronic cystitis in symptomatology as well as in cystscopic findings. Urine cytology was highly positive with almost all showing more than class 3b abnormalities. In many instances, CIS lesion involved all bladder area and extened also to the ureter and prostate in some. Total cystectomy, TUR and irradiation were treatment of choice in ten, two and one patient, respectively. T antigen, which is expressed in many carcinomas, and arbitrarily defined here as T(+), is usually not detected in normal epithelium of such organs as the bladder. Normally, T antigen is cryptic but can be unmasked with neuraminidase. The cells which express the T antigen only after pretreatment with neuraminidase are defined as cryptic T(+). The cells which lacked T even after neuraminidase treatment are called cryptic T(-). We investigated the T antigen expression in CIS lesion and ureteropelvic tumor by staining paraffin section with T-specific lectin (peanut agglutinin). In nine cases of CIS which ABH was negative, cryptic T(+), T(+) and cryptic T(-) were found in three, one and five cases, respectively. In ten cases of high grade ureteropelvic tumor, which ABH was negative in all cases, cryptic T(+) was found in five cases. Of these five cases, three are alive and well over five years after surgery, while one was dead and the other was lost to follow up. These data, although preliminary, indicate that, by com bining two markers (ABH antigen and T antigen), prognosis of urothelial tumor may be assessed with much improved predictability. Prospective study along this line is warranted in our CIS cases.