BACK GROUND: Cancer of the bladder represents the ninth most common cause of cancer worldwide and the 13th most numerous cause of death from cancer. Most patients (70–80%) with newly diagnosed urothelial carcinoma of the bladder present with well–differentiated superficial papillary tumors. Prolonged survival in most patients with superficial cancers is achieved by transurethral resection (TUR) with or without intravesical chemotherapy. Nonetheless, these patients still have a high risk of recurrence following initial resection. The major prognostic factors in carcinoma of the bladder are the depth of invasion into the bladder wall and the degree of differentiation of the tumor.

AIMS & OBJECTIVES: To evaluate and analyze the diagnostic utility of immunochemical expression of p53,CK20,CD10 in urothelial malignancies as per 2016 WHO/ISUP classification with reference to histopathological grading and TNM staging, age, sex preponderance and clinical presentation.

RESULTS: The age of the patients ranged from 24 to 90, Among 76 cases, 65 cases were male and 11 cases were female with an average male to female ratio of 8.5:1. All bladder lesions were classified according to 2016 WHO/ISUP. No flat lesions were detected, 3 cases of PUNLMP, 17 cases of low grade papillary urothelial carcinoma, 42 cases of high grade papillary urothelial carcinoma, 7 cases of high grade papillary urothelial carcinoma with squamous differentiation, 7 cases of invasive urothelial carcinoma ( 6 cases– T2N0M0 & 1 case – T1N0M0). CD10,p53 and CK20 immunohistochemical markers were run on selected slides of 56 cases out of 76 cases due to unavailability of the rest of the paraffin blocks of 20 cases. Out of 5 cases of invasive urothelial carcinoma with squamous differentiation ( 4 cases with T2N0M0 and 1 case of T1N0M0) high expression of p53 and CD10 with negative expression of CK20 was noted  and 5 cases of noninvasive urothelial carcinoma showing squamous differentiation which showed high expression of CD10 and p53 with variable expression of CK20 (negative/1+)

CONCLUSION: Our findings indicate that CD10 expression is strongly correlated with high tumor grade and stage in urothelial carcinoma of the bladder, and that CD10 may be associated with tumor progression in bladder cancer pathogenesis. The p53 and cytokerain 20 expression is diffuse and strong positive in cases of higher grade urothelial carcinoma as compared to low grade urothelial carcinoma which in majority of cases show focal and weak positive expression. These markers should be used in assigning grade to urothelial malignancies in cases of borderline histologic features.