الفهرس 
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Abstract
SUMMARY
In the current study, fifty urothelial carcinoma cases of urinary bladder were collected from the Pathology department, Faculty of Medicine, Beni-Suef University during the period (2017-2018). Our included cases in this study were underwent TURT (30 cases) and radical cystectomy (20 cases), we found that the mean age of our cases is 60.4 years, and most of them are in age group (≥ 60 years). The majority of studied cases (80%) were males with male: female ratio 4:1. The majority of the studied UC tumors found in or near lateral wall of urinary bladder.
All tumors in the present study were solitary, ranging in size from (3.5cm to 5.5cm) with a mean size mean size 4.25cm. Out of fifty patients, 19 (38%) cases showed negative bilharzial infestation while those with positive bilharzial infestation were 31 (62%) cases. In this study, most of urothelial bladder carcinomas were conventional urothelial type 21 (42%) cases and urothelial with squamous differentiation 13 (26%) cases.
Grading of the presented UC cases were assessed according to the WHO histological classification of tumors of the urinary tract (2016) revealed that low grade was reported in 7 (14 % ) cases while those of high grade were 43 (86 %) cases. Assessment of the pathological stage of the 20 cases of radical cystectomy specimens according to the Tumor Node Metastasis (TNM) system of the American Joint Committee on Cancer (AJCC) revealed that most of the tumors invade muscularis propria tissue (T2) and 9 out of 20 cases showed positive lymph node metastasis.
The total 50 primary UC cases included in this study were evaluated by immunohistochemistry, using monoclonal antibody against PD-L1. It was noticed that expression of PD-L1 was seen in 12 (24%) cases, while 38(76%) were negative. whereas 22(44%) cases were score 0, 16 (32 %) cases with score +1, 2 (4%) cases with score +2, and 10 (20 %) cases with score +3.
from the results of this work, although the relationship between PDL-1 and tumor grade was statistically non-significant (p- value 0.11), we found that all positive PD-L1 cases were high grade and all low grade cases were negative. Also the detection of PDL-1 immunostaining (expression and scoring) was not statistically significant in different pathological (pT) stages of studied cases (p- value 0.31 and 0.16 respectively).
In this present study, there was a statistically significant relationship between PD-L1 immunohistochemical expression in tumor cells and tumor associated necrosis that detected in the studied cases (p- value 0.02). Also there was a statistically significant relationship between PD-L1 immunostaining (expression and score) and associated TIMCs detected by H&E staining in the studied cases, p- value 0.03 and 0.04 respectively.
The correlation between PD-L1 expression in tumor cells and other clinicopathological parameters such as age, sex, lymph node status, perineural and lymphovascular invasion were statistically insignificant.
Regarding PD-L1 expression in tumor infiltrating mononuclear cells, 38% of studied cases showed positive PDL-1 expression. PDL-1 score in TIMCs was correlated significantly with pathological (pT) stage of the presented radical cystectomy cases, with p- value 0.002.
The relationships between PDL-1 (expression and scoring) in TIMCs and other histopathological parameters including: tumor grade, state of muscle invasion and associated tumor necrosis, they were statistically non-significant with P- values 0.58, 0.07, 0.69, 0.33, 0.19 and 0.30 respectively.
These findings may have clinical implications for the management of patients with PDL-1 positive immunostaining. PDL-1 status (in both tumor cells and TIMCs) would be helpful in formulating a treatment strategy for patients with urothelial bladder cancer.