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Hemant Kamal
Accurate recognition of muscularis propria (MP) and muscularis mucosae (MM) in bladder cancer is crucial as carcinoma confined to the lamina propria is usually treated conservatively, whereas one extending into the MP always dictates a more radical surgical management. Distinguishing bladder MP from MM can be problematic on H&E staining, especially in transurethral resection specimens of bladder tumors (TURBT), due to hyperplastic MM mimicking MP, desmoplastic reaction and splayed MP due to tumor. Desmin stains both MM and MP equally. Smoothelin is a novel smooth muscle specific marker expressed only in terminally differentiated smooth muscle cells and relatively specific for MP.