Reduced E-cadherin expression in distant metastases, local recurrences, and stage IV tumors suggests a role in later stages of tumor progression.20 In rare cases, tumors with local recurrences and distant metastases have E-cadherin positivity rates of more than 30%.20 A decrease in expression was noted with increasing tumor grade, with E-cadherin expression detected in 34% of grade II cases and 89% of grade I cases.20 Studies on meningiomas and bladder cancer have also shown that as tumor aggressiveness increases, E-cadherin expression decreases.20,21. The gene discussed is CDH1; the disease is urinary bladder cancer.