Clinical Details
Voided urine sample of a 50 year old male who has a complaint of hesitancy and
increased frequency of urination.
Images
Image 1 (Pap, 200x)
Image 2 (Pap, 400x)
Image 3 (Pap, 200x)
Image 4 (Pap, 400x)
Please choose the correct answer:
1. Atypical urothelial cells
2. Low grade urothelial carcinoma cells
3. High grade urothelial carcinoma cells
Correct answer is Atypical urothelial cells
Clinical details:
Voided urine sample of a 50 year old male who has a complaint of hesitancy and
increased frequency of urination.
Description:
Cellular smears showing singly occurring, large and small urothelial cells with abundant
cytoplasm, at times bi and multinucleation is noted. The background is clean (Image1 &
2). Also seen are occasional singly occurring cells with enlarged nuclei and fine
chromatin pattern (Image 3 & 4). These are atypical urothelial cells as they show changes
intermediate between normal cells and cancer cells.
Discussion:
Urinary cytology is a useful diagnostic tool for the detection and follow-up of patients
with bladder cancer. However, at times, cytological diagnosis is difficult in voided urine
due to paucity of cells and presence of few cytomorphological features of malignancy (1).
In this case there were occasional cells, which showed enlarged nuclei. However the
chromatin was fine, nuclear membrane was smooth and the N: C ratio was slightly
increased. Hence these are interpreted as atypical urothelial cells.
Low-grade urothelial carcinoma generally exfoliates in clusters composed of atypical
urothelial cells showing subtle nuclear abnormality (3).
High-grade urothelial carcinoma will show obvious malignant cells (2).
Presence of atypical cells should trigger further search for cancer cells.
Follow up:
After cytology, cystoscopy was done. This showed a papillary tumor on left lateral wall
of urinary bladder and biopsy of the same showed Transitional Cell Carcinoma WHO
grade I/III.
References:
1. Diagnostic Cytology and its histopathologic Bases, Volume 2 ,L.G.Koss, 4th
Edition, page N. 949
2. Comphrehensive Cytopathology – 2nd Edition, Marluce Bibbo, page No. 464
3. Murata S., Kishikawa T, Isojima Y, Tsuchihashi Y and Katoh R.: Acta Cytol
2004;48:492 - 496