Bladder - Cytology - Non-neoplastic lesions

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Bladder

Cytology

Non-neoplastic lesions

Reviewer: Dr. Rugvedita Parakh, Cedars-Sinai Medical Center

Revised: 29 May 2010, last major update May 2010

See also description under individual bladder topics

Infection / bacterial cystitis

● See also acute cystitis in Bladder chapter

● Women in the reproductive age group

● Abundant neutrophils, few enlarged urothelial cells with vacuolated cytoplasm. N/C ratio is maintained with fine chromatin pattern of nuclei; also urothelial cells with degenerative changes

Human Polyomavirus infection

● See also BK virus in Bladder chapter

● Due to reactivation of infection in immunosuppressed states; e.g. chemotherapy, diabetes, organ transplantation or AIDS

● Single dense basophilic homogeneous intra-nuclear inclusions, pale nuclear inclusions creating a homogeneous space or clearing of the nuclei with a network of chromatin filaments

● “Decoy” cells: nuclear hyperchromasia mimicking carcinoma cells; polyomavirus infected cells show filaments of chromatin

Parasites

● See also schistosomiasis in Bladder chapter

● Trichomonas vaginalis, Schistosoma hematobium and Filariasis.

● Schistosoma hematobium: most common in Egypt and elsewhere in Africa; abundant squamous cells and anucleated squames due to squamous metaplasia induced by the infection

● Bladder infection by Schistosoma hematobium is strongly associated with squamous cell carcinoma

Lithiasis (stones)

● See also lithiasis in Bladder chapter

● Increased cellularity

● Urothelial cell clusters with or without cellular atypia

● Hyperchromasia and prominent nucleoli

● Differential diagnosis includes a low grade papillary lesion; clinical history is paramount in interpreting these specimens

Malakoplakia

● See also malakoplakia in Bladder chapter

● Middle aged women

● Histiocytes with eosinophilic cytoplasm containing basophilic inclusions that are PAS+; also calcium and iron positive concentric laminations (Michaelis-Guttmann bodies)

● Background of granular debris

● Urothelial cells display reactive changes

Vesico-enteric fistula

● Due to colon cancer, diverticulitis, inflammatory bowel disease, radiation therapy or surgery

● Urine contains fecal material including vegetable cells or degenerated striated cells associated with amorphous debris and bacilli

Cystitis glandularis /cystitis cystica

● See also cystitis cystica / glandularis in Bladder chapter

● A few cohesive groups of bland columnar cells are present, which are occasionally associated with goblet cells

● Clean background

● Differential diagnosis includes adenocarcinoma (dirty background and nuclear atypia with coarse chromatin, pleomorphism and nucleoli)

Squamous metaplasia

● See also squamous metaplasia in Bladder chapter

● Premenopausal women

● The presence of keratinized epithelium, particularly with atypia, warrants further evaluation

Nephrogenic adenoma

● See also nephrogenic metaplasia in Bladder chapter

● Cuboidal or columnar shaped cells with fine chromatin pattern and fine vacuolated cytoplasm

● Differential diagnoses include urothelial carcinoma, clear cell adenocarcinoma and gastric adenocarcinoma; differentiate based on clinical history and careful evaluation of the nucleoli; also nephrogenic adenoma and clear cell adenocarcinoma are PAX2+ or PAX8+ (Am J Surg Pathol 2008;32:1380)

End of Bladder > Cytology > Non-neoplastic lesions

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