Bladder, ureter & renal pelvis
Cytology-general & normal findings

Topic Completed: 1 December 2014

Minor changes: 19 August 2020

Copyright: 2003-2020,, Inc.

PubMed Search: Bladder [title] normal cytology

Rugvedita Parakh, M.D.
Page views in 2019: 2,576
Page views in 2020 to date: 2,232
Cite this page: Parakh R. Cytology-general & normal findings. website. Accessed September 24th, 2020.
Definition / general
  • Cytology is useful to detect carcinoma in situ or marked chronic inflammation (i.e. when there is no specific lesion to biopsy), carcinoma hidden in diverticula, or for detecting residual tumor from urine specimens
  • Cystoscopic biopsy of visible lesions is more sensitive than cytology in most cases
  • Bladder irrigation is superior to collecting voided urine
  • Most sensitive and highly specific for high grade tumors (diagnosis or follow-up) whether flat (carcinoma in situ), papillary or mixed
  • Low sensitivity (difficult to diagnose) for papilloma and low malignant potential lesions because they have normal histology (Mod Pathol 1995;8:394)
  • Follow up examination of urine with FISH may improve sensitivity and specificity of cytology (Am J Clin Pathol 2001;116:79)
Types of specimens
Voided urine:
  • Non invasive, easiest to obtain
  • Obtaining three second “morning voided” midstream urine samples collected over three consecutive days appears to optimize the detection of urothelial malignancies

Instrumented urine:
  • Catheterization of the bladder or irrigation of bladder

Ileal conduit urine:
  • Ileal conduit and neobladder are the most common urine diversion techniques used in patients who have undergone cystectomy
  • A portion of the ileum is anastomosed with the ureters to the skin or to the urethra
Processing / preservation of specimen
  • Immediate processing is recommended or refrigerate if immediate processing cannot be done
  • If fixation if needed, use equal volumes of 50% ethanol or a methanol based fixative (Cytolyt® or similar)
Cytology description
Voided urine
  • Paucicellular
  • Urothelial cells, squamous cells, inflammatory cells and possibly red blood cells
  • The umbrella cells have one nucleus, abundant delicate cytoplasm, low N/C ratio, smooth nuclear contours with fine chromatin pattern and a small chromocenter
  • The basal and intermediate layers are smaller and have a columnar or cuboidal appearance; the nuclei are round with smooth nuclear contours with a fine chromatin pattern
  • Nucleoli are either absent or single and minute
  • Reactive conditions (e.g. urolithiasis, post instrumentation) demonstrate clusters of basal and intermediate urothelial cells

Instrumentation related urine
  • More cellular
  • Presence of clusters of urothelial cells forming cell balls and pseudopapillary clusters
  • The urothelial cells have a low N/C ratio, round nuclei, fine chromatin pattern and smooth nuclear contours
  • Instrumentation effect: crowded cluster formations, hyperchromasia and distinct nucleoli; may lead to a false positive diagnosis

Ileal conduit urine
  • Cellular
  • Many degenerated single cells (oval with pyknotic nuclei) and few glandular cells (vacuolated cytoplasm, hyperchromatic nuclei but preserved N/C ratio of normal cells)
  • Dirty background
  • Non-specific eosinophilic cytoplasmic inclusions
  • A potential pitfall due to hyperchromasia
Cytology images

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Urine cytology

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