Bladder - Cytology - Primary invasive neoplasms

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Bladder

Cytology

Primary invasive neoplasms

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

Revised: 29 May 2010, last major update May 2010

Invasive urothelial carcinoma

● See also invasive urothelial carcinoma in bladder chapter

● Increased numbers of irregular, three dimensional cell groups

● Marked pleomorphism with enlarged nuclei, coarse chromatin and prominent nucleoli

● Presence of necrosis, lysed blood and degenerated red blood cells is most suggestive

● Invasion cannot be conclusively diagnosed on cytology specimens

Adenocarcinoma

● See also adenocarcinoma-general in bladder chapter

● Colonic or clear cell cytology

● Finely vacuolated cytoplasm

● Nuclei with vesicular chromatin and prominent nucleoli

● Colonic-type adenocarcinoma: columnar morphology in a mucinous background, necrosis

● Signet-ring cell type adenocarcinoma: round cells with a large cytoplasmic vacuole pushing the nuclei

● Clear cell adenocarcinoma: large cells with thin or vacuolated cytoplasm, round to oval nuclei, vesicular chromatin and prominent nucleoli

● Differential diagnosis: nephrogenic adenoma and cystitis cystica

Lymphoepithelioma-like carcinoma

● See also lymphoepithelioma-like carcinoma in bladder chapter

● Single tumor cells either isolated or intermixed with inflammatory cells

● Large cells with high N/C ratio, vesicular chromatin and prominent nucleoli

● Differential diagnosis: high-grade urothelial carcinoma, reactive urothelial cells, large cell lymphoma

Micropapillary carcinoma

● See also micropapillary carcinoma in bladder chapter

● Micropapillary clusters with markedly atypical cells

● High N/C ratio, irregular nuclear contours and coarse granular chromatin pattern; occasional prominent nucleoli

Nested Variant of Urothelial Carcinoma

● Bland morphologic findings, but aggressive behavior

● Medium-sized, round or polygonal cells with abundant, dense, slightly granular basophilic cytoplasm and well defined cell borders

● The nuclear/cytoplasmic ratio is increased, the nuclear membranes have irregular contours, and the nuclei display coarse chromatin with occasional prominent nucleoli.

● Differential diagnosis: nephrogenic adenoma, reactive changes, low-grade papillary urothelial carcinoma

Plasmacytoid variant of Urothelial Carcinoma

● See also plasmacytoid/lymphomatoid carcinoma in bladder chapter

● Moderately cellular

● Atypical cells have a plasmacytoid appearance with abundant cytoplasm, relatively low nuclear to cytoplasmic ratios, eccentrically located nuclei, irregular nuclear contours, coarsely clumped chromatin and inconspicuous nucleoli

● Cellular pleomorphism and mitotic figures

Small cell carcinoma

● See also small cell carcinoma in bladder chapter

● Cellular with either single cells or clusters of small round to oval cells with scant cytoplasm, nuclear molding, hyperchromatic nuclei and granular chromatin pattern

● Also karyorrhectic nuclei and necrosis

● Associated with urothelial carcinoma, squamous cell carcinoma or adenocarcinoma

● Immunohistochemistry is helpful

Squamous cell carcinoma

● See also squamous cell carcinoma in bladder chapter

● Poorly differentiated squamous cell carcinoma: pleomorphic hyperchromatic nuclei, focal eosinophilic dense cytoplasm (keratinized cells)

● Well differentiated squamous cell carcinoma: squamous cells with subtle nuclear abnormalities and keratinization

Mesenchymal neoplasms

Rhabdomyosarcoma

● See also rhabdomyosarcoma in bladder chapter

● Pediatric population, <15 years old

● Cells are small in size

● Arranged as single cells and small clusters

● Scant cytoplasm and hyperchromatic nuclei with no nucleoli; occasional cells with wispy cytoplasm; also cells with eosinophilic cytoplasm and cross striations

Leiomyosarcoma

● See also leiomyosarcoma in bladder chapter

● Scattered large atypical cells with a moderate amount of cytoplasm

● Ill-defined cytoplasmic borders

● Large, hyperchromatic nuclei with occasional nucleoli; irregular nuclear margins

Lymphoma

● See also lymphoma in bladder chapter

● Cell morphology corresponds to the type of lymphoma

● Immunohistochemistry is helpful

Melanoma

● See also melanoma in bladder chapter

● The cells are large, round or oval, with eccentric nuclei

● The cytoplasm is finely granular and may contain melanin

● The chromatin is vesicular with macronucleoli

● S100+, HMB45+, MelanA/A103+

End of Bladder > Cytology > Primary invasive neoplasms

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