Bladder
Cytology
Primary invasive neoplasms

Author: Rugvedita Parakh, M.D. (see Authors page)

Revised: 21 March 2016, last major update February 2013

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: Bladder invasive
Table of Contents
General
General

Invasive urothelial carcinoma
  • See also invasive urothelial carcinoma
  • 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
  • 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: neophrogenic adenoma and cystitis cystica


Lymphoepithelioma-like carcinoma


Micropapillary carcinoma
  • See also micropapillary carcinoma
  • 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: low-grade papillary urothelial carcinoma, nephrogenic adenoma, reactive changes


Plasmacytoid variant of urothelial carcinoma
  • See also plasmacytoid / lymphomatoid carcinoma
  • 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
  • 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
  • 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
  • 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
  • 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
  • Cell morphology corresponds to the type of lymphoma
  • Immunohistochemistry is helpful


Melanoma
  • See also melanoma
  • 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+