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Bladder

Cytology

Primary invasive neoplasms

Reviewer: Rugvedita Parakh, M.D. (see Reviewers page)
Revised: 9 February 2013, last major update May 2010
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

Invasive urothelial carcinoma
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● 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
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● 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
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● See also lymphoepithelioma-like carcinoma
● 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, large cell lymphoma, reactive urothelial cells

Micropapillary carcinoma
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● 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
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● 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
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● 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
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● 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
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● 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
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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
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● See also lymphoma
● Cell morphology corresponds to the type of lymphoma
● Immunohistochemistry is helpful

Melanoma
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● 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+

End of Bladder > Cytology > Primary invasive neoplasms

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