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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

Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.

 

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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