Bladder - Cytology - Primary noninvasive urothelial neoplasms

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Bladder

Cytology

Primary noninvasive urothelial neoplasms

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

Revised: 29 May 2010, last major update May 2010

Papilloma

● See also papilloma in bladder chapter

● Increased number of urothelial cells with minimal atypia and a small number of red blood cells

Papillary urothelial neoplasm of low malignant potential (PUNLMP)

● See also papillary neoplasm of low malignant potential in bladder chapter

● These lesions are cytologically indistinguishable from low grade urothelial carcinomas

● Diagnosis of PUNLMP based only on cytology is not a reproducible diagnosis

Low grade papillary urothelial carcinoma

● See also low grade papillary in bladder chapter

● Low sensitivity of urine cytology

● Heterogeneous with small and large clusters of urothelial cells with enlarged nuclei, higher N/C ratio and a small nucleolus

● Cells with a nucleolated globular body and variable slender cytoplasm are suggestive of low grade papillary urothelial carcinoma

● Homogeneous cytoplasm, irregular nuclear membranes and increased N/C ratio are helpful criteria for diagnosis

High grade papillary urothelial carcinomas

● See also high grade papillary in bladder chapter

● Clusters and single markedly atypical cells with pleomorphic nuclei, coarse chromatin and prominent nucleoli

● Cells have abundant cytoplasm and may show vacuoles

● Also irregular nuclear contours, coarse chromatin pattern and frequent nucleoli

Urothelial carcinoma in-situ (CIS)

● See also carcinoma in situ in bladder chapter

● Cytology is a very important aid in diagnosis CIS

● Voided specimens from cases with CIS show clusters and single large pleomorphic cells showing marked atypia with hyperchromatic angulated nuclei, coarse chromatin, irregular nuclear contours and occasional prominent nucleoli

● The N/C ratio is high and the cytoplasm is dense

● Differential diagnosis: “decoy” cells (BK virus), degenerated cells, treatment effect (bCG or chemotherapy)

End of Bladder > Cytology > Primary noninvasive urothelial neoplasms

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