ON
B
Cytology of Other Body Sites
chapter
1 5
Urinary Tract
Marluce Bibbo and William H. Kern
Contents
In tro d u c tio n
U r o t h e lia l D y s p la s ia a n d C a r c in o m a In S itu
S c re e n in g fo r B la d d e r C a n c e r
In v a s iv e N o n p a p illa r y U r o t h e lia l C a r c in o m a
S q u a m o u s C e ll C a r c in o m a
E x a m in a tio n o f S y m p to m a t ic p a t ie n t s
A d e n o c a r c in o m a
F o llo w - U p a f t e r T r e a t m e n t
M is c e lla n e o u s T u m o r s
S a m p lin g T e c h n iq u e s
S p e c ia l A s p e c ts o f A n a to m ic S ite s O t h e r T h a n U rin a i
y
B la d d e r
S a m p le C o lle c t io n
Ia tro g e n ic C h a n g e s
B la d d e r W a s h in g s
L a s e r-In d u c e d C h a n g e s
A s p ir a te s , W a s h in g s , B ru s h in g s , a n d C e ll B lo c k s o f U re te r s a n d R e n a l p e lv is
Irr a d ia tio n C h a n g e s
S a m p le p r e p a r a t io n
E ffe c ts o f C h e m o th e r a p y a n d I m m u n o t h e r a p y
U ro th e liu m a n d S p e c ia liz e d L in in g
C y t o lo g y o f Ile a l C o n d u it s
H is t o lo g y
R e n a l A llo g r a ft M o n it o r in g
N o r m a l C y t o lo g y
S p e c ia l T e c h n iq u e s
N o n -N e o p la s tic A b n o rm a litie s
F lo w C y t o m e t r y
D e v e lo p m e n t a l A b n o r m a lit ie s
I m m u n o c y t o c h e m is t r y
E n d o m e t r io s is
M o r p h o m e t i
y
D iv e r tic u lo s is o f t h e U rin a t
y
B la d d e r
B lo o d G r o u p A n t ig e n p r e d ic t o r s
N o n s p e c ific a n d B a c te ria l I n f la m m a t io n
B T A s ta t a n d B T A T R A K
V iru s I n f e c t io n s
N u c le a r M a t r ix p r o te in (N M p 2 2 )
M a la c o p la k ia
F lu o re s c e n c e in S itu H y b r id iz a tio n (F IS H ) a n d I m m u n o C y t T e s t
D e g e n e r a t iv e C h a n g e s
T e lo m e r a s e
I n t r a c y to p la s m ic a n d In t r a n u c le a r In c lu s io n s
D N A M e t h y la t io n
C y t o lo g ic C h a n g e s A s s o c ia te d w it h C a lc u li
O t h e r T u m o r M a r k e r s
Ia tr o g e n ic C h a n g e s
D ia g n o s tic A c c u r a c y
H y p e rp la s ia , A ty p ia , a n d D y s p la s ia
C o n c lu d in g R e m a rk s
T u m o rs o f T h e U rin a ry T ra c t
P a p illa ry T u m o r s
Introduction
Screening for Bladder Cancer
Urine cytology as a method for diagnosing bladder carcinoma
was introduced in 1945 by Papanicolaou and Marshall.1
Urothe-
lial cells are present in all urine specimens and exfoliate readily
from tumors of the urothelial lining. Urine cytology is therefore
an important primary method of diagnosing urothelial tumors,
and in combination with cytoscopy and biopsy, it is used as an
adjunct.2-7
Cytologic examination of urine is performed in screening
programs of asymptomatic but high-risk patients for case find-
ing, in the diagnostic evaluation of symptomatic patients, and
in the follow-up and monitoring of patients with known and
treated disease. The clinical history, including any prior surgical
procedures, treatment modalities, and comparison with previ-
ous biopsy or cytologic specimens, is essential for a cytopatho-
logic evaluation. This may permit the diagnosis of recurrent
well-differentiated tumors that could not be identified without
comparison with previous material, and it prevents overdiagno-
sis of atypias that may be associated with previous treatment.
Screening programs for bladder cancer by cytologic examina-
tion have been undertaken and reported sparingly.8 Such pro-
grams were conducted for individuals considered at high risk,
such as industrial workers exposed to aromatic amines or
cadmium, phenacetin or opium abusers, and bilharzial popu-
lations. Holmquist reported results of screening of 9870 out-
patients by routine urinalysis wet preparations.9 Of these, 148
(1.5%) were considered abnormal. Cytopathologic and his-
topathologic follow-up studies revealed evidence of cancer
in 12 of these patients, a rate of 1.2 per 1000. Toluidine blue
and phase-contrast microscopy have been advocated for rapid
screening of a clinic or hospital population. This then must be
supplemented by examination of stained slides if abnormal
findings are identified.
Based on the known high sensitivity of urine cytology for
nonpapillary carcinoma in situ, which is the usual precursor of
invasive bladder cancer, screening programs of carefully chosen
high-risk populations should yield significant results. This is
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