15
Urinary Tract
Table 15.1 Nu mber of Neoplastic Cells in the Different Categories
Normal, 501 nuclei
36
24
14
3_|
5
25
45
65
85
105
125
145
165
186
200
>200
Benign atypical, 1328 nuclei
Range: 11-311p2
Mean: 52p2
25
45
65
85
105
125
145
165
186
200
>200
5
Papillary transitional cell carcinoma, grade I, 3272 nuclei
Range: 11-534p2
Mean: 54p2
23
21
13 13
—3 |
2
2
1 1 1 1 1
5
25
45
65
85
105
125
145
165
186
200
>200
Papillary transitional cell carcinoma grade II, 1965 nuclei
Range: 11-726u2
Mean: 78u2
Papillary transitional cell carcinoma grade III and IV, 1389 nuclei
Range: 17-450p2
Mean: 90p2
O
9
10
H 8
4 4
3
3
2
1
1
1
25
45
65
85
105
125
145
165
186
200
>200
12
4
0
5
Fig. 15.27 Nuclear size of normal, atypical, and neoplastic cells as
measured by planimetry.
frequency, dysuria, or hematuria. Dysplasia, on the other hand,
is not associated with specific symptoms and is therefore recog-
nized primarily in patients with associated symptomatic bladder
cancer or in patients being monitored after treatment. The excep-
tions are the occasional cases detected in screening programs.
Dysplasia of the urothelium, most commonly of the bladder,
Fig. 15.28 Voided urine in a case of poorly differentiated urothelial
carcinoma of bladder. The loose cluster of cells show large, moderately
irregular nuclei with prominent nucleoli and a high nucleocytoplasmic ratio
(Papanicolaou x HP).
or atypical hyperplasia, is customarily further subclassified into
mild, moderate, or severe. Mild dysplasia closely resembles nor-
mal urothelium, and severe dysplasia mimics transitional cell
carcinoma in situ.
Mild Dysplasia
Mild dysplasia is characterized by normal or nearly normal thick-
ness of the epithelium (usually less than seven layers), a slight
increase in the number and slight crowding of the cells, and
slight-to-moderate nuclear enlargement. The nuclear outlines are
still fairly uniform. Some of the cells have nuclei with a coarsely
granular chromatin. Few mitoses may be seen.
Severe Dysplasia
In this condition, the urothelium is strikingly abnormal. The
cells are large, with enlarged, hyperchromatic, and more pleo-
morphic nuclei and an increased nucleocytoplasmic ratio. The
nuclear outlines are irregular, and a coarse chromatin pattern
is prominent. Mitoses are considerably more common than in
mild dysplasia. Moderate dysplasia is characterized by changes
between these two extremes.
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