PART TWO
Diagnostic Cytology
Table 15.2
Grade and Pathologic Stage of Bladder Cancer Cases
Classification
Pathologic stage
and grade
Cases
P-O
PIS
PA
P-1
P-2
P-3A
P-3B
P-4
Cystectomies
CIS
10
9
1
PUC
I
2
'
2
II
10
21 (18%)
1
3
5
1
III
9
5
2
1
1
UC
I
0
1
II
13
70 (61%
)
8
2
1
1
11
I
I
I
57
8
4
10
16
8
Squamous
carc
inoma
5
1
2
1
1
Adenocarcinoma
3
1
2
Sarcoma
1
1
No tumor
4
4
Total
114
4
9
3
25
13
16
21
23
CIS=carcinoma in situ; PUC = papillary urothelial carcinoma; UC = urothelial carcinoma.
Modified from Kern WH, The grade and pathologic stage of bladder cancer.
Cancer
1984;53:1187.
Table 15.3
Correlation of Cytologic and Histologic Classification in 125 Bladder Cancer Cases
Cytologic
PUC
UC
diagnosis
Cases
CIS
I
II
III
II
III
Other
Negative
14 (11%)
0
7
4
0
0
2
1
Suspicious
22 (18%)
4
4
3
3
1
3
4
Positive
89 (71%)
12
5
20
7
3
28
14
All cases
125
16
16
27
10
4
33
19
PUC = papillary urothelial carcinoma; UC = urothelial carcinoma; CIS = carcinoma in situ.
Modified from Kern WH, The grade and pathologic stage of bladder cancer.
Cancer.
1984;53:1188.
sensitivity for the detection of bladder cancer was obtained by
combining cytologic and flow cytometric examinations.
The finding of nontetraploid DNA aneuploidy after earlier
treatment of bladder cancer is diagnostic of recurrence, whereas
DNA diploidy 6 months or more after therapy indicates a good
response and favorable prognosis.40
Squamous Cell Carcinoma
Squamous cell carcinoma may represent a component of poorly
differentiated urothelial carcinoma, but in 2-3% of patients it
is the principal primary tumor. The percentage is much higher
in regions of the world in which Schistosoma haematobium
commonly infects the bladder and where more than one-half
of bladder cancers are squamous in type. Many squamous
cell carcinomas are associated with squamous metaplasia and
occasionally with the squamous metaplasia found in bladder
diverticula. Most tumors are keratinizing. Cytologically, the
urine specimens contain keratinizing malignant epithelial cells
(Fig. 15.37). If the tumor is high grade and if keratinization is
not readily apparent, the diagnosis may nevertheless be sug-
gested by the association of the malignant cells with atypical
metaplastic squamous cells.
Adenocarcinoma
Glandular components of transitional cell carcinomas are less
common than squamous areas. Pure adenocarcinomas are
relatively rare and represent approximately 2% of all primary
urothelial tumors. Some tumors are mucin secreting and resem-
ble colonic adenocarcinoma, probably arising from metaplastic
differentiation to this type of epithelium as is often observed
424
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