PART TWO
Diagnostic Cytology
Table 15.4 Cytologic Diagnosis by Modality
Patient
Surgical specimen
Site
Aspirate urine
Washing
Smear/cytospin
Cell block
1.
GrIII UC
a
Ureter
Neg.
__b
Atypical
Atypical
2.
GrI-II UC
r.p.
c
Neg.
Atypical
Atypical
Atypical
3.
GrI UC
r.p.
Low-gr. UC
Low-gr. UC
Grl UC
4.
Grll UC
r.p.
Neg.
UC, NOS
Grll, UC
5.
Grll UC
r.p.
Atypical
Atypical
6.
Grll UC
Ureter
Neg.
Atypical
7.
Grll UC
r.p.
UC, NOS
Grll UC
Grll UC
8.
Grlll UC
Ureter
UC, NOS
Atypical
9.
Grl UC
Ureter
Neg.
Atypical
10.
Grll UC
r.p.
High-gr, UC
High-gr. UC
High-gr. UC
Grlll UC
11.
Grl UC
r.p.
Atypical
UC, NOS
NC
d
Grll UC
12.
Grll UC
r.p.
Neg.
Neg.
UC, NOS
Grll UC
13.
Grl UC
r.p.
Neg.
Low-gr. UC
Low-gr. UC
Grl UC
14.
Grl UC
r.p.
Atypical
UC, NOS
15.
Grl UC
Ureter
High-gr. UC
High-gr. UC
UC, NOS
Grll UC
16.
Grll UC
r.p.
Neg.
Grll UC
17.
Grll UC
r.p.
UC, NOS
UC, NOS
Grll UC
18.
Grl UC
r.p.
Atypical
Atypical
NC
NC
19.
Grll-lll UC
Ureter
UC, NOS
High-gr. UC
High-gr. UC
Grlll UC
20.
Grl-ll UC
Ureter
UC, NOS
Low-gr. UC
UC, NOS
Grl-ll UC
21.
Grll UC
Ureter
Atypical
UC, NOS
Low-gr. UC
Grl-ll UC
22.
Grll-lll UC
r.p.
UC, NOS
UC, NOS
UC, NOS
Grll-lll UC
23.
Grll-lll UC
r.p.
Grll-lll UC
UC, NOS
Grll UC
24.
Grll-lll UC
Ureter
UC, NOS
NC
UC, NOS
Grll-lll UC
25.
Grll-lll UC
Ureter
UC, NOS
Grll UC
NC
Accu racy (%)
60
91
89
89
(Combined 95)
aUC = urothelial carcinoma.
bNot performed.
c
.r.p. = renal pelvis.
dNC = noncontributory.
Modified from Chaubal A, et al.15
Fig. 15.52 Reactive urothelial cells from renal pelvis aspirate. Note
cells with abundant cytoplasm and nuclei with delicate chromatin pattern
(Papanicolaou x MP).
Fig. 15.53 Post-laser aspirate of renal pelvis. Note thermal artifact in
spindly tumor cells of an urothelial carcinoma (Papanicolaou x MP).
intravesically by catheter. Cyclophosphamide is an alkylating
agent given systemically for various cancers. Active metabolites
are excreted in the urine, where they often cause enlargement of
the urothelial cells, with nuclear enlargement, irregularity, and
hyperchromasia and a salt-and-pepper nuclear chromatin distri-
bution. Nucleoli may be seen, and multinucleated cells are often
present. This is usually associated with a hemorrhagic cystitis and
increased exfoliation of the epithelial cells. The patient's history
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