Cytologie urinaire (Images) Flashcards
Pap vessie iléale: cellules intestinales cylindrique (haut à droite), background sale avec macrophages et débris
Milieu liquide pap: Cellules intestinalesa discohésives
Cellules entériques dégénérées (ressemble à histiocyte!)
Cellule parapluie (au-dessus)
Cellules squameuses
Métaplasie squameuse
Cellules parapluies
Cellules parapluies
Cellules intermédiaires
Cellules intermédiaires
Cellules intermédiaires
Cellules intermédiaires
Cellules basales
Cellules basales et superficielles
Cellules parapluie, intermédiaires et basales
Cellules basales et parapluies
Vessie iléale
●Cellules isolées ou plages
●Inclusions éosinophiles intracytoplasmique (un peu à la manière de corps de Melamed Wolinska)
●Ressemblent à histiocytes
●Généralement arrière plan sale et inflammatoire
Cellules urothéliales dégénérées
Cellules urothéliales dégénérées
Cellules tubulaires rénales
Cellules tubulaires rénales
Cellules tubulaires rénales
Cellules tubulaires rénales
Modifications réactionnelles
Modifications réactionnelles
Modifications réactionnelles
Modifications réactionnelles
Cluster dans miction libre avec augmentation ratio N:C mais chromatine fine, hypochromasie, membranes nucléaires lisses
BUTF (benign urothelial tissue fragment) dans miction libre
BUTF (benign urothelial tissue fragment) d’un pelvis rénal instrumenté (donne un aspect qui ressemble à papille ! Ici avait été répondu suspect bas grade mais histo - N)
Cluster/sheet de cellules monocouches et monotones sans atypies, avec “fenêtres”
Négatif
Modifications secondaires à des lithiases
Concrétions de calcium
Concrétions de calcium
Négatif
Modifications secondaires aux lithiases
Négatif
Modifications secondaires aux lithiases
Négatif
Modifications secondaires aux lithiases
Modifications secondaires aux lithiases
Sans antécédents de lithiases le diagnostic approprié est atypique
Malakoplakie
Corps de Michaelis Gutman
Candida
Polyomavirus
Polyomavirus
Polyomavirus
Polyomavirus
Polyomavirus
Polyomavirus
Polyomavirus
Polyomavirus
Trichomonas vaginalis
Changements post-radiques
Granulome
Cellule de la vésicule séminale
Cellule de la vésicule séminale et spermatozoïdes
Endométriose (cellules glandulaires bénignes)
Négatif
Cystite glandulaire
Négatif
Cystite glandulaire
Négatif
Cystite glandulaire
Négatif
Cystite glandulaire
Nodule à cellules fusiformes
●Présence de cellules bizarres au noyau irrégulier d’origine mésenchymateuse et pouvant prendre un aspect épithélioïde
Nodule à cellules fusiformes
●Présence de cellules bizarres au noyau irrégulier d’origine mésenchymateuse et pouvant prendre un aspect épithélioïde
Négatif
Cystite folliculaire
Atypique
En haut: cellules intermédiaires N
En bas: Ratio N:C ↑, irrégularité contour nucléaires mais pas changement chromasie (idem dans 2 groupes).
Atypique
Ratio N:C ↑ et irrégularité contour nucléaire.
Pas d’hyperchromasie.
Chromatine dégénérée clumpée
Atypique
Ratio N:C ↑, gros noyau, contours nucléaires légèrement irréguliers, chromatine irrégulière mais hypochromatique.
Atypiques
Ratio N:C ↑, gros noyau
Irrégularité contours nucléaires
Chromatine uniforme et hypochromasie
Atypique
Ratio N:C ↑, gros noyau
Irrégularité contours nucléaires
Chromatine clumpée mais hypochromatique
Atypique
Irrégularité nucléaire, anisocariose, hyperchromasie. Dégénérescence (perte de cytoplasmes et des détails nucléaires)
Cellule avec ratio N:C ↑, mais vu dégénérescence et hx de lithiase: AUC
Atypique
Ratio N:C ↑ et membrane irrégulière mais chromatine fine et hypochromasie
Atypique
Hyperchromasie et ratio N:C augmenté
mais pas chromatine clumpée ni irrégularité membrane
Atypique
Hyperchromasie et ratio N:C augmenté
mais pas chromatine clumpée ni irrégularité membrane
Atypique
Cellule unique et dégénérée (détails chromatiniens sont mal préservés, perte de cytoplasme, membrane nucléaire discontinue) avec ratio N:C ↑, hypercrhomasie et chromatine clumpée. Comme dégérénée; AUC et non SHGUC (pourrait aussi être polyomavirus)
Atypique
Cellule unique et dégénérée (détails chromatiniens sont mal préservés, perte de cytoplasme, membrane nucléaire discontinue) avec ratio N:C ↑, hypercrhomasie et chromatine clumpée. Comme dégérénée; AUC et non SHGUC (pourrait aussi être polyomavirus)
Atypique
Ratio N:C ↑ et hyperchromasie. Or dégénérescence empêche analyse plus poussée
Atypique
Irrégularité contours nucléaires mais cellules tellement dégénérées (vacuolisation) que DX définitif impossible.
Atypique
Ratio N:C ↑ (50%) et hyperchromasie et irrégularité de membrane mais dégénérescence trop poussée et ratio N:C n’atteint pas 70% donc pas de DX de HGUC
Suspect de haut-grade
Suspect de haut-grade
Tous critères HG même si noyaux, pas tellement plus gros que ceux de cellules intermédiaires
Suspect de haut-grade
Pas toutes les cellules ont un ratio de ≥0,7 mais comme elles sont autrement semblable, on peut les considérer comme faisant partie de la même lésion. Avec 6 cellules, DX SHGUC ou HGUC selon suspicion clinique.
Suspect de haut-grade
Suspect de haut-grade
Suspect de haut-grade
N:C ↑, hyperchromasie, membranes irrégulières mais rares cellules
Suspect de haut-grade
2 des 4 cellules ont un ratio N:C de plus de 0,7
Hyperchromasie
Membrane irrégulière
Détail chromatinien ne peuvent être évalués
Suspect de haut-grade
ratio N:C ↑
Hyperchromasie, nucléole
Membrane irrégulière
Détail chromatinien ne peuvent être évalués
Suspect de haut-grade
Pas tous les critères HG car chromatine fine et également distribuée
Carcinome urothélial de haut-grade
Carcinome urothélial de haut-grade
Carcinome urothélial de haut-grade
Carcinome urothélial de haut grade
Carcinome urothélial de haut grade
Carcinome urothélial de haut grade
Carcinome urothélial de haut grade
Carcinome urothélial de haut grade
Carcinome urothélial de haut grade
Haut : uretère bénin
Bas : uretère avec Carcinome urothélial de haut grade
Carcinome urothélial de haut grade dans une vessie iléale
Carcinome urothélial de haut grade dans une vessie iléale
Carcinome urothélial de haut grade avec différentiation malpighienne
Carcinome urothélial de haut grade avec différentiation malpighienne
Carcinome urothélial de haut grade avec différentiation malpighienne
Carcinome urothélial de haut grade avec différentiation glandulaire
Carcinome urothélial de haut grade avec différentiation glandulaire
Carcinome urothélial de haut grade avec différentiation glandulaire
Carcinome urothélial de haut grade avec différentiation glandulaire
Carcinome urothélial de bas-grade
Carcinome urothélial de bas-grade
Oeuf de schistosomiase
Schistiosomase
Carcinome épidermoïde
Carcinome épidermoïde
Carcinome épidermoïde
Carcinome épidermoïde
Carcinome épidermoïde
ADK NOS: cytoplasme vacuolisé, noyau excentré, nucléole.
Dans un seul fragment, difficile de déterminer si la vacuolisation est 2e dégénérescence ou différenciation glandulaire. Si celle-ci est généralisée è plusieurs fragments, probablement différenciation.
ADK entérique (cylindrique, peu de cytoplasme vacuolisé)
ADK cellules claires: hobnail et vacuolisé, gros nucléole, noyau excentré
Adénocarcinome à cellules en bagues
Carcinome à petites cellules
Carcinome à petites cellules
Léiomyosarcome
Léiomyosarcome: cellules fusiformes atypiques + inflammation. Noyaux “cigar shaped”, légèrement hyperchromatiques, cytoplasme modérément abondant mal défini
Figure 03-01. Normal Voided Urine. Most benign voided urine samples show a mixture of urothelial cells and squamous cells. In voided urine, most of the urothelial cells are of “intermediate” type, with an oval or pyramidal shape; they resemble the parabasal cells of the cervix.
Figure 03-02. Cytoplasmic Inclusions (Melamed-Wolinska Bodies). Degenerating urothelial cells frequently have round, red (or sometimes green) cytoplasmic inclusions of varying sizes. A normal columnar-shaped urothelial cell is also present.
Figure 03-03. Umbrella Cells (Ureteral Washing). These are the largest urothelial cells. They cover the surface of the urothelium and are often binucleated or multinucleated. Normal columnar urothelial cells are also present.
Figure 03-04. Benign Urothelial Cells Can Have a Folded and Flattened Nucleus (Catheterized Specimen). The nucleus of benign urothelial cells is not always perfectly round. Some indentation and deformation, including straight edges that give the cells a flat geometric contour, are common. They are recognized as benign because of their normal nuclear-to-cytoplasmic ratio and normochromasia.
Figure 03-05. Basal Urothelial Cells (Catheterized Specimen). Basal urothelial cells are rare in voided urine but common in catheterized specimens and usually tightly clustered.
Figure 03-06. Seminal Vesicle or Prostatic Epithelial Cells (Voided Urine). These cells are recognized because of their golden-brown pigment. Sometimes they are less well preserved than seen here.
Figure 03-07A. Ileal Loop Specimen. (A) Most of the cells in an ileal loop specimen are degenerated intestinal cells and look very much like macrophages. (B) Degenerated intestinal cells can have Melamed-Wolinska bodies (arrows) just like urothelial cells. Lubricant is present (arrowheads).
Figure 03-07B. Ileal Loop Specimen. (A) Most of the cells in an ileal loop specimen are degenerated intestinal cells and look very much like macrophages. (B) Degenerated intestinal cells can have Melamed-Wolinska bodies (arrows) just like urothelial cells. Lubricant is present (arrowheads).
Figure 03-08A. Polyomavirus Infection. (A) In some cases, the nucleus is filled with and expanded by a glassy basophilic inclusion. Nuclear chromatin is pushed to the nuclear membrane, giving it a thickened and beaded appearance. (B) Some of the affected cells have a characteristic tear-drop or comet shape. (C) The inclusions do not always completely fill the nucleus, leaving clumps and threads of visible chromatin. Note the marked nuclear enlargement by comparison with the nuclei of normal squamous cells. (D) Some chromatin texture is visible. Note how round the nucleus is.
Figure 03-08B. Polyomavirus Infection. (A) In some cases, the nucleus is filled with and expanded by a glassy basophilic inclusion. Nuclear chromatin is pushed to the nuclear membrane, giving it a thickened and beaded appearance. (B) Some of the affected cells have a characteristic tear-drop or comet shape. (C) The inclusions do not always completely fill the nucleus, leaving clumps and threads of visible chromatin. Note the marked nuclear enlargement by comparison with the nuclei of normal squamous cells. (D) Some chromatin texture is visible. Note how round the nucleus is.
Figure 03-08C. Polyomavirus Infection. (A) In some cases, the nucleus is filled with and expanded by a glassy basophilic inclusion. Nuclear chromatin is pushed to the nuclear membrane, giving it a thickened and beaded appearance. (B) Some of the affected cells have a characteristic tear-drop or comet shape. (C) The inclusions do not always completely fill the nucleus, leaving clumps and threads of visible chromatin. Note the marked nuclear enlargement by comparison with the nuclei of normal squamous cells. (D) Some chromatin texture is visible. Note how round the nucleus is.
Figure 03-08D. Polyomavirus Infection. (A) In some cases, the nucleus is filled with and expanded by a glassy basophilic inclusion. Nuclear chromatin is pushed to the nuclear membrane, giving it a thickened and beaded appearance. (B) Some of the affected cells have a characteristic tear-drop or comet shape. (C) The inclusions do not always completely fill the nucleus, leaving clumps and threads of visible chromatin. Note the marked nuclear enlargement by comparison with the nuclei of normal squamous cells. (D) Some chromatin texture is visible. Note how round the nucleus is.
Figure 03-09A. Condyloma Acuminatum of Bladder (Catheterized Urine). (A) The sample contains koilocytes. (B) A bladder biopsy confirmed the diagnosis (hematoxylin and eosin stain).
Figure 03-10. Chemotherapy Effect (Catheterized Urine). This enormous multinucleated cell has a normal nuclear-to-cytoplasmic ratio. Note that, where the nuclei are not overlapped, one can tell that the chromatin is finely textured. Coarse vacuolization is typical of benign reactive changes, including chemotherapy and radiation effect.
Figure 03-11. Benign Stone Atypia (Voided Urine). In some patients with stones, urothelial cells are markedly abnormal, with hyperchromatic and angulated nuclei. A distinction from urothelial carcinoma in such cases is impossible. The patient’s age (27 years old) was the only clue that these cells might not be malignant. A subsequent computed tomography scan demonstrated bilateral renal stones. The exceptional atypia of these cells prompted a suspicious interpretation. Cystoscopic evaluation of the bladder, kidneys, and ureters was normal.
Figure 03-12A. Nephrogenic Adenoma (Catheterized Urine). (A) The cells are smaller than intermediate urothelial cells, with granular cytoplasm and a round nucleus. (B) A bladder biopsy demonstrates the resemblance to renal tubular epithelium (hematoxylin and eosin stain). The cells are positive for PAX8 (Inset).
Figure 03-13. High-Grade Urothelial Carcinoma (Catheterized Urine). Numerous isolated malignant cells have an enlarged nucleus, coarsely textured chromatin, and a markedly increased nuclear-to-cytoplasmic ratio. An occasional cell has a mucin vacuole, which is not uncommon.
Figure 03-14. High-Grade Urothelial Carcinoma With Jet-Black Chromatin (Ileal Loop Specimen). The cells have markedly irregular nuclear outlines, including nuclear points, but in many places the chromatin is smooth and black rather than coarsely granular.
Figure 03-15. High-Grade Urothelial Carcinoma With Straight and Curved Nuclei (Voided Urine). The nuclei are elongate and dark, with either a straight or curved edge that imparts a sickle or crescent-moon shape.
Figure 03-16A. High-Grade Urothelial Carcinoma With Umbrella-Cell Features (Catheterized Urines). (A) This malignant cell is large, with a markedly enlarged nucleus and prominent nucleoli. In most examples, like this one, the nuclear-to-cytoplasmic ratio is elevated, and there are usually far too many such cells for them to be normal umbrella cells, yet the nuclear membrane is smooth and regular, and the chromatin is finely textured. (B) Some of these “umbrella-cell” variants have obviously malignant nuclei, even though the nuclear-to-cytoplasmic ratio is only mildly increased.
Figure 03-16B. High-Grade Urothelial Carcinoma With Umbrella-Cell Features (Catheterized Urines). (A) This malignant cell is large, with a markedly enlarged nucleus and prominent nucleoli. In most examples, like this one, the nuclear-to-cytoplasmic ratio is elevated, and there are usually far too many such cells for them to be normal umbrella cells, yet the nuclear membrane is smooth and regular, and the chromatin is finely textured. (B) Some of these “umbrella-cell” variants have obviously malignant nuclei, even though the nuclear-to-cytoplasmic ratio is only mildly increased.
Figure 03-17A. High-Grade Urothelial Carcinoma With Pale Chromatin (Catheterized Urine). (A) The malignant cells have markedly enlarged nuclei but relatively pale chromatin, and there is a mitosis (arrow). (B) The marked nuclear enlargement can be appreciated by comparing to adjacent normal urothelial cells on the right.
Figure 03-17B. High-Grade Urothelial Carcinoma With Pale Chromatin (Catheterized Urine). (A) The malignant cells have markedly enlarged nuclei but relatively pale chromatin, and there is a mitosis (arrow). (B) The marked nuclear enlargement can be appreciated by comparing to adjacent normal urothelial cells on the right.
Figure 03-18. High-Grade Urothelial Carcinoma With Smooth Round Nuclei and Granular Chromatin. The nuclear-to-cytoplasmic ratio is very high, and chromatin is coarse and clumpy.
Figure 03-19. High-Grade Urothelial Carcinoma With Smooth Round Nuclei and Prominent Nucleoli. The nuclear-to-cytoplasmic ratio is increased, and nucleoli are prominent.
Figure 03-20. High-Grade Urothelial Carcinoma With Small Nuclei (Ileal Loop). The nuclear-to-cytoplasmic ratio is very high, the nuclear outline is irregular, and the cells may have one or more nucleoli, but the chromatin is not coarse and clumpy. These cells are smaller than reactive urothelial cells.
Figure 03-21. High-Grade Urothelial Carcinoma With Extensive Degeneration (Voided Urine). The sharp angularity (“points”) of degenerated cells helps to identify them as malignant.
Figure 03-22A. Urothelial Carcinoma Variants. (A) Some of the malignant cells show squamous differentiation, manifested by cytoplasmic orangeophilia. (B) Some urothelial carcinomas have foci of adenocarcinoma.
Figure 03-22B. Urothelial Carcinoma Variants. (A) Some of the malignant cells show squamous differentiation, manifested by cytoplasmic orangeophilia. (B) Some urothelial carcinomas have foci of adenocarcinoma.
Figure 03-23. Suspicious for Urothelial Carcinoma. The suspicious cells are few in number and poorly preserved. The irregularity of the nuclear membrane is more typical of malignancy than polyomavirus effect.
Figure 03-24. Clear Cell Adenocarcinoma. The cells are large, with abundant clear cytoplasm, large nuclei, and large nucleoli.
Figure 03-25. Prostatic Carcinoma (Voided Urine). Many prostate cancers are impossible to distinguish from urothelial carcinoma. Inset, Immunohistochemistry for prostatic markers can be helpful (cell block, prostate specific antigen).
Figure 03-26A. Metastatic Colon Cancer to the Bladder Neck (Voided Urine). (A) The majority of the malignant cells are round, with dark, angulated nuclei. Distinction from urothelial carcinoma is not possible by cytomorphology. (B) A cell block preparation contains occasional degenerated malignant cells. (Inset) the malignant cells show nuclear reactivity for CDX-2, commonly seen in colon cancers and usually absent in urothelial cancers. The malignant cells were also positive for cytokeratin 20 and negative for cytokeratin 7, the typical keratin profile of colon cancer.
