Module 11 Part 2 - Tumours of the Urinary Tract Flashcards
Tumours of the Urinary Tract
Urothelial carcinoma in situ
Non-invasive papillary urothelial ca, high/low grade
Non-invasive papillary urothelial neoplasm of low malignant potential
Urothelial papilloma
Inverted urothelial papilloma
HGUC - Criteria for Malignancy
Papillary structures, frequently fused, lined by cytologically malignant cells Cellularity: > 10 abnormal cells NC ratio: > 0.7 Nucleus: - moderate to severe hyperchromasia - markedly irregular and thick membrane - coarse/clumped chromatin - inflammation - necrosis - mitosis Dx pitfalls: - polyomavirus - non-urothelial tumour - treatment effect
Tumours of the Urinary Tract - Cytology
In situ Papillary Non-papillary - papillary and non-papillary tumours arise from areas of atypical urothelial proliferation - usually co-exist in the same patient Invasive transitional cell carcinoma
In Situ Tumours
Characterised by:
- presence of numerous abnormal cells that are moderately larger than normal transitional cells
- hyperchromatic, enlarged and irregularly outlined nuclei
Pattern is usually monotonous, and bizarre and very pleomorphic cancer cells are rare
In many cases there is no ulceration or inflammation and the background is usually clear
Features of In Situ Tumours
Numerous single abnormal cells
Enlarged, hyperchromatic and irregularly outlined nuclei
Prominent nucleoli
Clean background
Papillary Tumours
Papillomas are uncommon benign papillary tumours with thin fibrovascular cores covered by normal urothelium
Tumours are small, multiple and arise in areas of urothelium that usually show significant cytologic atypia
Transitional cell papillomas are composed of well differentiated transitional cells
Usually occur in elderly males, located in the trigone, bladder neck or prostatic urethra
Samples are highly cellular consisting of increased number of aggregated cells
Often necrotic or ulcerated
Can occur in the squamoid zone of the bladder leading to presence of malignant squamous epithelial cells
Papillary Tumors - Grade 1, 2 and 3 Information
Exfoliation of papillomas and grade 1 (low grade) papillary carcinoma’s are usually scant and a diagnosis on cytology is often difficult
Grade 2 and 3 (high grade) papillary carcinomas are readily identifiable using urine cytology
Features of High Grade Papillary Tumors
Moderate to high cellularity Syncytial or papillary clusters Loss of polarity Nuclear pleomorphism High NC ratio Irregular nuclear borders Coarsely granular chromatin pattern Large, irregular nucleoli Necrosis
Non-Papillary Tumors
Grossly, these carcinomas are often ulcerated, nodular, or bulky and infiltrate the bladder wall
Histologically, the tumors are composed or irregular nests, sheets and cords of cells with enlarged, irregular, hyperchromatic nuclei and relatively scant cytoplasm
Cytological Features of Invasive Non-Papillary Tumors
Highly cellular with more than 1/4th of the cell population neoplastic
Predominantly single cell presentation with few clusters
Nuclear pleomorphism
High NC ratio
Coarsely granular chromatin pattern
Macronucleoli
Glandular and squamoid component may be seen
Necrosis
Treatment Options - Radiation
Irradiation changes seen in urothelial cells and include:
- enlarged and frothy cytoplasm
- marked nuclear enlargement
- hyperchromatic nuclei
- multiple nucleoli
Treatment Options - Chemotherapy
Bladder is affected by chemotherapeutic agents for malignancies
Cyclophosphamide, an alkylating agent for several other malignancies and metabolites are secreted into the urine
Cytologically:
- enlarged urothelial cells
- nuclear enlargement, irregularity and hyperchromasia
- granular chromatin
- potential nucleoli
- multinucleated cells may be present
Treatment Options - Triethylenephosphoramide (thiotepa)/Mitomycin C
Polyfunctional alkylating agents for the tx of TCC of the bladder Cytologically: - moderate hyperchromasia - chromatin smudgy and lacks detail - nuclei moderately enlarged round to oval with moderately smooth membranes - multinucleated cells - small multiple nucleoli may be seen - cytoplasm show degenerative changes
