sft GU Cytology

Question 1

Cellularity of specimen based on acquisition method.

Answer 1

Clean catch urines are usually sparsely cellular with single cells if benign. Cath and bladder washings are usually much more cellular/may contain benign papillary groups.

Question 2

What are the categories in the Paris system?

Answer 2

Question 3

Urine specimen, dx?

Answer 3

Negative for HGUC; post-cath specimen, numerous umbrella cells and a cluster of basal-type cells. 2nd picture shows a bizarre umbrella cell, but note the preserved low n/c ratio.

Question 4

Urine specimen, what’s going on?

Answer 4

Ileal conduit. 1st pic is a cytospin that shows a dirty background. 2nd pic is a liquid based preparation, which loses the dirty background but shows columnar cells.

Question 5

Urine specimen. Diagnosis and association?

Answer 5

Granuloma, associated with BCG therapy.

Question 6

Urine specimen, diagnosis? What feature can it also have?

Answer 6

Cystitis glandularis, can also have goblet cells.

Question 7

Viral infections you can see evidence of in urine cytology.

Answer 7

Polyomavirus (BK virus and JC virus, usually post kidney tranplant) and adenovirus

Question 8

In urine, buzzword?

Answer 8

Comet cell/decoy cell: Dark, basophilic nucleus with slight membrane irregularity; smudgy or glassy nuclear inclusion; can mimic a carcinoma cell; associated with polyomavirus (JC or BK, usually post transplant); can also be pale cells with eosinophilic inclusions

Question 9

Urine, benign or malignant?

Answer 9

Benign urothelial cells with cytoplasmic vacuoles in a patient undergoing chemotherapy.

Question 10

Urine specimen, dx?

Answer 10

HGUC:

• Enlarged nuclei with pleomorphism, hyperchromasia, coarsely granular chromatin, and irregular nuclear membranes; nucleoli may be present
• Single cells and loosely cohesive clusters
• Increased nuclear:cytoplasmic ratios
• “Coy” cells are single atypical cells that on low power appear innocuous but on high power show nuclear irregularities. The number of these cells increases with the grade of tumor

Question 11

Molecular adjunct test for high-grade urothelial carcinoma? What are the most frequently involved chromosomes? Specific gene loci associated with bladder cancer?

Answer 11

UroVysion FISH analysis: Detects chromosomal aberrations commonly associated with urothelial carcinoma; –chromosomes 1, 3, 5, 7, 9, 11, and 17; locus specific 9p21

Question 12

What infection is associated with higher rates of bladder SCC?

Answer 12

Schistosomiasis.

Question 13

Urine specimen, dx? Most likely origin?

Answer 13

Adenocarcinoma, most likely extension from anohter organ (<2% of bladder tumors are primary adenocarcinoma).

Question 14

4 components of the multioclor FISH probe (Abbott molecular)? Interpretation?

Answer 14

–Centromeric 3 (CEP 3): Red signal

–Centromeric 7 (CEP 5): Green signal

–Centromeric 17 (CEP 17): Aqua signal

–Locus-specific 9p21 (LSI 9p21): Gold signal

≥ 4 cells with polysomy (≥ 3 copies of ≥ 2 chromosomes) or ≥ 12 cells with homozygous 9p21 deletion

Question 15

Urine cytology, dx?

Answer 15

Negative for HGUC; these are seminal vesicle cells (note pigment).