Urinary Tract

Question 1

They’re large, flat, polygonal cells, measuring 15-30μm in diameter.

Cell formations: isolated or sheets and clusters
 Nuclei: one or two, relatively large, round to oval, central or eccentric,
multinucleation common.

 Chromatin: pale, finely granular, salt and pepper appearance (small chromatin
granules are separated by relatively clear nucleoplasm).
 Nuclear membrane: smooth, well-defined.
 Nucleoli: small, inconspicuous or absent.
 Cytoplasm: well defined, cyanophilic, may be finely vacuolated.
 The N/C ratio is high

Answer 1

Transitional cells

Question 2

Cell formations: small aggregates with a glandular of ball-like configuration.
 Cells: small, columnar or round.
 Cytoplasm: slightly acidophilic, vacuolated, or granular, distinct cell membranes.
 Nucleus: single, small, round to oval.
 Chromatin: finely granular.

Answer 2

Prostatic cell

Question 3

Cells: smaller than transitional cells and almost always degenerated.
 Nuclei: enlarged, hyperchromatic, uniformly smudged or glassy.
 Chromatin: little or no chromatin structure.
 These cells can also be identified by the presence of cytoplasmic golden brown
lipochrome pigment and vacuoles.

Answer 3

Seminal vesicle cells

Question 4

Cells: small, round, cuboidal, or columnar cells.
 Nuclei: small, round, hyperchromatic.
 Nucleoli: occasional small.
 Cytoplasm: variable amount, eosinophilic or amphophilic, distinct cell borders.
 These cells are usually degenerated and may resemble histiocytes.

Answer 4

Renal tubular cells

Question 5

This infection is characterised by budding

yeast and pseudohyphae.

Answer 5

Candida species

Question 6

They appear as blue-grey pear shaped organisms with a small crescent shaped
nucleus and red granules in the cytoplasm.

Answer 6

Trichomonas vaginalis

Question 7

The characteristic ova with terminal spines and refractive shell as well as an
abundance of metaplastic squamous cells

Answer 7

Schistosoma

Question 8

Single or multinucleated transitional cells with a characteristic “ground glass”
nuclear appearance or typical eosinophilic intranuclear inclusions surrounded by a
halo are seen.
 Nuclear moulding and margination of the chromatin are characteristic features.

Answer 8

Herpes simplex virus

Question 9

This virus results in the appearance of
enlarged tubular cells, with an enlarged nucleus, which contains a single,
irregular, cyanophilic, central “owl-eye” inclusion, surrounded by a halo and
thickened nuclear membrane

Answer 9

Cytomegalovirus

Question 10

Smears show characteristic epithelial cells (“decoy cells”).
 Nuclei: enlarged, round to oval, eccentric, may be binucleated, almost completely
filled with a homogenous, dark, basophilic inclusion, N/C ratio is high and may
mimic carcinoma, spherical non-encapsulated viral particles present singly or in
loose crystalline arrays within the nuclei are seen by electron microscopy.
 Nuclear membrane: markedly thickened, smooth.
 Chromatin: clumped along the periphery, thin halo may separate the inclusion
from the clumped chromatin.
 Viral particles may leach out of the cells resulting in a coarse “fishnet” chromatin
appearance, which is also characteristic

Answer 10

Polyoma virus

Question 11

Infected cells may show atypia, koilocytosis and dyskeratosis identical to cervical
lesions.

Answer 11

Human papilloma virus

Question 12

Associated with intracytoplasmic
eosinophilic inclusions
and multinucleated syncytia of epithelial cells

Answer 12

Measels

Question 13

Single or multiple, cyanophilic, concentrically lamellated inclusions,
referred to as Michaelis-Gutman bodies, are present within the macrophages.
 These structures are seen along with macrophages, multinucleated giant cells,
and occasional leukocytes in the bladder submucosa, resulting in characteristic
yellow plaques.

Answer 13

Malakoplakia

Question 14

Large eosinophilic intranuclear inclusion

surrounded by a halo in desquamated renal tubular cells. Differentiation is done by an acid fast stain

Answer 14

Severe lead poisoning

Question 15

The urothelium/transitional epithelium is replaced by squamous metaplasia (full
formation of squamous epithelium).
 This epithelium shows excessive keratinisation of cells forming white plaques on
the mucosa.

 There is hyperkeratosis with the presence of anucleated squamous or
hyperkeratotic cells (orangeophilic polygonal shaped cells with no nucleus but a
“ghost” nucleus).

Answer 15

Leukoplakia

Question 16

Ground glass or eosinophilic with a halo

Multinucleation and nuclear moulding

Answer 16

Herpes simplex

Question 17

Well defined cyanophilic, with a halo, “owl-eye”
Nucleus and cytoplasm markedly enlarged
Early inclusions in cytoplasm are multiple, small, cyanophilic

Answer 17

Cytomegalovirus

virus

Question 18

Homogenous glassy, cyanophilic, with a thin halo
Nucleus enlarged, round or oval/cup shaped, single or
binucleated

Answer 18

Polyoma virus

Question 19

Large eosinophilic with a halo, acid fast

Answer 19

Lead poisoning

Question 20

These are non-pathological homogenous glassy transparent threads that can also
be seen in renal disease.

Answer 20

Hyaline casts

Question 21

May result from aggregation of protein in the matrix or from cellular degeneration.
 They have traditionally been classified as finely or coarsely granular.

Answer 21

Granular casts

Question 22

Associated with several renal disorders and are formed by the exfoliation of renal
tubular cells, which form two parallel rows of cells or are scattered throughout the
protein matrix of the cast.

Answer 22

Epithelial casts

Question 23

Casts consisting of leukocytes in a proteinaceous matrix, signal tubulointerstitial
disease as well as transplant rejection.

Answer 23

White blood cell casts

Question 24

Casts are smooth appearing, wide, blunt ended casts with a high refractive
index that indicate chronic renal disease.

Answer 24

Waxy casts

Question 25

Casts contain fat droplets or oval fat bodies due to degeneration of tubular
epithelium or the incorporation of lipids into the protein matrix

Answer 25

Fatty casts

Question 26

Renal tubular cells have large eccentric nuclei, fine chromatin, prominent nucleoli,
and vacuolated cytoplasm.
 They may be single or in clusters, sheets, or tubules.
 Lymphocytes may be small plasmacytoid or large immunologically reactive cells.
 Other features include increased cellularity with abundant red blood cells, casts,
and mixed clusters of epithelial cells and leukocytes.
 The specimen also shows evidence of nuclear degeneration and a dirty
background.

Answer 26

renal transplant rejection

Question 27

Benign tumour
Little or no atypia
Clusters
Papillary structures
with palisading cells
Honeycomb
Many columnar cells
Elongated, spindle
cells

Nuclei and N/C ratio are normal

Chromatin is fine and evenly distributed

Nuclear rim is smooth and nucleoli are not present.

Cytoplasm forms long tail-like processes

Background is clean with few RBC

Answer 27

Low grade tumour - Papilloma

Question 28

Malignant tumour
Slight atypia
Clusters
Papillae
Crowded cells
Irregular border

Nucleus: Eccentrically
Vary in size, shape
and staining intensity

N/C ratio slightly increased

Chromatin: Fine or granular
Evenly distributed
Mitotic figures rare

Nuclear rim has 1 or 2 indentations

Nucleoli are small if present

Cytoplasm loses it’s rim

Background is usually clean with RBS

Answer 28

Papillary TCC Grade

I

Question 29

Malignant tumour
Obvious atypia
Isolated cells
Small dyscohesive
clusters
Syncytia
Few loose clusters
Crowded cells with
disarray
Irregular outlines
Apoptosis

Nucleus: Enlarge
Pleomorphic
Hyperchromatic

N/C ratio increased

Chromatin: Coarse
Irregularly distributed
Viable mitotic activity

Nuclear rim is irregular

Nucleoli: May be prominent, 
Irregular
Cytoplasm: Variable amounts
Amphophilic
Vacuolated
Background: Dirty

Answer 29

Papillary TCC Grade

III

Question 30

Malignant tumour
Isolated cells
Clusters
Syncytia
No papillae
Apoptosis

Nucleus: Enlarged
Hyperchromatic

N/C ratio markedly increased

Chromatin: Coarse
Irregularly distributed
Frequent mitotic
figures

Nuclear rim is irregular

Nucleoli: May be prominent
Cytoplasm: Scant
Background: Clean with RBC

Answer 30

CIS

Question 31

Malignant tumour
Isolated cells
Small aggregates
Variable cell size and
shape
Spindle cells
Malignant pearls

Nucleus: Hyperchromatic
May be pyknotic

N/C ratio increased

Chromatin: Coarse
Irregularly distributed

Nuclear rim is smooth to irregular

Nucleoli rarely noted

Cytoplasm:  Dense
Eosinophilic or
cyanophilic
Ectoplasmic rim can be
identified

Background: Inflammatory and bloody

Answer 31

Well-differentiated SCC

Question 32

Malignant tumour
May be colonic, colloid,
signet ring or clear cell
types
Small groups
Cells align side by side
in groups of 3-4
Nuclear polarized to
one side.

Nucleus: Enlarge
Not hyperchromatic
Round to oval
Eccentrically placed

N/C ratio moderately increased

Chromatin: Fine
Evenly distributed
Mitotic figures may be
present

Nuclear rim is smooth to irregular

Nucleoli: Large, prominent,
single or multiple red

Cytoplasm: Vacuolated
Abundant
Basophilic

Background: Clean

Answer 32

Adenocarcinoma