Urine cytology

Question 1

Types of urine samples

Answer 1

Voided urine Bladder washing Cystoscope Illieal conduit Urethral brushing Urethral and pelvic washing and brushing

Question 2

Specimen. Preparations

Answer 2

Direct smear Cytospin Membrane filter Thin prep Paraffin block( rare)

Question 3

Types of cels

Answer 3

Urothelial cells: Multinuclated umbrella cells Intermediate pyrimydial cells Basal cuboidal cells Squamous cells: females indicate contamination Male: squamous metaplasia Rare: renal epithelial le s In illleal conduit: intestinal cells Female: may be endometrial cells Spermatozoa( after prostrate message) Red cells Inflammatory cells

Question 4

Reporting terminology

Answer 4

Unsatisfactory, criteria? Negative of malignancy Atypical cesll favour reactive Atypical urothelial cells of underdetermined significance Atypical urothelial cells , suspicious for malignancy Malignant cells : low/ high grade Others

Question 5

Reactive cells

Answer 5

N/ c ratio maintained Regular nuclei May have single nucleoli Fine granular chromatin Cytoplasmic vacuoles

Question 6

Instrumentation and lithaisis

Answer 6

Increased cellularity Cohesive balls Tight clusters Numerous giants cells ( umbrella cells )

Question 7

Decoy cells

Answer 7

Polyoma virus effect High N/ C ratio Ground glass cells due io intranuclear inclusion Single Dark ink black large smudgy inclusion Peripheral ring of chromatin May have cytoplasmic tail( comet cells )

Question 8

In illleal conduit cells

Answer 8

Intestinal cells Degenerated cells Exfoliated cells

Question 9

Clue to malignant cells

Answer 9

Papillary clusters in the absence of background inflammation or stone

Question 10

Urine cytology indication

Answer 10

Prefect tool to detect high grade ca, even before clinical detection False positive is true false positive if extensive work up is negative More predictive of high grade carcinoma Cannot d/ d between low grade, papilloma and intraepithelial lesions Cannot d/ d between high grade invasive and high grade insitu

Question 11

Who classifiaction

Answer 11

Flat, papillary Flat: reactive , Aus Insitu: low and high grade Papillary: hyperplasia Papilloma Inverted papilloma Pun lump ( grade 1) Ca: low grad High grade Invasive; laminar propria invasions Muscular propria invasion

Question 12

Ancillary study

Answer 12

FISH, urovison for chromosome 3,7,17 to detect gain and fourth probe to detect loss of chromosome 9 of 9p21 locus

Question 13

Malignant cell features

Answer 13

Cellular smear in the absence of inflammation Papillary clusters and single cells High n/c ratio Eccentric hyper chromatic nuclei Irregular nuclear contours