48,790
edits
(create) |
m (→Paris system for urinary cytology: tweak) |
||
(34 intermediate revisions by the same user not shown) | |||
Line 1: | Line 1: | ||
[[Image:Benign urine cytology - 2a -- very high mag.jpg|thumb|right|Urine cytology - squamous cells and urothelial cells. (WC)]] | |||
[[Image:Benign urine cytology - 3b -- very high mag.jpg|thumb|right|Urine cytology. (WC)]] | |||
[[Image:Benign urine cytology - 4 -- very high mag.jpg|thumb|right|Urine cytology. (WC)]] | |||
'''Urine cytopathology''' is a large part of cytopathology. | '''Urine cytopathology''' is a large part of cytopathology. | ||
Line 7: | Line 10: | ||
*Negative for malignancy. | *Negative for malignancy. | ||
*Urothelial carcinoma. | *Urothelial carcinoma. | ||
**AKA ''urothelial cell carcinoma'', abbreviated ''UCC''. | **[[AKA]] ''urothelial cell carcinoma'', abbreviated ''[[UCC]]''. | ||
*Urothelial carcinoma with squamous features. | *Urothelial carcinoma with squamous features. | ||
*Polyomavirus infection. | *Polyomavirus infection. | ||
Line 16: | Line 19: | ||
*Schistosoma. | *Schistosoma. | ||
*Malignancies other than urothelial carcinoma (UC): | *Malignancies other than urothelial carcinoma (UC): | ||
**Lymphoma. | **[[Lymphoma]]. | ||
**Melanoma. | **[[Melanoma]]. | ||
**Adenocarcinoma. | **Adenocarcinoma. | ||
Line 25: | Line 28: | ||
*Large (benign) squamous component. | *Large (benign) squamous component. | ||
**Usually contamination from gential tract (in females). | **Usually contamination from gential tract (in females). | ||
===Paris system for urinary cytology=== | |||
This is a reporting standard with the following categories:<ref name=pmid27318895>{{Cite journal | last1 = Barkan | first1 = GA. | last2 = Wojcik | first2 = EM. | last3 = Nayar | first3 = R. | last4 = Savic-Prince | first4 = S. | last5 = Quek | first5 = ML. | last6 = Kurtycz | first6 = DF. | last7 = Rosenthal | first7 = DL. | title = The Paris System for Reporting Urinary Cytology: The Quest to Develop a Standardized Terminology. | journal = Acta Cytol | volume = 60 | issue = 3 | pages = 185-97 | month = | year = 2016 | doi = 10.1159/000446270 | PMID = 27318895 }}</ref> | |||
#Nondiagnostic/unsatisfactory | |||
#Negative for [[urothelial carcinoma|high-grade urothelial carcinoma]] | |||
#Atypical urothelial cells | |||
#Suspicous for high-grade urothelial carcinoma | |||
#High-grade urothelial carcinoma | |||
#Low-grade urothelial neoplasm | |||
#Other malignancy (includes both primary and secondary) and miscellaneous lesions | |||
==Normal== | ==Normal== | ||
Line 30: | Line 43: | ||
*Benign cells are often in small clumps. | *Benign cells are often in small clumps. | ||
=== | ===Major cell types=== | ||
Practical cell typing:<ref>SM. 7 January 2010.</ref> | Practical cell typing:<ref>SM. 7 January 2010.</ref> | ||
{| class="wikitable" | {| class="wikitable" | ||
Line 46: | Line 59: | ||
| Irregular/jagged | | Irregular/jagged | ||
|} | |} | ||
====Images==== | |||
=====Case 1===== | |||
<gallery> | |||
Image: Benign urine cytology - 4 -- very high mag.jpg | Benign - c/w renal tubular cells - very high mag. (WC) | |||
Image: Benign urine cytology - 4 - alt -- very high mag.jpg | Benign - c/w renal tubular cells - very high mag. (WC) | |||
</gallery> | |||
=====Case 2===== | |||
<gallery> | |||
Image: Benign urine cytology - 1 -- very high mag.jpg | BUC - very high mag. (WC) | |||
Image: Benign urine cytology - 1a -- very high mag.jpg | BUC - very high mag. (WC) | |||
Image: Benign urine cytology - 1b -- very high mag.jpg | BUC - very high mag. (WC) | |||
</gallery> | |||
=====Case 3===== | |||
<gallery> | |||
Image: Benign urine cytology - 3 -- high mag.jpg | BUC - high mag. (WC) | |||
Image: Benign urine cytology - 3a -- very high mag.jpg | BUC - very high mag. (WC) | |||
Image: Benign urine cytology - 3b -- very high mag.jpg | BUC - very high mag. (WC) | |||
</gallery> | |||
=====Case 4===== | |||
<gallery> | |||
Image: Benign urine cytology - 2 -- high mag.jpg | BUC - high mag. | |||
Image: Benign urine cytology - 2a -- very high mag.jpg | BUC - very high mag. | |||
Image: Benign urine cytology - 2x -- very high mag.jpg | BUC - very high mag. | |||
Image: Benign urine cytology - 2i -- very high mag.jpg | BUC - very high mag. | |||
</gallery> | |||
===Degenerative cells=== | ===Degenerative cells=== | ||
Line 57: | Line 98: | ||
*Vacuolated cytoplasm - "moth-eaten" appearance. | *Vacuolated cytoplasm - "moth-eaten" appearance. | ||
**Normal urothelial cytoplasm is dense and has no vacuoles. | **Normal urothelial cytoplasm is dense and has no vacuoles. | ||
===Urine crystals=== | |||
{{Main|Urine crystals}} | |||
==Tabular DDx== | ==Tabular DDx== | ||
Line 108: | Line 152: | ||
| Usu. <=2X normal | | Usu. <=2X normal | ||
| Alone not much value, many large cells benign, many small cells malignant | | Alone not much value, many large cells benign, many small cells malignant | ||
| Limited value, NC ratio much better measure | | Limited value, [[NC ratio]] much better measure | ||
|} | |} | ||
Line 196: | Line 240: | ||
*Both have eccentric nuclei. | *Both have eccentric nuclei. | ||
==Human | ==Human polyomavirus infection== | ||
{{Main|Polyomavirus nephropathy}} | |||
===General=== | ===General=== | ||
*Caused by ''Human | *Caused by ''Human polyomavirus'', AKA ''BK virus''.<ref>{{Ref APBR|681 (Q26)}}</ref> | ||
*Associated with immunosuppression/immunodeficiency. | *Associated with immunosuppression/immunodeficiency. | ||
*BK virus related to JC virus. | *BK virus related to JC virus. | ||
*BK virus associated with [[urothelial carcinoma]].<ref name=pmid24879380>{{Cite journal | last1 = Tsai | first1 = HL. | last2 = Chang | first2 = JW. | last3 = Wu | first3 = TH. | last4 = King | first4 = KL. | last5 = Yang | first5 = LY. | last6 = Chan | first6 = YJ. | last7 = Yang | first7 = AH. | last8 = Chang | first8 = FP. | last9 = Pan | first9 = CC. | title = Outcomes of kidney transplant tourism and risk factors for de novo urothelial carcinoma. | journal = Transplantation | volume = 98 | issue = 1 | pages = 79-87 | month = Jul | year = 2014 | doi = 10.1097/TP.0000000000000023 | PMID = 24879380 }}</ref><ref name=pmid24103071>{{Cite journal | last1 = Li | first1 = JY. | last2 = Fang | first2 = D. | last3 = Yong | first3 = TY. | last4 = Klebe | first4 = S. | last5 = Juneja | first5 = R. | last6 = Gleadle | first6 = JM. | title = Transitional cell carcinoma in a renal allograft with BK nephropathy. | journal = Transpl Infect Dis | volume = 15 | issue = 6 | pages = E270-2 | month = Dec | year = 2013 | doi = 10.1111/tid.12142 | PMID = 24103071 }}</ref> | |||
DDx: | DDx: | ||
*Urothelial carcinoma. | *[[Urothelial carcinoma]]. | ||
**May exist together with urothelial carcinoma ~ nuclei 2-4x the size of not infected malignant cells.<ref name=pmid20891007>{{Cite journal | last1 = Loghavi | first1 = S. | last2 = Bose | first2 = S. | title = Polyomavirus infection and urothelial carcinoma. | journal = Diagn Cytopathol | volume = 39 | issue = 7 | pages = 531-5 | month = Jul | year = 2011 | doi = 10.1002/dc.21490 | PMID = 20891007 }}</ref> | |||
===Cytology=== | ===Cytology=== | ||
Features:<ref>APBR | Features:<ref>{{Ref APBR|681-2 (Q26)}}</ref><ref>SB. 27 January 2010.</ref> | ||
*"Decoy cells": | *"Decoy cells": | ||
**Usually 2x the size of a normal urothelial cell nucleus. | **Usually 2x the size of a normal urothelial cell nucleus. | ||
**Single cells - '''important feature'''. | **Single cells - '''important feature'''. | ||
**Scant "degenerative-appearing" cytoplasm. | **Scant "degenerative-appearing" cytoplasm. | ||
**High NC ratio. | **High [[NC ratio]]. | ||
**Intranuclear inclusions - '''key feature'''. | **Intranuclear inclusions - '''key feature'''. | ||
***Central smudging (or "wash-out") of the chromatin/"Ground glass" chromatin. | ***Central smudging (or "wash-out") of the chromatin/"Ground glass" chromatin. | ||
Line 220: | Line 267: | ||
*Normal urothelial cell nucleus ~ 1.5X the size of a lymphocyte. | *Normal urothelial cell nucleus ~ 1.5X the size of a lymphocyte. | ||
====Image==== | |||
<gallery> | |||
Image:Polyomavirus_2.jpg | Polyomavirus. (WC) | |||
</gallery> | |||
===IHC=== | ===IHC=== | ||
*JC/BK virus.<ref>[http://www.acta-cytol.com/toc/auto_abstract.php?id=22895 http://www.acta-cytol.com/toc/auto_abstract.php?id=22895]</ref> | *JC/BK virus.<ref>[http://www.acta-cytol.com/toc/auto_abstract.php?id=22895 http://www.acta-cytol.com/toc/auto_abstract.php?id=22895]</ref> | ||
=="Inflammation" in urine specimens== | =="Inflammation" in urine specimens== | ||
Line 233: | Line 280: | ||
==Urothelial cell carcinoma== | ==Urothelial cell carcinoma== | ||
{{Main|Urothelial cell carcinoma}} | |||
*Abbreviated ''UCC''. | |||
===General=== | ===General=== | ||
*Very hard/impossible to diagnose low-grade UCC on cytology. | |||
*Very hard/impossible to | |||
**The diagnosis of low-grade UCC is based on architecture (papillae). | **The diagnosis of low-grade UCC is based on architecture (papillae). | ||
===Cytology=== | ===Cytology=== | ||
Features:<ref>APBR | Features:<ref>{{Ref APBR|682}}</ref> | ||
#"Large nuclei" (3-4X the size of a normal urothelial cell) - '''low power''' feature. | #"Large nuclei" (3-4X the size of a normal urothelial cell) - '''low power''' feature. | ||
#*These are not required for the diagnosis.<ref>SM. 12 January 2010.</ref> - | #*These are not required for the diagnosis.<ref>SM. 12 January 2010.</ref> - | ||
#*Large nuclei may be seen in benign umbrella cell, where the NC ratio is normal. | #*Large nuclei may be seen in benign umbrella cell, where the [[NC ratio]] is normal. | ||
#Hyperchromasia - '''low power''' feature. | #Hyperchromasia - '''low power''' feature. | ||
#Irregular nuclear membrane - '''key feature'''. | #Irregular nuclear membrane - '''key feature'''. | ||
Line 256: | Line 304: | ||
*Coarse chromatin may be benign. | *Coarse chromatin may be benign. | ||
**Fine/non-granular chromatin suggests benign. | **Fine/non-granular chromatin suggests benign. | ||
*One does not usually call ''squamous cell carcinoma'' on cytology. | *One does not usually call ''[[squamous cell carcinoma]]'' on cytology. | ||
**If features of squamous differentiation are present one calls ''urothelial carcinoma with squamous features''. | **If features of squamous differentiation are present one calls ''urothelial carcinoma with squamous features''. | ||
Line 271: | Line 319: | ||
*S. haematobium has a "spike" approx. the size of a PMN. | *S. haematobium has a "spike" approx. the size of a PMN. | ||
Image | ====Image==== | ||
<gallery> | |||
Image:Schistosomiasis_haematobia.jpg| Schistosoma haematobium. (WC) | |||
</gallery> | |||
==See also== | ==See also== | ||
Line 282: | Line 332: | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
==External links== | |||
*[http://www.cytologystuff.com/study/nongynintro3.htm Urine cytology (cytologystuff.com)]. | |||
[[Category:Cytopathology]] | [[Category:Cytopathology]] |
edits