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Difference between revisions of "Urine cytopathology"
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[[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. | ||
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**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 | #Nondiagnostic/unsatisfactory | ||
#Negative for [[ | #Negative for [[urothelial carcinoma|high-grade urothelial carcinoma]] | ||
#Atypical urothelial cells | #Atypical urothelial cells | ||
# | #Suspicious for high-grade urothelial carcinoma | ||
# | #High-grade urothelial carcinoma | ||
#Low grade urothelial neoplasm | #Low-grade urothelial neoplasm | ||
#Other malignancy | #Other malignancy (includes both primary and secondary) and miscellaneous lesions | ||
==Normal== | ==Normal== | ||
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*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" | ||
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| 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=== | ||
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*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== | ||
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===Cytology=== | ===Cytology=== | ||
Features:<ref>{{Ref APBR|682}}</ref> | Features:<ref>{{Ref APBR|682}}</ref> | ||
#Hyperchromasia - '''low power''' feature. | #Hyperchromasia - '''low power''' feature. | ||
#Irregular nuclear membrane - '''key feature'''. | #Irregular nuclear membrane - '''key feature'''. | ||
#Increased NC ratio. | #Increased NC ratio. | ||
#*Often uniform - when comparing malignant cells. | #*Often uniform - when comparing malignant cells. | ||
#"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> | |||
#*Large nuclei may be seen in benign umbrella cell, where the [[NC ratio]] is normal. | |||
#Nuclear size variation, >=2X other malign. looking cells - very useful. | #Nuclear size variation, >=2X other malign. looking cells - very useful. | ||
#+/-Large irregular nucleoli - common. | #+/-Large irregular nucleoli - common. | ||
Minimal criteria: | Minimal criteria: | ||
*Criteria # | *Criteria #1-3. † | ||
Notes: | Notes: | ||
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*Degeneration. | *Degeneration. | ||
*Polyomavirus. | *Polyomavirus. | ||
† Willner ''et al.'' require all of the following:<ref name=pmid33088909>{{cite journal |authors=Willner J, Matloob A, Colanta A, Khader SN |title=Educational Case: Urothelial Carcinoma: An Overview of Pathologic Diagnosis |journal=Acad Pathol |volume=7 |issue= |pages=2374289520958172 |date=2020 |pmid=33088909 |doi=10.1177/2374289520958172 |url=}}</ref> | |||
#Nucleus-to-cytoplasm ratio >0.7. | |||
#Hyperchromasia (moderate or severe). | |||
#Irregular nuclear membranes, marked. | |||
#Coarse chromatin. | |||
Willner's criteria can be remember by ''CHIN'' = '''''c'''oarse chromatin, '''h'''yperchromasia, '''i'''rregular nuclear membrane, '''N'''C ratio increased''. | |||
==Schistosoma== | ==Schistosoma== | ||
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</gallery> | </gallery> | ||
==Trichomonas== | |||
{{Main|Gynecologic_cytopathology#Trichomoniasis}} | |||
*Trichomonas is found in approximately 0.1% of urine cytology specimens.<ref>{{cite journal |authors=Doxtader EE, Elsheikh TM |title=Diagnosis of trichomoniasis in men by urine cytology |journal=Cancer Cytopathol |volume=125 |issue=1 |pages=55–59 |date=January 2017 |pmid=27636204 |doi=10.1002/cncy.21778 |url=}}</ref> | |||
==Atypical squamous cells in urine== | |||
*Atypical squamous cells in urine cytology specimens are rare ~ 0.3%.<ref>{{cite journal |authors=Velez Torres JM, Zhao J, Epstein JI, Kryvenko ON |title=Condyloma acuminatum of the urinary tract demonstrates atypical squamous cells in urine cytology |journal=Hum Pathol |volume=130 |issue= |pages=110–116 |date=December 2022 |pmid=36244465 |doi=10.1016/j.humpath.2022.10.006 |url=}}</ref> | |||
*An older series describes an association with SCC/UCC of the bladder and SCC of the cervix.<ref>{{cite journal |authors=Owens CL, Ali SZ |title=Atypical squamous cells in exfoliative urinary cytology: clinicopathologic correlates |journal=Diagn Cytopathol |volume=33 |issue=6 |pages=394–8 |date=December 2005 |pmid=16299739 |doi=10.1002/dc.20344 |url=}}</ref> | |||
<pre> | |||
Atypical squamous cells present, see comment. | |||
Benign urothelial cells present in background. | |||
Negative for High-Grade Urothelial Carcinoma. | |||
Comment: | |||
Due to the atypical squamous cells, consideration of further work-up is suggested within the clinical context, based on reported associations.[1] | |||
1. Diagn Cytopathol. 2005 Dec;33(6):394-8. doi: 10.1002/dc.20344 - https://pubmed.ncbi.nlm.nih.gov/16299739/ | |||
</pre> | |||
==See also== | ==See also== | ||
*[[Cytopathology]]. | *[[Cytopathology]]. | ||
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==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
==External links== | |||
*[http://www.cytologystuff.com/study/nongynintro3.htm Urine cytology (cytologystuff.com)]. | |||
[[Category:Cytopathology]] | [[Category:Cytopathology]] | ||