Difference between revisions of "Urine cytopathology"

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Urine cytopathology (view source)

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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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*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.
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*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
#Suspicious 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==
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*Benign cells are often in small clumps.
*Benign cells are often in small clumps.


===Cell types===
===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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| 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
|}
|}


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*Both have eccentric nuclei.
*Both have eccentric nuclei.


==Human polyoma infection==
==Human polyomavirus infection==
{{Main|Polyomavirus nephropathy}}
===General===
===General===
*Caused by ''Human polyoma virus'', AKA ''BK virus''.<ref>{{Ref APBR|681 (Q26)}}</ref>
*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===
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**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.
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*Normal urothelial cell nucleus ~ 1.5X the size of a lymphocyte.
*Normal urothelial cell nucleus ~ 1.5X the size of a lymphocyte.


Images:
====Image====
*[http://pathology2.jhu.edu/cytopath/masterclass/urine/benign/1uri14.htm Polyomavirus (jhu.edu)].
<gallery>
*[http://commons.wikimedia.org/wiki/File:Polyomavirus_2.jpg Polyomavirus - example 2 (WC)].
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==
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==Urothelial cell carcinoma==
==Urothelial cell carcinoma==
{{Main|Urothelial cell carcinoma}}
*Abbreviated ''UCC''.
===General===
===General===
*Abbreviated ''UCC''.
*Very hard/impossible to diagnose low-grade UCC on cytology.
*Very hard/impossible to diagnosis low-grade UCC on cytology.
**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>{{Ref APBR|682}}</ref>
Features:<ref>{{Ref APBR|682}}</ref>
#"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.
#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 #2-4.
*Criteria #1-3. †


Notes:
Notes:
*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''.


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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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*S. haematobium has a "spike" approx. the size of a PMN.
*S. haematobium has a "spike" approx. the size of a PMN.


Image:
====Image====
*[http://commons.wikimedia.org/wiki/File:Schistosomiasis_haematobia.jpg Schistosoma haematobium (WC)].
<gallery>
Image:Schistosomiasis_haematobia.jpg| Schistosoma haematobium. (WC)
</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]]
Michael
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