Urology

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  Superficial cells with a multinucleated cell in an umbrella configuration. Large round nuclei, with prominent nucleoli. Papanicolaou stain
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  Urothelial and squamous cells in normal voided urine. Cytospin preparation. May-Gruenwald Giemsa ( MGG ) stain
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  A large multinucleated urothelial cell of the type seen most commonly in uretal and pelvic washing. Papanicolaou stain
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  Urothelial cells with prominently vacuolated cytoplasm. ( MGG ) stain
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  Urine voided: benign cells. The superficial squamous cells with small nuclei and abundant cytoplasm are admixed with a few inflammatory cells. ( MGG ) stain
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  Normal urotelial cells slightly elongated cell shapes. Papanicolaou stain
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  Reactive urothelial cells. Two clusters of benign, degenerated urothelial cells, the nuclei vary in size and are hyperchomatic. Papanicolaou stain.
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  Bening transitional cells admixed with inflammatory cells.
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  Schistosoma hematobium
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  Transicional- cell carcinoma. Pleomorphic malignant cells hyperchormatic eccentric nuclei dense cytoplasm.
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  Group of larger pleomorphic malignant transicional cells.
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  Loose cluster of large malignant urothelial cells; prominent cytoplasmic vacuolation.
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  Urine specimen in a case of carcinoma in situ of bladder. Abnormal cells with enlarged irregular nuclei are present. The chromatin is coarsely granular and the nucleo-cytoplasmic ratio is high.
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  Single abnormal urothelial cells with enlarged hyperchromatic nculei in urothelial carcinoma in situ of bladder.
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  Urine washing: three-dimensional cell group. A large staghorn cluster of urothelial cells is infiltrated by a few acute and chronic inflammatory cells. The urothelial cell nuclei are round to oval and contain thickened nuclear rims although the chromatin pattern is hyperchromatic.
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  Urine voided: high grade urothelial carcinoma. The malignant cell nuclei are large and the nuclear membranes show focal thickening. Several of the nuclei show multiple prominent nucleoli.
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  Urine voided: high grade urothelial carcinoma. Occasional malignant urothelial cell nuclei have a “cool black” appearance with densely hyperchromatic chromatin patterns.
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  Urine voided: high-grade urothelial carcinoma. The malignant urothelial cells vary in size and shape and exhibit degrees of degeneration.
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  Urine voided: high-grade urothelial carcinoma. The malignant urothelial cells contain a thin rim of homogeneous cytoplasm. There is an obsence of cytoplasmic vacuoles.
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  Poorly differentiated (grade III) urotelial carcinoma. Considerable nuclear pleomorphism and hyperchromasia. The nucleo- cytoplasmic ratio is high.
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  Group of malignant cells from high grade (III) urothelial carcinoma of bladder. The nuclei display an irregular chromatin pattern and contain nucleoli. The cytoplasm is focally eosinophilic.
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  Poorly differentiated grade (III) urothelial carcinoma of bladder. The nuclei are very large and contain prominent nucleoli.
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  Voided urine a case of poorly differentiated urothelial carcinoma of bladder. The loose cluster of cells show large moderately irregular nuclei and a high nucleo -cytoplasmic ratio.

Urinary cytology is mostly used for the detection of malignant tumors of the urinary tract. Symptomatic patients, usually hematuria, or those who are at risk for bladder cancer are suitable candidates for morphologic examination of their urine. A urothelial tumor can develop anywhere in the urothelium but the majority of such tumors occur in the bladder. Although 70% of bladder tumors are superficial or only minimally invasive, and theoretically curable, 50-70 % of these patients will have recurrent or new tumors, up to a third of which are of higher grade and/or stage. The patient becomes a lifetime candidate for recurrent or new urothelial lesions. The remaining 30% initially present with muscle invasion or distant metastases.
Even more important than the detection of bladder tumors is the follow-up of patients after treatment ( mainly transurothral resection, instillations of cytostatic solutions, and irradiation). Cytology plays an important role in the management of these patients. A recurrence of tumor will nearly always be seen by exfoliated cells, sometimes even before it seen by cystoscopy.