Cytology of in Situ Carcinoma of the Urinary Bladder

Abstract

The cytological presentation of nonpapillary in situ carcinoma of the urinary bladder was studied.In all 5 cases, a diagnosis of malignancy has been made by cytological examination of voided urine at a time when the patients had in situ carcinoma. The symptoms of the cases, such as pain on urination and urinary frequency, suggested chronic cystitis. There was no specific picture to be made by cytoscopy. But cancer cells were found in all 5 cases.The characteristic features of malignant cells in urinary sediment from the patients with carcinoma in situ were studied, and a comparison was made with the features of malignant cells from invasive carcino ma. Cytological smears of urine from the 5 patients showed little evidence of inflammation and none of necrosis, a uniform pattern of relatively small malignant cells. Most of these cells were 13-14 microns in size, round or oval in shape. Anisocytosis was rare. Nuclei were slightly enlarged and also round or oval in shape;there were always hyperchromatic nuclei with finely distributed chromatin. A few large cells and malignant cells with degenerated bizarre nuclei were found, mixed with the uniform pattern of malignant cells.These large and malignant cells were numerous in cytological smears of urine from patients with invasive carcinoma.Biopsy specimens appearances are sometimes misle ading and apt to be diagnosed as chronic cystitis, since nonpapillary in situ carcinoma denudes easily. Therefore, routine cytological examination of urinary sediment is most useful in the detection of carcinoma in situ of the urinary bladder.