English

Abstract

Objectives: Urine cytology is an easy to perform non-invasive screening test forpatients who are suspected of having urinary tract malignancy. Urothelial carcinoma constitutesapproximately 90% of all primary tumors of urinary bladder.1 High-grade urothelial carcinomasare represented by well characterized cytological features. Whereas cytological features forlow-grade urothelial carcinomas show considerable overlap with features secondary to chronicinflammation, calculi, indwelling catheters or effects of intra-vesical chemotherapy.2 Thepurpose of this study is to find an appropriate set of cytological features of shed urothelial cellsthat will be useful to differentiate low-grade urothelial carcinoma cells from atypical urothelialcells secondary to non-neoplastic conditions. Study Design: Retrospective study. Setting:Charsada Teaching Hospital affiliated with Jinnah Medical College Peshawar. Period: 2010to 2015. Methods: All cases of urine and bladder washing cytology were retrieved for threediagnostic categories namely: low-grade urothelial carcinoma (LGUC), high-grade urothelialcarcinoma (HGUC), and “atypical urothelial cells”; for which histological diagnoses were alsoavailable. These cases were reviewed for cell clusters with smooth or irregular communityborders, cytoplasm texture, nucleomegaly, high nucleus to cytoplasm ratios (N/C ratio),presence of nucleoli, nuclear membrane irregularity, and chromatin texture. Results: Cellclusters with smooth borders were common in reactive changes, whereas irregular communityborders were seen in low-grade urothelial carcinomas and dyscohesive pattern was a featureof HGUC. The increase in N/C ratio ›2:1 was always associated with malignancy. The nuclearmembrane irregularity was also a strong indicator of malignancy. Cytoplasmic homogeneityand nuclear hyperchromasia were more prominent and consistently seen in high-gradeurothelial carcinomas. Conclusions: The study showed that nuclear membrane irregularity,nucleomegaly and high N/C ratio of › 2:1 were the most consistent features found in LGUC.These features can be used with high certainty to differentiate LGUC (malignant) from atypicalurothelial cells (non-neoplastic).