Study on Cytology of Urinary Transitional Cell Carcinoma

Abstract

In 1962, Umiker reported the difficulty of cytological diagnosis of voided urine, especially in class III group. Up to the present, it seems that this problem has been not resolved.We performed a statistical analysis and a karyomethric examination using available materials for cytology of Sakai Municipal Hospital from 1974 to 1977. Our statistical data were similar to Umiker's. In 84% we observed desquamated cell clusters in the voided urine of patients with transitional cell carcinoma. Consequently we conducted a karyometry on cells in clusters in the voided urine of patients with transitional cell carcinomas grade III, II, I and false positive. Totally 33 patients were karyometrically examined.The discriminant point between transitional cell carcinoma grade I and grade II was determined by the comparison of nuclear sizes (p<0.01). In examination of two more cells in a transitional cell cluster, if the sum of long diameter and short diameter of a tumor cell nucleus is 2.5 times larger than that of lymphocyte, the cell cluster is considered to belong to transitional cell carcinoma grade II or grade III. The comparison of the nuclear diameters among them, however, did not seem to be easy under microscope. Therefore we tried to convert the length to the dimensions concerning the discriminant point, using the ratio of long diameter/short diameter of the tumor cell nucleus with the size of discriminant point, that of the lymphocyte's nucleus of average size in the urine and the discriminant value of the sum of long and short diameters of tumor cell nucleus.Consequently, in case that observed more than two cells 6 times larger than a lymphocyte's nucleus in a transitional cell cluster, we suspected transitional cell carcinoma grade II or III. But in microscopic examination, when we put lymphocyte's figure on a tumor cell nucleus in the above condition, we are just able to place four lymphocytes on it, because we cannot put six figures of almost circle like lymphocyte on an elliptical figure like a nucleus of transitional cell carcinoma without an unfilled space.In this study the renewed transitional cells with clear cell dysplasia, renal tubular epithelium and glandular epithelium were excluded out of the karyometric examination of transitional cell carcinoma. Additionally we studied on the features of nuclei in all groups of transitional cell carcinomas grade III, II, I, false positive and negative respectively.The result concerning the karyometrical differentiation between transitional cell carcinoma grade I and grade II should be evaluated as a preliminary one, because the condition of desquamated cells, e. g. shrinkage, swelling, or other degenerative changes, could not be uniform as long as we would use the voided urine as materials and because the number of cases examined karyometrically were not enough to settle the conclusion. So we continued to confirm the above results in the practice of urine cytology almost for two years.In other words, we conducted supplementarily the urinocytological examination cytology from January 1978 to October 1979 on the basis of the above results.As result, we obtained more accurate information of urinary cytology in class V, IV, II follow up, II and I. In fact, a correct diagnosis could be made 94% in class V, IV and 83% in class H follow up, while the former 86%, the latter 55% in the previous data. However a correct diagnosis rate became lower in class III.The result in class III suggests that it is very difficult to distinguish between transitional cell carcinoma grade I and hyperplasia of non-malignant transitional epithelium only by the estimation of nuclear sizes.