Papillary Urothelial Carcinoma Research Articles

Urothelial neoplasms: a review of pathological reporting practices

Introduction: Urothelial carcinoma has observed great strides of advances in the field of diagnostics and therapeutics. On the other hand, the last decade witnessed an upheaval in pathological grading which seems to settle down in the recent times. Aims and Objectives: Our study intends to evaluate pathology practices in reporting papillary urothelial carcinomas and highlight the features which can define prognosis and guide molecular studies. Materials and Methods: A consecutive of 32 cases of papillary urothelial carcinoma reported over duration of 2 years were collected. Histopathological slides were reviewed applying WHO/ISUP 2004 diagnostic criteria and compared with primary diagnosis. Results: High grade papillary urothelial carcinoma formed the largest group with 14 cases. Concordance between original diagnosis and review diagnosis was seen in 19 cases only. Invasion into underlying tissue was missed in 6 cases. Associated features like carcinoma in situ, lymphovascular invasion, perineural invasion and stalk invasion were missed in primary reports. Conclusion: As grade and stage dictate prognosis and management plans, it is essential to release veritable reports. The findings emphasize the need to generate a consensus report with multiple opinions. Keywords: Urothelial neoplasms, Invasion, Tumor Grade

Widespread Osseous Metaplasia in Malign Tumors: High Grade Papillary Urothelial Carcinoma of The Bladder and Metastatic Colonic Adenocarcinoma

Widespread Osseous Metaplasia in Malign Tumors: High Grade Papillary Urothelial Carcinoma of The Bladder and Metastatic Colonic Adenocarcinoma

Robotic genitalia sparing female cystectomy.

This article presents our surgical technique on robotic cystectomy preserving female genitalia. A 59 year-old female patient with muscle invasive bladder cancer was referred to our hospital for robotic radical cystectomy and intracorporeal Studer-pouch construction. An incomplete trans urethral resection of the bladder cancer was performed 2 months earlier at a peripheral hospital and pathological examination revealed muscle invasive, high-grade papillary urothelial carcinoma (T2GIII). She had undergone two open abdominal surgeries (appendectomy and cesarean section) 30 and 35 years previously. Laboratory tests including blood urea nitrogen, serum creatinine, hemogram, ALT, and AST were within normal limits. A CT scan of the abdomen and pelvis revealed several masses within the bladder, measuring up to 1 cm in greatest dimension. However, perivesical fatty tissue and upper urinary tract were normal in appearance.

A descriptive study of bladder tumors in Benin City, Nigeria: An analysis of histopathological patterns

Aims and Objectives: This study is aimed at determining the frequency and histopathological patterns including grading and staging of bladder tumors as seen in University of Benin Teaching Hospital, Benin City, Nigeria and to compare with similar research works elsewhere. Materials and Methods: A retrospective study of all data of surgical excision and cystoscopic bladder biopsies received over a 10-year period (2003-2012) at the Department of Histopathology, University of Benin Teaching Hospital, Benin City, Nigeria. Histological criteria published by the World Health Organization/International Society of Urological Pathology were used for the diagnosis and grading of these tumors. Results: A total of 75 bladder lesions were received in the Pathology Department. Of these, 64% were males and 36% were females giving a male to female ratio of 1.7:1.0. The peak and mean age incidence of urothelial bladder lesions was 60-69 years and 54.9 years ± 8.6 standard deviation, respectively. Bladder tumors accounted for 74.7% of all bladder lesions. Fifty-one (68%) cases out of 75 lesions were malignant tumors. Transitional cell carcinoma (TCC) was the most commonly encountered histological pattern accounting for 64.7% of bladder cancer. High grade papillary urothelial carcinoma was the most common tumor grade accounting for 51.4%. Only 40.6% cases were urothelial confined carcinoma (PTa) while 29.7% each accounted for lamina propria (PT1) and muscle (PT2) invasive carcinoma. Conclusion: Bladder tumors are more commonly encountered in males with the majority of cases occurring in the 7 th decade. Both high-grade TCC in stage (PT2) and low-grade carcinomas stage (PTa) were relatively common patterns seen in this study.

Unusual manifestations of secondary urothelial carcinoma

High-grade papillary urothelial carcinoma regularly invades the bladder wall, adjacent prostate, seminal vesicles, ureters, vagina, rectum, retroperitoneum, and regional lymph nodes. In advanced stages, it may disseminate to the liver, lungs, and bone marrow. On rare occasions, unusual metastatic foci like skin have been reported. The incidence of urothelial carcinoma has increased with associated rise in variants of urothelial carcinoma and unusual metastatic foci. It is imperative that urologists and pathologists are aware of the unusual variants and unusual metastatic locations to expedite the diagnostic process. Hereby we report an unusual case of secondary involvement of spinal nerve by conventional urothelial carcinoma. Also a second case of rhabdoid variant of urothelial carcinoma showing synchronous involvement of bladder and subcutaneous tissue of upper extremity is presented.

Multiphoton microscopy for rapid histopathological evaluation of kidney tumours.

To explore the potential of multiphoton microscopy (MPM) for rapid evaluation and triaging of ex vivo kidney tissue. Fresh neoplastic and non-neoplastic tissues from nephrectomy specimens (n = 40) were imaged with MPM and later submitted for routine histopathology. On MPM, normal kidney architecture was evident and clearly distinguishable from tumour. Forty malignant tumours (20 clear-cell renal cell carcinomas [RCCs], 10 papillary RCCs, five chromophobe RCCs and five papillary urothelial carcinomas [UCs], as diagnosed by haematoxylin and eosin staining) were imaged and subtyped as non-papillary and papillary, based on their architecture. Non-papillary tumours were further classified based on their unique cytoplasmic signatures. Clear-cell RCCs had a predominant population of cells with fat droplets in cytoplasm. Chromophobe RCCs had cells with non-fatty/homogeneous cytoplasm and distinct intra-cytoplasmic granules. Papillary RCCs had single-cell-lined papillae with often abundant histiocytes in their core, whereas PUC had multi-layered urothelium-lined papillae. The diagnostic accuracy of tumour subtyping by two independent uropathologists was 95%. We showed that MPM can reliably differentiate neoplastic from non-neoplastic kidney tissue and subtype kidney tumours in fresh, unprocessed tissue, MPM might therefore be useful as a rapid real-time diagnostic tool for the evaluation of kidney biopsies, and surgical margins in partial nephrectomies, to improve overall patient management.

Review of Medical Advisory Services by the Korean Society of Pathologists from 2003 to 2014.

Background:Since 2003, the Korean Society of Pathologists (KSP) has been officially providing medical advisory services (MAS). We reviewed the cases submitted to the KSP between 2003 and 2014.Methods:In total, 1,950 cases were submitted, most by private health insurance companies. The main purposes of the consultations were to clarify the initial diagnoses and to assign a proper disease classification code. We comprehensively reviewed 1,803 consultation cases with detailed information.Results:In spite of some fluctuations, the number of submitted cases has been significantly increasing over the 12 study years. The colon and rectum (40.3%), urinary bladder (14.2%), and stomach (6.9%) were the three most common tissues of origin. The most common diagnoses for each of the three tissues of origin were neuroendocrine tumor (50.7%), non-invasive papillary urothelial carcinoma (70.7%), and adenocarcinoma (36.2%). Regardless of the tissue of origin, neuroendocrine tumor of the digestive system was the most common diagnosis (419 of 1,803).Conclusions:In the current study, we found that pathologic consultations associated with private health insurance accounted for a large proportion of the MAS. Coding of the biologic behavior of diseases was the main issue of the consultations. In spite of the effort of the KSP to set proper guidelines for coding and classification of tumors, this review revealed that problems still exist and will continue to be an important issue.

Significance of a minor high-grade component in a low-grade noninvasive papillary urothelial carcinoma of bladder

To assess the clinicopathological features and prognostic significance of the presence of 5% or less high-grade component in otherwise low-grade noninvasive bladder urothelial carcinoma, referred to as mixed-grade (MG) urothelial carcinoma, we reviewed all archival cases with such diagnosis between 2005 and 2014. Clinicopathological and outcome parameters were compared to those in our previously reported low- and high-grade noninvasive bladder urothelial carcinoma cohorts (LGUC and HGUC, respectively). The study included 31 MG urothelial carcinomas. Mean patient age was 67.6 years, and mean follow-up was 39.7 months. Intravesical treatment was administered in 15 patients (48.4%). Recurrence occurred in 14 cases (45.2%): 10 as LGUC and 4 as HGUC; there was no stage progression. Mean time to progression was 9 months (5-17 months), and there was no death of disease. MG urothelial carcinoma stage progression and dead of disease rates were comparable to that of LGUC. MG urothelial carcinoma stage progression was significantly lower than that of HGUC, P = .002, using Pearson χ(2) test. MG urothelial carcinoma patients with no intravesical treatment had higher incidence rate of grade progression (25%) compared to LGUC patients (7.9%); however, the difference was not statistically significant. MG urothelial carcinoma had a prognosis closer to "pure" LGUC than "pure" HGUC. Untreated MG urothelial carcinoma may have a higher rate of grade progression than LGUC, although more data are needed before this issue can be definitively addressed. Until such data are available, it is reasonable to keep MG urothelial carcinoma as a distinct grade category with potential management implications.

Positive fibroblast growth factor receptor 3 immunoreactivity is associated with low-grade non-invasive urothelial bladder cancer.

In addition to conventional clinicopathological parameters, molecular markers are also required in order to predict the course of disease in patients with urothelial bladder cancer (BC). Little is known about fibroblast growth factor receptor 3 (FGFR3) immunoreactivity and the clinical significance it may possess with regard to BC. The present study aimed to investigate the immunoreactivity of FGFR3 in primary urothelial bladder tumours, with regard to clinicopathological features and FGFR3 mutation status. Tissue microarrays were used to immunohistochemically analyse FGFR3 expression in 255 primary, unselected patients with BC. FGFR3 mutations were detected using SNaPshot analysis. Positive FGFR3 immunoreactivity was identified in 113/207 analysable cases (54.6%), and was significantly associated with FGFR3 mutation (P<0.001), low tumour stage (P<0.001), low histological grade (P<0.001) and a papillary growth pattern (P<0.001). Positive FGFR3 immunostaining (P=0.002) and FGFR3 mutation (P=0.002) were found to be significantly associated with increased disease-specific survival following univariate analysis, demonstrating a median follow-up period of 75 months. Using multivariate analyses, FGFR3 immunoreactivity was found not to be independent of classical pathological parameters. Immunohistochemical expression of FGFR3 is an early occurrence during the carcinogenesis of papillary non-invasive BC. The presence of FGFR3 immunoreactivity in non-invasive papillary urothelial carcinomas may be utilised as an indicator of tumours possessing low-grade features and good prognosis.

Invasive low-grade papillary urothelial carcinoma: an immunohistochemical study of 26 cases

Invasive low-grade papillary urothelial carcinoma (LGPUC) is rare. We studied the immunohistochemical (IHC) expressions of CK20, p53, E-cadherin, phosphatase and tension homolog (PTEN), and Ki-67 in both noninvasive and invasive components in 26 cases. In the noninvasive component of LGPUC, 81% showed CK20 expression, and 50% showed p53 labeling. There was a wide range of Ki-67 labeling from less than 5% to 70%. All cases had intact PTEN except 1 that showed focal clonal PTEN loss in both noninvasive and subjacent invasive components. All cases had preserved strong and diffuse E-cadherin expression in both noninvasive and invasive components. There was no significant change between the noninvasive and invasive components in the IHC labeling of these markers, although 7 (33%) of 21 cases showed decreased CK20 expression to a certain extent in the invasive component. Only 2 cases showed significant increase of p53 expression in the invasive component compared with the noninvasive component. Two cases showed increase of Ki-67 labeling from less than 5% in the noninvasive to 20% and 40%, respectively, in the invasive component. High Ki-67 labeling was present in a significant portion of invasive LGPUC cases in both noninvasive and invasive components, much higher than in previous studies of noninvasive LGPUC. Whether higher Ki-67 in these cases is associated with more aggressive disease warrants further study. In general, it is not very helpful to use immunostains in diagnosis and predicting prognosis. This is the largest series to study the IHC characteristics of this entity.

Endoscopic Ultrasound and Anal Pain: The Key to Diagnosis

A 73-year-old male patient with a history of pulmonary tuberculosis in childhood, a gastric adenocarcinoma (intestinal type) T1N0M0 (TNM classification), submitted to a partial gastrectomy Roux-en-Y, 10 years before, and a T1 lowgrade papillary bladder urothelial carcinoma treated with a transurethral resection and epirubicin, 1 year before, reported anal pain and fever for the last 5 days. The patient denied diarrhea, hematochezia or weight loss. In the anoscopy a painful bulging lesion with 2--3 cm was detected in distal rectum. Anorectal endoscopic ultrasonography (EUS) showed a heterogeneous, irregular lesion in

BCG-related renal granulomas managed conservatively: A case series.

The aim of this case series is to present two cases of renal granulomas discovered incidentally post-intravesical Bacillus Calmette-Guerin (BCG) installations and were managed conservatively. The first case is a 68-year-old man with bladder and right ureteral orifice carcinoma in situ. After transurethral resection of the right ureteral orifice and bladder tumours, he received 6 + 3 weekly intravesical installations of BCG and then 6 + 3 weekly intravesical installations of BCG with interferon alpha (IFN) in the presence of an indwelling ureteral stent since he had refused cystoprostatectomy. At the 18-month follow-up, his computed tomography scan showed two right renal masses. Biopsy demonstrated non-necrotizing granulomatosis. Serial follow-up with imaging studies showed complete resolution of these masses without anti-tuberculous medications. The second case is a 74-year old man with left renal high-grade papillary urothelial carcinoma. After ureteral meatotomy and insertion of indwelling ureteral stents, he received 6 weekly intravesical installations of BCG followed by 3 weekly installations of BCG and IFN prior to the definitive management with laparoscopic left nephroureterectomy. Final pathology showed pT1 urothelial carcinoma and an incidental finding of BCG-related renal granulamotosis. The patient has been asymptomatic and did not require anti-tuberculous medications. While these two cases demonstrate the ability of intravesical BCG to reach the renal pelvis, patients with a history of intravesical BCG with incidental renal masses may benefit from renal biopsy. These renal granulomas may resolve without anti-tuberculous medications.

Histopathological study of cystoscopic bladder biopsies

Background: Urinary bladder diseases constitute an important source of clinical signs and symptoms which are more disabling than lethal. The prevalence of bladder tumor in developed countries is approximately six times higher compared with that in developing countries. The aim of this study was to find out various lesions in urinary bladder biopsies and its frequencies.Materials and Methods: This was a five year retrospective study from January 2008 to December 2013, carried out at B&amp;B Hospital, Lalitpur. All the relevant data of 324 patients who had undergone cystoscopic biopsy of urinary bladder were included in the study. All blocks were retrieved and stained with Hematoxylin and Eosin stain and examined under light microscope.Results: The spectrum of pathological lesions included inflammations and tumors. Non-neoplastic lesions were predominant (61.11%) followed by Transitional cell tumors accounted for 124 cases (38.27%). Non-neoplastic lesions comprises of cystitis and tuberculosis. Papillary urothelial neoplasms was the most common tumors seen in this study with 55 low grade, and 54 high grade Papillary urothelial carcinoma according to recent WHO grading. Single cases each of adenocarcinoma and paraganglioma were diagnosed.Conclusion: Cystoscopic biopsies help in the early diagnosis and treatment of various bladder lesions. Analysis of cystoscopic biopsies was done to ascertain the type of urinary bladder lesions in our country.Journal of Pathology of Nepal (2015) Vol. 5, 717-719

Intestinal metaplasia of the bladder with dysplasia: a risk factor for carcinoma?

Intestinal metaplasia (IM) of the bladder is a benign glandular proliferation, where the urothelium becomes lined by intestinal-type epithelium. There is no association between IM and an increased risk for the development of adenocarcinoma. However, in rare cases IM shows dysplasia, similar to that of the gastrointestinal tract. We evaluated the significance of urothelial IM with dysplasia. Consultation cases were searched for IM of the bladder with dysplasia. We identified 20cases, including 17 males and females, aged 31-85years (mean 60years). Twelve (60%) patients had low-grade dysplasia and eight (40%) patients had high-grade dysplasia. Focal dysplasia was found in eight (40%) patients and non-focal dysplasia in 12 (60%) patients. IM with dysplasia was found with concurrent adenocarcinoma in eight (40%) cases. Five of these patients (63%) had disease recurrence and three (38%) patients died from their disease. IM with dysplasia was found with concurrent urothelial carcinoma in one case. Eleven patients had IM with dysplasia without evidence of malignancy. Of these, one went on to develop non-invasive, high-grade papillary urothelial carcinoma. Clinical follow-up is recommended in cases of IM with dysplasia, as a significant number of these cases are associated with concurrent carcinoma.

Nephrogenic Adenoma of the Urinary Bladder: A Review of the Literature.

Background. Nephrogenic adenoma of the urinary bladder (NAUB) is a rare lesion associated with nonspecific symptoms and could inadvertently be misdiagnosed. Aim. To review the literature. Methods. Various internet search engines were used. Results. NAUB is a benign tubular and papillary lesion of the bladder, is more common in men and adults, and has been associated with chronic inflammation/irritation, previous bladder surgery, diverticula, renal transplantation, and intravesical BCG; recurrences and malignant transformations have been reported. Differential diagnoses include clear cell adenocarcinoma, endocervicosis, papillary urothelial carcinoma, prostatic adenocarcinoma of bladder, and nested variant of urothelial carcinoma; most NAUBs have both surface papillary and submucosal tubular components; both the papillae and tubules tend to be lined by a single layer of mitotically inactive bland cells which have pale to clear cytoplasm. Diagnosis may be established by using immunohistochemistry (positive staining with racemase; PAX2; keratins stain positive with fibromyxoid variant), electron microscopy, DNA analysis, and cytological studies. Treatment. Endoscopic resection is the treatment but recurrences including sporadic malignant transformation have been reported. Conclusions. There is no consensus on best treatment. A multicentre study is required to identify the treatment that would reduce the recurrence rate, taking into consideration that intravesical BCG is associated with NAUB.

Cyclosporine A and tacrolimus inhibit urothelial tumorigenesis.

The functional role of nuclear factor of activated T-cells (NFAT), while it has been extensively investigated in the immune system, remains uncertain in bladder cancer development. We here aim to assess the effects of cyclosporine A (CsA) and tacrolimus (FK506), immunosuppressants known to specifically inactivate the NFAT pathway in immune cells, on neoplastic transformation of urothelial cells. Immunohistochemistry revealed that the expression levels of NFATc1, a NFAT isoform shown to function as an oncogene in a sarcoma model, were elevated in urothelial neoplasms, compared with non-neoplastic urothelial tissues, and in low-grade and high-grade papillary urothelial carcinomas, compared with papillary urothelial neoplasms of low malignant potential. In an immortalized normal urothelial cell line SVHUC, CsA and FK506 reduced NFATc1 expression, NFAT transcriptional activity, and the expression of c-myc, a downstream target of NFATc1 signals. Treatment with CsA or FK506 in the SVHUC cells undergoing neoplastic transformation induced by exposure to a chemical carcinogen 3-methylcholanthrene resulted in strong inhibition in colony formation in vitro as well as tumor formation in NOD-SCID mice. CsA and FK506 were additionally found to up-regulate the expression of several molecules that play a protective role in bladder tumorigenesis, including p53, p21, and p27, and down-regulate that of oncogenic genes, such as cyclin D1, cyclin D3, and cyclin E, in SVHUC cells with the carcinogen challenge. Thus, CsA and FK506 likely inhibit urothelial tumorigenesis. These findings offer a potential chemopreventive approach for urothelial tumors using NFAT inhibitors.

Cytomorphological characteristics of low-grade papillary urothelial carcinoma for differential diagnosis from benign papillary urothelial lesions: logistic regression analysis in SurePath(™) liquid-based voided urine cytology.

The diagnosis of low-grade papillary urothelial carcinoma (LGPUC) in urine cytology specimens is challenging because of its subtle, minimally atypical findings. Furthermore, as SurePath(™) liquid-based cytology (LBC) is becoming a widely used method in urine cytology, the inevitable cytomorphological alterations resulting from this technique call for new morphological diagnostic criteria in LGPUC. Logistic regression analysis was carried out on SurePath slides from surgically proven voided urine specimens. The study was designed to include a test set (n=141) and a validation set (n=61), and evaluated significant discriminative parameters between LGPUC and benign papillary urothelial neoplasm (BPUN). Of the seven cytological findings that were found to have statistical significance in univariate analysis, five were found to be independent variables: loss of polarity of papillaroid clusters, irregular contours, absence of columnar cells, hobnail features and hyperchromasia. These independent variables had an area under the curve (AUC) of 0.781. The distinctive cytological criteria identified above may prove to be helpful in cases in which other conventional criteria for LGPUC are insufficient for diagnosis.

P53 is Still a Reliable Marker in Prognosis of Non Muscle Invasive Tumors

Aim: We aimed to analysis immunostaining of p53 regarding to grade, stage, recurrence and progression in non muscle urotelial cancers (pTa and pT1 papillary tumors). Methods: A total of 60 patients undergoing their first transurethral resection for bladder cancer and newly diagnosed papillary urothelial carcinoma (pTa and pT1) were included in retrospective study. Immunohistochemically, all tissue sections were stained with p53. The patients were divided into two groups based on recurrence and progression. Results: Using Spearman’s correlation test, p53 was significantly positively correlated with tumor stage and tumor grade (r = 0.372 and 0.443, respectively; p < 0.001). Based on a multivariate analysis, p53 staining was found to be the only independent predictive factor for recurrence (OR = 12.01, 95% CI = 1 16.6) and no independent predictive factor for progression was found. Conclusion: p53 may prove useful in predicting recurrence of pTa and pT1 urothelial cancers.

Rapid evaluation of fresh ex vivo kidney tissue with full-field optical coherence tomography

Background: Full-field optical coherence tomography (FFOCT) is a real-time imaging technique that rapidly generates images reminiscent of histology without any tissue processing, warranting its exploration for evaluation of ex vivo kidney tissue. Methods: Fresh tissue sections from tumor and adjacent nonneoplastic kidney (n = 25 nephrectomy specimens; clear cell renal cell carcinoma (CCRCC) = 12, papillary RCC (PRCC) = 4, chromophobe RCC (ChRCC) = 4, papillary urothelial carcinoma (PUC) = 1, angiomyolipoma (AML) = 2 and cystic nephroma = 2) were imaged with a commercial FFOCT device. Sections were submitted for routine histopathological diagnosis. Results: Glomeruli, tubules, interstitium, and blood vessels were identified in nonneoplastic tissue. In tumor sections, the normal architecture was completely replaced by either sheets of cells/trabeculae or papillary structures. The former pattern was seen predominantly in CCRCC/ChRCC and the latter in PRCC/PUC (as confirmed on H&E). Although the cellular details were not very prominent at this resolution, we could identify unique cytoplasmic signatures in some kidney tumors. For example, the hyper-intense punctate signal in the cytoplasm of CRCC represents glycogen/lipid, large cells with abundant hyper-intense cytoplasm representing histiocytes in PRCC, and signal-void large polygonal cell representing adipocytes in AML. According to a blinded analysis was performed by an uropathologist, all nonneoplastic tissues were differentiated from neoplastic tissues. Further, all benign tumors were called benign and malignant were called malignant. A diagnostic accuracy of 80% was obtained in subtyping the tumors. Conclusion: The ability of FFOCT to reliably differentiate nonneoplastic from neoplastic tissue and identify some tumor types makes it a valuable tool for rapid evaluation of ex vivo kidney tissue e.g. for intraoperative margin assessment and kidney biopsy adequacy. Recently, higher resolution images were achieved using an experimental FFOCT setup. This setup has the potential to further increase the diagnostic accuracy of FFOCT.

Investigation of the Possible Cytopathological Effect of Human Papillomavirus Infection on p-16INK4a Overexpressed Urothelial Carcinomas of the Bladder in the Urine

Background and objectives: Human papillomavirus (HPV) is well-known as the etiological agent for uterine cervical cancer or carcinoma of the oropharynx, anus and vulva. However, the cytopathologic effect of the HPV infection in urinary bladder tumors has rarely been reported. The present study has been carried out to search for cytopathologic differences between HPV positive and negative cases with urothelial carcinoma. Methods: We examined 91 specimens from 63 patients who underwent transurethral resection or biopsy for papillary urothelial carcinomas between May 2010 and September 2012. p-16INK4a expression was evaluated by immunohistochemistry. Detection of HPV DNA was carried out by in situ hybridization on formalin-fixed, paraffinembedded tissue sections. Urine smears were compared cytomorphologically between HPV-positive and HPVnegative cases. Results: p-16INK4a overexpression was detected in 29 cases (31.9%, 29/91). Of them, HPV DNA was detected in 11 cases. No significant cytopathologic differences were found in tumor cells when HPV-positive and HPV-negative cases were compared. Conclusion: HPV could be detected in urothelial carcinomas of the urinary bladder. There were no significant differences in cytopathologic features of urine smears between HPV-positive and HPV-negative cases with urothelial carcinomas. These results suggest that HPV infection in urinary tract does not add substantial clinically relevant importance to the carcinogenesis and cytomorphology of urothelial carcinomas.