Amjad Ali Khan, Abdul Shaheed Asghar, Muhammad Ishaq, Israr Ahmed Akhund.
LOW GRADE UROTHELIAL CARCINOMA; Cytological features discriminating from atypical urothelial cells.
Professional Med J Jan ;23(11):1323-7.

Urine cytology is an easy to perform non-invasive screening test for patients who are suspected of having urinary tract malignancy. Urothelial carcinoma constitutes approximately 90% of all primary tumors of urinary bladder.1 High-grade urothelial carcinomas are represented by well characterized cytological features. Whereas cytological features for low-grade urothelial carcinomas show considerable overlap with features secondary to chronic inflammation, calculi, indwelling catheters or effects of intra-vesical chemotherapy.2 The purpose of this study is to find an appropriate set of cytological features of shed urothelial cells that will be useful to differentiate low-grade urothelial carcinoma cells from atypical urothelial cells secondary to non-neoplastic conditions. Study Design: Retrospective study. Setting: Charsada Teaching Hospital affiliated with Jinnah Medical College Peshawar. Period: 2010 to 2015. Methods: All cases of urine and bladder washing cytology were retrieved for three diagnostic categories namely: low-grade urothelial carcinoma (LGUC), high-grade urothelial carcinoma (HGUC), and “atypical urothelial cells”; for which histological diagnoses were also available. These cases were reviewed for cell clusters with smooth or irregular community borders, cytoplasm texture, nucleomegaly, high nucleus to cytoplasm ratios (N/C ratio), presence of nucleoli, nuclear membrane irregularity, and chromatin texture. Results: Cell clusters with smooth borders were common in reactive changes, whereas irregular community borders were seen in low-grade urothelial carcinomas and dyscohesive pattern was a feature of HGUC. The increase in N/C ratio ›2:1 was always associated with malignancy. The nuclear membrane irregularity was also a strong indicator of malignancy. Cytoplasmic homogeneity and nuclear hyperchromasia were more prominent and consistently seen in high-grade urothelial 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 atypical urothelial cells (non-neoplastic).

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