Cytopathology

1. URINE CYTOLOGY
KIPRONO FELIX
H31/2244/2011
UNIVERSITY OF NAIROBI
S U P E R V I S E D B Y D R N D U N G ’ U
25TH JULY 2 0 1 4

2. A 58 year old man has a 3 month history of haematuria. He works in
a dye factory and smokes 30 cigarettes per day for the last 25 years.
He denies taking alcohol.
Discuss the role of urine cytology in diagnosis of his condition
What instruction will you give to the patient regarding collection
of the urine and what precaution should be taken?
What type of bladder cancer is this gentleman likely to have and
what are the predisposing factors? List other predisposing factors.
Discuss grading of bladder cancer.

3. Introduction
Voided urine cytology is the standard noninvasive method for
diagnosis in the detection of bladder carcinoma.
Cytology is used to assess morphologic changes in intact cells.
The test may also detect cancers of the kidney, ureter, prostate, and
urethra.

4. Role of urine cytology in diagnosis of conditions
Provides a timely and meaningful clinical information to the doctor as to what the
patient is suffering from. This allows the doctor the advantage of investigating suspicious,
possibly malignant disease process early in its course in the patient.
It is a simple, non-invasive and inexpensive technique that provides satisfaction and full
cooperation from the patient.
Urine cytology will provide the information that aids the doctor in diagnosing the
patient’s condition. It also provides a pathway for a more definitive diagnosis and
subsequent choice of therapy
It is an adjunct to sophisticated direct-visualization urologic diagnostic techniques.
It supports diagnosis of infectious, inflammatory and neoplastic diseases of the urinary
tract.
In this patient with high industrial exposure to carcinogens in dyes, urine cytology would
be the initial test for screening and detection of bladder cancer

5. Collection of urine for cytology
Good viable cellular content in urine is required for proper
utilization of cytologic consultation.
The patient is to collect second morning voided urine
Wash and dry hands thoroughly
Midstream, clean-catch urine specimen is to be collected
Pass a small amount of urine into the toilet
Midway through micturition the patient is to fill the sterile collection container
upto the desired level
Finish voiding into the toilet
Replace lid and tighten firmly
Wash and dry hands thoroughly after collection

6. Precautions
First morning voided urine and twenty four hour urine should not be
collected
The patient must ensure that they clean the area around the urethra to
avoid contamination of the urine
sterile urine cup

7. Bladder Cancer and Predisposing Factors
Transitional cell carcinoma (TCC) is the most common type of bladder
cancer. It is also known as urothelial carcinoma. Up to 5% of bladder
cancers are squamous cell in origin, and 2% are adenocarcinomas.
Therefore the most likely cancer that this patient could be suffering from
is transitional cell carcinoma of the bladder.
The risk factors that are associated with TCC in this patient are:
 Working in a dye factory (aniline dyes and aromatic amines exposure)
 Smoking 30 cigarettes in a day for 25 years. About 50% of all bladder
cancers may be caused by cigarette smoking. The longer and heavier the
exposure, greater are the chances of developing bladder cancer.
(nitrosamine & 4-aminobiphenyl
 His male gender(M:F=4-1) Men are more prone to developing bladder
cancer compared to women
 His age 55years old. About 90 percent of people with bladder cancer are
over age 55, (uncommon <50y)

8. Other factors that predispose a person
to develop bladder cancer are:
 Schistosomiasis infection
(S.haematobium)
 Long term cyclophosphamide therapy
and radiatioin therapy
 Bladder exstrophy & bladder
diverticular
Working in a rubber industry
 NSAID abuse (paracetamol)
 Family history of bladder cancer
cancers
ar

9. Grading of bladder cancer
Grading of bladder cancer is a measure of the extent
by which the tumor cells differ in their appearance
from normal bladder cells. The greater the distortion
of cellular appearance, the higher the grade the
tumour is assigned. High-grade cancers are more
aggressive than low-grade ones and have a greater
propensity to invade into the bladder wall and
metastasize.

10. Grade I
The cells of these bladder tumors resemble normal cells. They are thus low grade or
well differentiated and tend to grow slowly and are not likely to spread.
Grade II
There is a large variation in cell and nuclear sizes. They are medium grade and are
moderately differentiated with more epithelial layers. They may grow or spread more
quickly than low grade cancers
Grade III
The cells of these tumours have no resemblance to their cells of origin. They are
poorly differentiated with breakdown of connection between the cells causing them
to fragment hence highly metastatic.
They are often ulcerated and they penetrate through the bladder wall. They have the
worst prognosis.

11. various stages of bladder carcinoma
Low-grade, noninvasive papillary urothelial carcinoma
Low-grade, noninvasive papillary urothelial carcinoma
Various stages of bladder carcinoma

12. World Health Organization
Bladder Cancer Grading (2004)
 Urothelial papilloma - noncancerous (benign) tumor
 Papillary urothelial neoplasm of low malignant potential
(PUNLMP) - slow growing and unlikely to spread
 Low-grade papillary urothelial carcinoma - slow growing
and unlikely to spread
 High-grade papillary urothelial carcinoma - more quickly
growing and more likely to spread

13. References
Berry Schumann and Franklin Colon; The Clinicians Guide To Diagnostic
Cytology; Yearbook Medical Publisher.
specimencare.com
emedicine.medscape.com
THANK YOU!!